An Umbrella Review Exploring the Effect of Periodontal Treatment in Pregnant Women on the Frequency of Adverse Obstetric Outcomes.

OBJECTIVE: In the recent years, efforts have been made to reduce epidemiologic indicators of periodontal disease in pregnant women. This umbrella review aims to analyze the systematic reviews/meta-analyses investigating the effect of periodontal therapy in pregnant women on the frequency of obstetric complications (low birth weight, preterm delivery, and preeclampsia) and to identify the gaps in the scientific literature. METHODS: A systematic review of systematic reviews with and without meta-analysis of intervention studies was conducted. Quality evaluation and qualitative analysis of the reviews were performed. RESULTS: A total of 223 articles were obtained, and 18 of them were included in the analysis, 13 articles included meta-analysis, where 11 were of high quality and 7 of medium quality according to the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guide. These systematic reviews/meta-analyses included a total of 19 studies (17 randomized clinical trials). Descriptive systematic reviews showed that periodontal therapy has positive effects on reducing the frequency of adverse pregnancy outcomes. In systematic reviews with meta-analysis, overall effect estimators were not significant, although a reduction in the incidence of obstetric complications was observed. Subgroup analysis resulted in significant effects, depending on sociodemographic conditions. CONCLUSIONS: Differential findings are not enough to demonstrate that there is a significant reduction in the frequency of adverse pregnancy outcomes in pregnant women receiving periodontal therapy. Possible explanations are related to factors such as the type of studies analyzed, indicator of obstetric complication considered, and specific variables included in the analysis. Many systematic reviews did not address publication bias and did identify gaps in knowledge that require further clarification.

Gaps in Knowledge About the Association Between Maternal Periodontitis and Adverse Obstetric Outcomes: An Umbrella Review.

OBJECTIVES: Scientific literature has established that the periodontal condition during pregnancy could be associated with obstetric/neonatal morbidity, and these effects have an important relationship with problems during childhood and cardiovascular disease in adulthood. This umbrella review aimed to summarize the results about the association between maternal periodontitis and obstetric complications (low birth weight, preterm delivery, and preeclampsia) and identify the gaps in the scientific literature. METHODS: An umbrella review of systematic reviews with or without meta-analysis was performed. Quality evaluation and descriptive analysis of the characteristics of the included studies were conducted. RESULTS: Nineteen systematic reviews/meta-analyses were considered. In total, the systematic reviews included 99 observational studies. Most of the reviews established an association between maternal periodontitis and a higher risk of low birth weight, preterm delivery, and preeclampsia. The magnitude and statistical significance of this relationship are influenced by the context in which the studies have been conducted. Gaps were identified in the definition/evaluation of periodontal disease, criteria of gestational age for study purposes, and potential confounders, among others. CONCLUSIONS: Although scientific literature has established an association among the analyzed pathologies, conceptual and methodological gaps were identified, and they should be considered as integral components when this association is investigated.