Periodontal Disease and Pregnancy Outcomes: Overview of Systematic Reviews.
Periodontal Disease and Pregnancy Outcomes: Overview of Systematic Reviews.
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DOI：
10.1177/2380084417731097
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发表时间：
2018-01
影响因子：
--
通讯作者：
Been JV
中科院分区：
文献类型：
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作者：
Daalderop LA;Wieland BV;Tomsin K;Reyes L;Kramer BW;Vanterpool SF;Been JV
牙周病在怀孕期间很常见。尽管它与不良妊娠结局有关，但系统评价对这些联系得出了不同的结论。因此，我们对研究牙周病与不良妊娠结局之间关系的系统评价进行了系统概述。我们检索了截至 2016 年 11 月的 6 个在线数据库，并手工检索了符合条件的论文的参考文献和引文。对比较患有和不患有牙周病的女性妊娠结局的研究进行系统评价，符合纳入条件。主要结局是孕产妇死亡率、早产和围产儿死亡率。两名评审员提取数据并评估个别系统评审的偏倚风险。研究结果以表格和叙述的形式进行描述。纳入了 23 项系统评价（包括 3 至 45 项研究）。没有人报告牙周病与孕产妇或围产儿死亡率之间的关联。偏倚风险最低的系统评价一致证明牙周病与早产之间存在正相关（相对风险，1.6；95%置信区间，1.3至2.0；17项研究，6,741名受试者）、低出生体重（LBW；相对风险，1.7；95% CI，1.3至2.1；10项研究，5,693名受试者）、先兆子痫（几率）比率，2.2；95% 置信区间，1.4至3.4； 15 项研究，5,111 名受试者）和早产 LBW（相对风险 3.4；95% CI，1.3 至 8.8；4 项研究，2,263 名受试者）。根据这些数据，估计早产牙周病的人群归因比例为 5% 至 38%，低出生体重者为 6% 至 41%，先兆子痫为 10% 至 55%。就局限性而言，由于一些初步研究没有针对混杂因素进行调整，荟萃分析可能高估了所研究关联的强度。由于纳入的主要研究存在大量重叠，我们无法汇总各评价的结果。来自低偏倚风险的系统评价的一致证据表明，患有牙周病的孕妇患先兆子痫和产下早产儿和/或低出生体重儿的风险增加（PROSPERO：CRD42015030132）。知识转移声明：这项研究强调牙周病是几种常见不良妊娠结局的重要危险因素。临床医生应该意识到这一联系以指导风险选择。需要研究来制定新的预防和治疗策略。
Periodontal disease is very common during pregnancy. Although it has been linked to adverse pregnancy outcomes, systematic reviews have reached discrepant conclusions on these links. Therefore, we conducted a systematic overview of systematic reviews studying the association between periodontal disease and adverse pregnancy outcomes. We searched 6 online databases up to November 2016 and hand-searched references and citations of eligible papers. Systematic reviews of studies comparing pregnancy outcomes among women with and without periodontal disease were eligible for inclusion. Primary outcomes were maternal mortality, preterm birth, and perinatal mortality. Two reviewers extracted data and assessed risk of bias of individual systematic reviews. Findings are described in tabular and narrative form. Twenty-three systematic reviews (including between 3 and 45 studies) were included. None reported the association between periodontal disease and maternal or perinatal mortality. Systematic reviews with the lowest risk of bias consistently demonstrated positive associations between periodontal disease and preterm birth (relative risk, 1.6; 95% confidence interval, 1.3 to 2.0; 17 studies, 6,741 participants), low birth weight (LBW; relative risk, 1.7; 95% CI, 1.3 to 2.1; 10 studies, 5,693 participants), preeclampsia (odds ratio, 2.2; 95% CI, 1.4 to 3.4; 15 studies, 5,111 participants), and preterm LBW (relative risk 3.4; 95% CI, 1.3 to 8.8; 4 studies, 2,263 participants). Based on these figures, estimated population-attributable fractions for periodontal disease were 5% to 38% for preterm birth, 6% to 41% for LBW, and 10% to 55% for preeclampsia. In terms of limitations, as several primary studies did not adjust for confounding, meta-analyses may have overestimated the strength of the associations under study. Due to substantial overlap in included primary studies, we could not aggregate results across reviews. Consistent evidence from systematic reviews with low risk of bias indicates that pregnant women with periodontal disease are at increased risk of developing preeclampsia and delivering a preterm and/or LBW baby (PROSPERO: CRD42015030132). Knowledge Transfer Statement: This study highlights that periodontal disease is an important risk factor for several common adverse pregnancy outcomes. Clinicians should be aware of this link to guide risk selection. Research is needed to develop novel preventive and treatment strategies.