Introduction
Methods
PECO Question
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Exposure: periodontitis
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Comparator: without periodontitis
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Outcome: frequency of women with periodontitis in each group
Population, Exposure and Comparator
Outcomes
Search Strategy
Study Selection Process
Data Extraction
Risk of Bias (RoB)
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Low quality: High risk of bias for all questions, or any potential bias could seriously affect confidence in the results.
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Medium quality: risk of bias is unclear for one or more questions, or any plausible bias raises some concerns about the study results.
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High quality: Low risk of bias for all questions, or any plausible bias is unlikely to seriously affect the study results.
Meta-analysis
Publication Bias
Quality of Evidence and Strength of Recommendation
Results
Authors | Design | Observations | Age | Age case group | Age control group | Participants (n) |
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Davenport et al. 2002 England | Case–control | Periodontitis was not associated with LBW | 26.7 | 26.7 | 26.9 | 743 |
Moore et al. 2004 United Kingdom | Cohort | There was no association between PTB or LBW and periodontal disease in this population | 29.9 | 29.8 | 30 | 546 |
Cruz et al. 2005 Brazil | Case–control | Periodontal disease is a possible risk factor for LBW | 13–48 | 13–48 | 13–48 | 302 |
Lunardelli et al. 2005 Brazil | Cross-sectional | No association was found between periodontal disease and LBW. An association was found between PTB and periodontal pockets, but it was confounded by maternal health variables | 15—40 | 15–40 | 15–40 | 449 |
Jarjoura et al. 2005 USA | Cross-sectional | The data support the notion that periodontitis is independently associated with PTB and LBW | 28.6 | 28.6 | 28.6 | 203 |
Offenbacher et al. 2006 USA | Cohort | Maternal periodontal disease increases the relative risk of preterm or spontaneous PTB | 28.2 | 28.2 | 28.2 | 1,206 |
Bassani et al. 2007 Brazil | Case–control | Weak association, as a strong association of perinatal outcomes and periodontal disease could not be detected in the present study | 20–24 | 20–24 | 20–24 | 915 |
Siqueira et al. 2007 Brazil | Case–control | Maternal periodontitis is associated with increased risk of PTB and LBW | 18–35 | 18–35 | 18–35 | 1,277 |
Agüeda et al. 2008 Spain | Cohort | This study found a modest association between periodontitis and PTB | 29.6 | 28 | 29.6 | 1,296 |
Saddki et al. 2008 Malaysia | Cohort | Pregnant women with periodontitis are at significantly increased risk of delivering LBW babies | 29.1 | 14–46 | 14–46 | 472 |
Nabet et al. 2010 France | Case–control | Maternal periodontitis is associated with an increased risk of induced preterm labor due to preeclampsia | 25–34 | 25–34 | 25–34 | 2,202 |
Santacruz et al. 2012 Spain | Cohort | The presence and counts of E. corrodens and Capnocytophaga spp. showed a significant association with PTB and LBW | 39.5 | 39.5 | 39.3 | 170 |
Arteaga-Guerra et al. 2010 Colombia | Cross-sectional | Periodontal disease was associated with LBW and PTB | 2.,2 | 46 | ||
Wolff et al. 2010 Argentina | Cohort | Moderate to severe maternal periodontitis is a true risk factor for PTB | 18–40 | 44 | ||
Baskaradoss et al. 2011 India | Case–control | Periodontal disease is an independent risk factor for PTB, resulting in an almost three-fold increased risk for PTB | 25.5 | 25.1 | 25.7 | 300 |
Schenkein et al. 2012 USA | Cross-sectional | No evidence that periodontitis predisposes to LBW | 24.6 | 24.,6 | 24.6 | 606 |
Ali et al. 2012 Malaysia | Cohort | Periodontitis was not shown to be a risk factor for PTB orLBW | 22–48 | 22–48 | 22–48 | 73 |
Martinez de Tejada et al. 2012 Switzerland | Case–control | PTB is associated with periodontitis when using the US consensus definitions | 18–40 | 18–40 | 18–40 | 429 |
Jacob et al. 2014 India | Case–control | Periodontitis represents a strong, independent and clinically significant risk factor for low birth weight | 23 | 23.4 | 24.0 | 340 |
Noack et al. 2015 Germany | Case–control | Periodontitis was not a detectable risk factor for low PTB weight in pregnant women | 27.8–30.3 | 28.6 | 30.2 | 58 |
Souza et al. 2015 Brazil | Case–control | No association between maternal periodontal disease and LBW was observed, even after appropriate adjustments for confounding factors | 18–35 | 18–35 | 18–35 | 951 |
Alves et al. 2016 Brazil | Cross-sectional | Periodontitis was an associated factor for prematurity and LBW | 18–36 | 18–36 | 18–36 | 59 |
Meqa et al. 2017 Republic of Kosovo | Cross-sectional | Periodontitis can be considered a risk factor for pregnancy complications | 26 | 187 | ||
Wazir et al. 2019 India | Case–control | The findings showed an association of maternal periodontal disease with LBW | 23.9 | 200 | ||
Lafaurie et al. 2020 Colombia | Case–control | Periodontal condition assessed by pocket depth was associated with adverse perinatal outcomes | < 35 | < 35 | < 35 | 735 |
Micu et al. 2020 Rumania | Cross-sectional | Maternal periodontal disease and its severity could, in part, be considered as contributing to PTB | 29.1 | 29.3 | 29.1 | 194 |
Pozo et al. 2020 Spain | Cross-sectional | Adverse pregnancy outcomes were associated with periodontitis | 29.4 | 130 | ||
Choi et al. 2021 USA | Cross-sectional | Maternal periodontal disease may be associated with an increased risk of complications and neonatal morbidity | 27.8 | 748,792 | ||
Ferrillo et al. 2021 Italy | Cross-sectional | High prevalence of PTB and LBW is present in affected pregnant women with periodontal disease and vitamin D deficiency | 18–35 | 72 | ||
Jyotirmay et al. 2021 India | Cross-sectional | No association between maternal periodontal health and preterm and LBW | 21–30 | 300 | ||
Gallagher-Cobos et al. 2022 Spain | Cohort | Periodontal disease in the mother was not related in a statistically significant way with PTB or LBW | 18–42 | 98 | ||
Lee et al. 2022 Taiwan | Cross-sectional | Increasing the severity of probing depth was associated with an increased risk of PTB | > 20 | 1,745,078 | ||
Peña-Sisto et al. 2022 Cuba | Case–control | There is a high frequency of periodontal diseases in significant association with the appearance of PTB and LBW | 20–35 | 703 | ||
Hussain et al. 2023 Pakistan | Case–control | Periodontitis is a predictor of LBW | 25.8 | 25.8 | 25.8 | 180 |
Bhavsar et al. 2023 India | Case–control | The presence of periodontal pockets and plaque increases the risk of complications during pregnancy | 25.0 | 24.5 | 25.3 | 1,200 |
Study | Case group | Control group | ||
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PD (mm) | AL (mm) | PD (mm) | AL (mm) | |
Davenport et al. 2002 England | 3,72 | 3,85 | ||
Moore et al. 2004 United Kingdom | 2,04 | 0,22 | 2,03 | 0,23 |
Jarjoura et al. 2005 USA | 2,5 | 1.5 | 2,4 | 1.7 |
Siqueira et al. 2007 Brazil | 4 | 4 | 4 | 4 |
Agueda et al. 2008 Spain | 2,2 | 2,1 | 2,1 | 1,9 |
Baskaradoss et al. 2011 India | 3,26 | 2,17 | 2,95 | 1,84 |
Ali et al. 2012 Malaysia | 2,54 | 2,31 | 1,65 | 0,23 |
Souza et al. 2015 Brazil | 1,6 | 1,59 | 1,6 | 1,6 |
Noack et al. 2015 Germany | 2,38 | 2,4 | 2,47 | 2,5 |
Meqa et al. 2017 Republic of Kosovo | 2,45 | 2,49 | 2,24 | 2,47 |
Hussain et al. 2023 Pakistan | 1,26 | 0,50 | ||
Bhavsar et al. 2023 India | 4,6 | 2,9 |
Assessment of the certainty of the evidence | |||||||||
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Number of studies | Design | Risk of Bias | Inconsistency | Indirectness | Imprecision | Publication bias | Other considerations | Certainty | Importance |
Low birth weight (primary outcome) | |||||||||
20 | Analytical observational | Serious: 4/20 studies carried great weight to the effect. 4/20 studies considered as moderate/high bias | Substantial: I2 93% and Chi2 279.94 | Not serious | Serious: confidence intervals in some studies are wide | Publication bias detected in asymmetric funnel plot. Small studies with positive results | Some of the studies demonstrated a higher prevalence of periodontitis in the case group compared to the control group | Low | Important |
Preterm birth (primary outcome) | |||||||||
25 | Analytical observational | Serious: 4/25 studies carried great weight to the effect. 11/25 studies considered to have moderate/high bias | Substantial: I2 95% and Chi2 510.16 | Not serious | Serious: confidence intervals in some studies are wide | Publication bias detected in asymmetric funnel plot. Small studies with positive results | Some of the studies demonstrated a higher prevalence of periodontitis in the case group compared to the control group | Low | Important |