Table 2.
Evidence of the Association between Periodontal Disease and Primary Outcome Preterm Birth.
| Systematic Review (Year); No. of Studies (Participants) | Main Findings1. Results of Meta-Analysis: or/RR (95%-Ci)2. Results of Subgroup Analysis: or/RR (95%-Ci) | Risk of Bias Assessment | Summary of Findings |
|---|---|---|---|
| Chambrone (2011) 8 (10,804) |
All studies RR 1.7 (1.0-2.8) Studies of high methodological quality RR 1.8 (1.0-3.1) All studies PD defined by PPD and CAL: RR 1.4 (1.1-1.8) PD defined by CAL alone: RR 3.1 (0.2-45.1) PD defined by other methods: RR 1.3 (0.5-3.0) Studies of high methodological quality PD defined by PPD and CAL: RR 1.4 (1.1-1.8) PD defined by CAL alone: RR 3.1 (0.2-45.1) Mild PD defined by PPD and CAL: RR 1.3 (1.0-1.7) Moderate-severe PD defined by PPD and CAL: RR 2.0 (1.3-2.9) Jeffcoat (2001) was not included in the meta-analysis. This cohort study found a positive association between PD and PTB, with the following ORs: 4.5 (2.2-9.2) (<37 weeks of GA), 5.3 (2.1-13.6) (<35 weeks of GA) and 7.1 (1.7-27.4) (<32 weeks of GA). |
Individual studies: NOS-scale (max. 14.0) Mean: 11.9 Range: 9.0-13.0 Systematic review: AMSTAR = 7 |
Overall analysis did not show a significant association between PD and PTB. PD was associated with PTB in studies where PD was defined by PPD and CAL. There was evidence of a dose-response association between severity of PD and risk of PTB. |
| Chambrone (2012b) 14 (8,588) |
OR 1.8 (1.6-2.0) No subgroup analyses performed |
Individual studies: Not reported Systematic review: AMSTAR = 6 |
PD showed a significant association with PTB. |
| Corbella (2016) 17 (6,741) |
RR 1.6 (1.3-2.0) Low risk of bias studies RR 1.7 (1.3-2.2)Moderate risk of bias studies: RR 1.5 (1.1-2.1) |
Individual studies: Cochrane Bias Methods Group (max. 5.0) Mean: 4.5 Range: 4.0-5.0 Systematic review: AMSTAR = 8 |
PD showed a significant association with PTB, which was consistent in studies with low and moderate risk of bias. |
| Ide(2013)24 (18,626) | CC studies reporting PD as a categorical variable: OR 2.5
(2.2-2.8) CC studies reporting PD as a continuous variable (PD): WMD 0.04 (0.01-0.06) CC studies reporting PD as a continuous variable (CAL): WMD -0.04 (-0.07-0.02) CC studies reporting PD as a continuous variable (BOP): WMD 4.7 (2.8-6.7) Prospective cohort studies reporting PD as a categorical variable: RR 1.2 (0.9-1.5) Prospective cohort studies reporting PD as a continuous variable (PD): WMD 0.01 (-0.00-0.02) Prospective cohort studies reporting PD as a continuous variable (CAL): WMD -0.02 (-0.03, -0.01) Prospective cohort studies reporting PD as a continuous variable (POB): WMD -0.00 (-0.6-0.6) |
Individual studies: NOS (max 8.0): Mean: 5.5 Range: 4-7 Systematic review: AMSTAR = 6 |
PD showed a positive association with preterm birth. |
| Khader (2005) 4 (2,156) |
OR 3.9 (2.1-7.0) PTB regardless of BW: OR 4.3 (2.6-7.0) PTB regardless of BW excluding the study with the lowest quality score: OR 4.3 (2.5-7.4) |
Individual studies: Margetts et al.a (max 100%) Mean: 60 Range: 35-71 Systematic review: AMSTAR = 7 |
PD showed a positive association with PTB. |
| Konopka (2012) 7 (3,253) |
OR 2.7 (2.1-3.6) No subgroup analyses performed |
Individual studies: Margetts et al.a (max 100%) Mean: 46 Range: 31-68 Systematic review: AMSTAR = 6 |
PD showed a positive association with PTB. |
| Vergnes (2007) Not reported |
OR 2.3 (1.1-4.9) No subgroup analyses performed |
Individual studies: Margetts et al.a (max. 100%) Mean: 54.9 Range: 30.0-82.0 Systematic review: AMSTAR = 7 |
PD showed a positive association with PTB. |
| Corbella (2012a) 25 (19,493) |
Fifteen studies found a significant positive association between PD and PTB (OR/RR 1.8-20), of which seven did not report an OR/RR, or reported an OR/RR without 95%-CI (OR/RR 1.1-1.9). Two studies found a significant association between PD and moderate-severe PTB only. Eight studies found no significant association (OR/RR 0.7-1.9). | Individual studies: Not reported Systematic review: AMSTAR = 2 |
The vast majority of included studies identified a positive association between PD and PTB, albeit with highly variable OR/RRs. |
| Madianos (2002) 1 (1,313) |
One cohort study included which found a positive association between PD and PTB: OR 4.5 (2.2-9.2) (<37 weeks of GA), 5.3 (2.1-13.6) (<35 weeks of GA) and 7.1 (1.7-27.4) (<32 weeks of GA). | Individual studies: Not reported Systematic review: AMSTAR = 4 |
One cohort study included which showed a positive association between PD and PTB. |
| Oliveira (2009) 11 (4,982) |
8/11 studies reported a positive association between PD and PTB (OR/RR 2.0-8.1), no 95%-CI were reported. Three studies showed no association. | Individual studies: Not reported Systematic review: AMSTAR = 2 |
The vast majority of included studies identified a positive association between PD and PTB. |
| Sanchez (2004)1 (1,313) | One cohort study included which reported a positive association between PD and PTB, with the following ORs: 4.5 (2.2-9.2) (<37 weeks of GA), 5.3 (2.1-13.6) (<35 weeks of GA) and 7.1 (1.7-27.4) (<32 weeks of GA). | Individual studies: Not reported Systematic review: AMSTAR = 1 |
One study included which showed a positive association between PD and PTB. |
| Scannapieco (2003)1 (1,313) | One cohort study included which reported a positive association between PD and PTB, with the following ORs: 4.5 (2.2-9.2) (<37 weeks of GA), 5.3 (2.1-13.6) (<35 weeks of GA) and 7.1 (1.7-27.4) (<32 weeks of GA). | Individual studies: Not reported Systematic review: AMSTAR = 3 |
One study included which showed a positive association between PD and PTB. |
| Teshome (2016) 4 (809) |
Three studies reported a significant positive association between PD and PTB (4.2-137.5). One study found no association. | Individual studies: NIH checklist Mean: 10.3 Range: 9-12 Systematic review: AMSTAR = 5 |
The vast majority of included studies identified a positive association between PD and PTB. |
| Vettore (2006) 12 (7,370) |
Four studies reported a significant positive association between PD and PTB (OR/RR 2.2-7.1). Another two studies reported a positive association between PD and PTB but OR/RR was not provided. Six studies showed no association. | Individual studies: Not reported Systematic review: AMSTAR = 4 |
Half of the included studies identified a positive association between PD and PTB |
| Wimmer (2008) 28 (15,822) |
16/28 studies reported a positive association between PD and PTB (OR/RR 1.1-20). 12 studies showed no association. | Individual studies: Not reported Systematic review: AMSTAR = 2 |
The majority of included studies identified a positive association between PD and PTB. |
| Xiong (2006) 11 (7,629) |
Seven studies reported a significant positive association between PD and PTB (OR/RR 2.1 to 20). One study reported only a significant association between moderate/severe PD and PTB (2.1 [1.3-3.4]) and not between mild PD and PTB (1.2 [0.9-1.7]). Four studies showed no association. | Individual studies: Not reported Systematic review: AMSTAR = 3 |
The vast majority of included studies identified a positive association between PD and PTB. |
| Xiong (2007) 20 (13,246) |
10/20 studies reported a positive association between PD and PTB (OR/RR 2.1 to 20.0), whereas 10 found no association. | Individual studies: Not reported Systematic review: AMSTAR = 3 |
Half of the included studies identified a positive association between PD and PTB |
BOP, bleeding on probing; BW, birth weight; CAL, clinical attachment loss; CC, case-control; CI, confidence interval; GA, gestational age; NIH, National Institutes of Health; NOS, Newcastle-Ottawa scale; OR, odds ratio; PD, periodontal disease; PPD, probing pocket depth; PTB, preterm birth; RR, relative risk; WMD, weighed mean difference.
Reviews in which meta-analyses were performed are listed first, followed by reviews in which no meta-analysis was performed.
a
Margetts BM, Thompson RL, Key T, et al. Development of a scoring system to judge the scientific quality of information from case-control and cohort studies of nutrition and disease. Nutr Cancer 1995;24:231-239.