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Treatment of Periodontal Disease in Pregnancy Does Not Affect Rates of Prematurity, Low Birth Weight, or Intrauterine Growth Restriction
mental health disorders, including schizophrenia, bipolar and unipolar disorders, puerperal disorders, and all disorders combined. Both outpatient contacts and hospitalizations for all mental health disorders were highest in primiparas when compared with non-mothers and other postpartum women beyond their first year or with a second or third child. While risk remains high for postpartum primiparas within the first year, it is highest 10 to 19 days following delivery. The state of being pregnant appeared to exert a protective effect against hospitalization or outpatient contact for mental health disorders in women. There were no significant mental health disorders noted for first-time fathers in the first year following birth of a child (when compared with similar men who were not fathers), though other studies have suggested otherwise. In the accompanying editorial, Wisner et al. point out that PPD is more common than is appreciated and very little about it has been studied since the Edinburgh Depression Scale was published in 1987—20 years ago! Given the new information presented in this study, clinicians can identify risk factors for PPD and consider screening primiparas earlier than the standard 6-week check-up and again later in the first year (at 3 months). More formal screening can take place and be documented in the record. The Edinburgh Depression Scale is a brief 10-item questionnaire, has been proven valid, and could be more widely applied in practice. Treatment for PPD is more successful when started early in the illness process. TREATMENT OF PERIODONTAL DISEASE IN PREGNANCY DOES NOT AFFECT RATES OF PREMATURITY, LOW BIRTH WEIGHT, OR INTRAUTERINE GROWTH RESTRICTION Michalowicz BS, Hodges JS, DiAngelis AJ, Lupo VR, Novak MJ, Ferguson JE, et al. Treatment of periodontal disease and the risk of preterm birth. N Engl J Med 2006;355:1885–94. Reviewed by: Sharon Bond, CNM, APRN-BC. Dental disease has been linked with poor pregnancy outcomes, such as premature labor, low birth weight, intrauterine growth restriction, and pre-eclampsia, though causation has not been established. It has been hypothesized that gram-negative bacteria which cause periodontitis and damage bone and connective tissues that support teeth also cause an inflammatory process
Journal of Midwifery & Women’s Health • www.jmwh.org
that may have systemic health implications. This has been theorized to occur when bacteria invade the placenta, membranes, and amniotic fluid, leading to preterm labor. This is a blinded, randomized, controlled trial which occurred in four medical centers involving 823 pregnant women. Following consent, all received screening for periodontal disease and, if present, were randomly assigned to a treatment or control group. The treatment group (N ⫽ 413) received non-surgical care for their disease, which included plaque and calculus removal and instruction in oral hygiene. The control group (N ⫽ 410) received the same number of visits, but their periodontal treatment was delayed until after delivery. All providers received training from the same clinician (Michalowicz) so that periodontal care would be delivered to subjects in the same way. Women were then compared for length of gestational age, birth weight, and whether their infants were small for gestational age. Outcomes for gestational age and birth weight were similar and there were no significant differences between the control and treatment groups. There were no measurable differences within the treatment groups among the four participating medical centers. Follow-up rates were fairly high. When authors looked at outcomes only for women having the most severe periodontal disease, there were no differences. Because these findings differ from those of earlier studies, the authors considered several possible reasons for the discrepancies. For example, perhaps the treatment did not affect the disease process enough to alter birth outcomes. Other studies used antibiotics in their treatment groups, or perhaps periodontal disease needs to be treated before (rather than during) pregnancy in order to measure differences. Many midwives work in settings where women have limited access to dental services. Some women have never consulted a dentist or hygienist. As health care professionals, it is our understanding that good dental hygiene and the absence of disease is beneficial in helping women maintain a healthy pregnancy. This study suggests that treatment of periodontal disease during pregnancy is safe and improves periodontal disease, but does not affect pregnancy outcome. If not to prevent premature births, midwives can continue to refer women noted to have poor oral hygiene to dental providers for evaluation and treatment.
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Journal of Midwifery & Women’s Health • www.jmwh.org
that may have systemic health implications. This has been theorized to occur when bacteria invade the placenta, membranes, and amniotic fluid, leading to preterm labor. This is a blinded, randomized, controlled trial which occurred in four medical centers involving 823 pregnant women. Following consent, all received screening for periodontal disease and, if present, were randomly assigned to a treatment or control group. The treatment group (N ⫽ 413) received non-surgical care for their disease, which included plaque and calculus removal and instruction in oral hygiene. The control group (N ⫽ 410) received the same number of visits, but their periodontal treatment was delayed until after delivery. All providers received training from the same clinician (Michalowicz) so that periodontal care would be delivered to subjects in the same way. Women were then compared for length of gestational age, birth weight, and whether their infants were small for gestational age. Outcomes for gestational age and birth weight were similar and there were no significant differences between the control and treatment groups. There were no measurable differences within the treatment groups among the four participating medical centers. Follow-up rates were fairly high. When authors looked at outcomes only for women having the most severe periodontal disease, there were no differences. Because these findings differ from those of earlier studies, the authors considered several possible reasons for the discrepancies. For example, perhaps the treatment did not affect the disease process enough to alter birth outcomes. Other studies used antibiotics in their treatment groups, or perhaps periodontal disease needs to be treated before (rather than during) pregnancy in order to measure differences. Many midwives work in settings where women have limited access to dental services. Some women have never consulted a dentist or hygienist. As health care professionals, it is our understanding that good dental hygiene and the absence of disease is beneficial in helping women maintain a healthy pregnancy. This study suggests that treatment of periodontal disease during pregnancy is safe and improves periodontal disease, but does not affect pregnancy outcome. If not to prevent premature births, midwives can continue to refer women noted to have poor oral hygiene to dental providers for evaluation and treatment.
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