Michalowicz Bryan S, Hodges James S, DiAngelis Anthony J, Lupo Virginia R, Novak M John, Ferguson James E, Buchanan William, Bofill James, Papapanou Panos N, Mitchell Dennis A, Matseoane Stephen, Tschida Pat A
Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis, USA.
N Engl J Med. 2006 Nov 2;355(18):1885-94. doi: 10.1056/NEJMoa062249.
Maternal periodontal disease has been associated with an increased risk of preterm birth and low birth weight. We studied the effect of nonsurgical periodontal treatment on preterm birth.
We randomly assigned women between 13 and 17 weeks of gestation to undergo scaling and root planing either before 21 weeks (413 patients in the treatment group) or after delivery (410 patients in the control group). Patients in the treatment group also underwent monthly tooth polishing and received instruction in oral hygiene. The gestational age at the end of pregnancy was the prespecified primary outcome. Secondary outcomes were birth weight and the proportion of infants who were small for gestational age.
In the follow-up analysis, preterm birth (before 37 weeks of gestation) occurred in 49 of 407 women (12.0%) in the treatment group (resulting in 44 live births) and in 52 of 405 women (12.8%) in the control group (resulting in 38 live births). Although periodontal treatment improved periodontitis measures (P<0.001), it did not significantly alter the risk of preterm delivery (P=0.70; hazard ratio for treatment group vs. control group, 0.93; 95% confidence interval [CI], 0.63 to 1.37). There were no significant differences between the treatment and control groups in birth weight (3239 g vs. 3258 g, P=0.64) or in the rate of delivery of infants that were small for gestational age (12.7% vs. 12.3%; odds ratio, 1.04; 95% CI, 0.68 to 1.58). There were 5 spontaneous abortions or stillbirths in the treatment group, as compared with 14 in the control group (P=0.08).
Treatment of periodontitis in pregnant women improves periodontal disease and is safe but does not significantly alter rates of preterm birth, low birth weight, or fetal growth restriction. (ClinicalTrials.gov number, NCT00066131 [ClinicalTrials.gov].).
孕妇牙周疾病与早产及低出生体重风险增加有关。我们研究了非手术牙周治疗对早产的影响。
我们将妊娠13至17周的女性随机分组，一组在妊娠21周前接受龈上洁治和根面平整（治疗组413例患者），另一组在分娩后接受（对照组410例患者）。治疗组患者还每月接受牙齿抛光并接受口腔卫生指导。妊娠结束时的孕周是预先设定的主要结局指标。次要结局指标是出生体重和小于胎龄儿的比例。
在随访分析中，治疗组407例女性中有49例（12.0%）发生早产（妊娠37周前）（44例活产），对照组405例女性中有52例（12.8%）发生早产（38例活产）。虽然牙周治疗改善了牙周炎指标（P<0.001），但并未显著改变早产风险（P=0.70；治疗组与对照组的风险比为0.93；95%置信区间[CI]，0.63至1.37）。治疗组和对照组在出生体重（3239 g对3258 g，P=0.64）或小于胎龄儿分娩率（12.7%对12.3%；比值比，1.04；95%CI，0.68至1.58）方面无显著差异。治疗组有5例自然流产或死产，对照组有14例（P=0.08）。
孕妇牙周炎治疗可改善牙周疾病且安全，但并未显著改变早产、低出生体重或胎儿生长受限的发生率。（ClinicalTrials.gov编号，NCT00066131 [ClinicalTrials.gov]）
