Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.
School of Dentistry, University of Maryland Baltimore, Baltimore.
JAMA Netw Open. 2022 Dec 1;5(12):e2247632. doi: 10.1001/jamanetworkopen.2022.47632.
Chlorhexidine mouthwash enhances treatment effects of conventional periodontal treatment, but data on chlorhexidine as a source of heterogeneity in meta-analyses assessing the treatment of maternal periodontitis in association with birth outcomes are lacking.
To assess possible heterogeneity by chlorhexidine use in randomized clinical trials (RCTs) evaluating the effect of periodontal treatment (ie, scaling and root planing [SRP]) vs no treatment on birth outcomes.
Cochrane Oral Health's Trials Register, Cochrane Pregnancy and Childbirth's Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database), US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov), and the WHO International Clinical Trials Registry Platform were searched through March 2022.
RCTs were included if they were conducted among pregnant individuals with periodontitis, used interventions consisting of SRP vs no periodontal treatment, and assessed birth outcomes.
Data were abstracted with consensus of 2 reviewers using Rayyan and assessed for bias with the Cochrane Risk of Bias 2 tool before random effects subgroup meta-analyses. Analyses were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline.
Outcomes of interest were preterm birth (ie, <37 weeks' gestation) and low birth weight (ie, <2500 g).
There were 12 studies with a total of 5735 participants evaluating preterm birth. Control group participants did not receive any treatment or use chlorhexidine during pregnancy. All intervention group participants received SRP; in 5 of these studies (with 2570 participants), pregnant participants in the treatment group either received chlorhexidine mouthwash or advice to use it, but participants in the remaining 7 studies (with 3183 participants) did not. There were 8 studies with a total of 3510 participants evaluating low birth weight, including 3 studies with SRP plus chlorhexidine (with 594 participants) and 6 studies with SRP only (with 2916 participants). The SRP plus chlorhexidine groups had lower risk of preterm birth (relative risk [RR], 0.56; 95% CI, 0.34-0.93) and low birth weight (RR, 0.47; 95% CI, 0.32-0.68) but not the SRP-only groups (preterm birth: RR, 1.03; 95% CI, 0.82-1.29; low birth weight: RR, 0.82; 95% CI, 0.62-1.08).
These findings suggest that treating maternal periodontitis with chlorhexidine mouthwash plus SRP was associated with reduced risk of preterm and low birth weight. Well-conducted RCTs are needed to test this hypothesis.
洗必泰漱口水可增强常规牙周治疗的效果，但关于洗必泰作为评估母体牙周炎与出生结局相关的元分析中异质性来源的数据尚缺乏。
评估在评估牙周治疗（即龈下刮治和根面平整 [SRP]）与不治疗对出生结局影响的随机临床试验 (RCT) 中使用洗必泰的情况下是否存在异质性。
Cochrane 口腔健康试验注册库、Cochrane 妊娠和分娩试验注册库、Cochrane 对照试验中心注册库（CENTRAL）、医学文献在线检索（Ovid MEDLINE）、Embase 在线检索（Ovid Embase）、巴西生物医学文献数据库（LILACS BIREME Virtual Health Library）、美国国立卫生研究院正在进行的临床试验注册（ClinicalTrials.gov）和世界卫生组织国际临床试验注册平台（WHO International Clinical Trials Registry Platform）于 2022 年 3 月前进行检索。
如果 RCT 是在患有牙周炎的孕妇中进行的，使用的干预措施包括 SRP 与不进行牙周治疗，并且评估了出生结局，则纳入研究。
由 2 位评审员使用 Rayyan 达成共识进行数据提取，并在进行随机效应亚组荟萃分析之前使用 Cochrane 偏倚风险 2 工具评估偏倚。分析遵循系统评价和荟萃分析报告指南的首选报告项目进行。
感兴趣的结局是早产（即<37 周妊娠）和低出生体重（即<2500 g）。
有 12 项研究共纳入 5735 名参与者，评估了早产的情况。对照组参与者在怀孕期间未接受任何治疗或使用洗必泰。所有干预组参与者均接受了 SRP；在其中 5 项研究（共 2570 名参与者）中，治疗组的孕妇接受了洗必泰漱口水或使用建议，但在其余 7 项研究（共 3183 名参与者）中未使用。有 8 项研究共纳入 3510 名参与者，评估了低出生体重的情况，包括 3 项 SRP 加洗必泰（共 594 名参与者）和 6 项 SRP 仅（共 2916 名参与者）。SRP 加洗必泰组早产风险较低（相对风险 [RR]，0.56；95%CI，0.34-0.93）和低出生体重（RR，0.47；95%CI，0.32-0.68），但 SRP 仅组则没有（早产：RR，1.03；95%CI，0.82-1.29；低出生体重：RR，0.82；95%CI，0.62-1.08）。
这些发现表明，用洗必泰漱口水联合 SRP 治疗母体牙周炎与降低早产和低出生体重的风险相关。需要进行精心设计的 RCT 来检验这一假设。
