Periodontal disease and pre-eclampsia: a systematic review.
OBJECTIVE
This review evaluates the possible relationship between periodontal disease and pre-eclampsia, a major pregnancy complication. A generalized inflammatory response plays an important role in the pathogenesis of pre-eclampsia. Because periodontal disease is a low-grade inflammatory state, periodontal disease might contribute to the pathogenesis of pre-eclampsia.


CONCLUSIONS
A literature search of PubMed, EMBASE and CINAHL until August 2010 revealed 12 eligible observational studies and three randomized-controlled trials (RCTs). It appeared difficult to compare these studies, due to variations in definitions of periodontal disease and pre-eclampsia, timing of periodontal examination and inadequate control for confounding factors. Eight observational studies reported a positive association, while four studies found no association. None of the RTCs reported reductions in pre-eclamptic rate after periodontal therapy during pregnancy. Therefore, it is questionable whether periodontal disease plays a causal role in the pathogenesis of pre-eclampsia. The observed association in eight observational studies might be the result of induction of periodontal disease due to the pre-eclamptic state or it may be an epiphenomenon of an exaggerated inflammatory response to pregnancy. Larger RCTs with pre-eclampsia as the primary outcome and pathophysiological studies are required to explore causality and to dissect biological mechanisms involved.
Department of Periodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. a.kunnen@ctm.umcg.nl
Alina
A
Kunnen
Jasper J
JJ
van Doormaal
Frank
F
Abbas
Jan G
JG
Aarnoudse
Maria G
MG
van Pampus
Marijke M
MM
Faas
D015984:Causality; D005260:Female; D006801:Humans; D010510:Periodontal Diseases / Q000150:complications*; D011225:Pre-Eclampsia; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012307:Risk Factors