title: Risk of adverse pregnancy outcomes in women with periodontal disease and the effectiveness of interventions in decreasing this risk: protocol for systematic overview of systematic reviews.
abstract: BACKGROUND
  Periodontal disease is an inflammatory disease of the tissues supporting the teeth. Women who have periodontal disease while pregnant may be at risk of adverse pregnancy outcomes. Although the association between periodontal disease and adverse pregnancy outcomes has been addressed in a considerable number of systematic reviews and meta-analyses, there are important differences in the conclusions of these reviews. Systematic reviews assessing the effectivity of various therapeutic interventions to treat periodontal disease during pregnancy to try and reduce adverse pregnancy outcomes have also arrived at different conclusions. We aim to provide a systematic overview of systematic reviews comparing the frequency of adverse pregnancy outcomes between women with and without periodontal disease and/or evaluating the effect of preventive and therapeutic interventions for periodontal disease before or during pregnancy on adverse pregnancy outcomes.
  
  
  METHODS
  We will include systematic reviews reporting on studies comparing adverse pregnancy outcomes: (i) between women with or without periodontal disease before (<6 months) or during pregnancy and/or (ii) according to preventive or therapeutic interventions for periodontal disease. Eligible interventions include (combinations of) the following: oral hygiene education, use of antibiotics, subgingival scaling, and root planing. For preventive and/or therapeutic reviews, the following comparisons will be considered: no intervention, a placebo intervention, or an alternative intervention. Our primary adverse pregnancy outcomes of interests are maternal mortality, preterm delivery, and perinatal mortality. Two reviewers will independently identify eligible published and unpublished systematic reviews from six electronic databases and using hand searching of reference lists and citations. Data items extracted from included systematic reviews are based on the Cochrane Effective Practice and Organization of Care checklist and the preferred reporting items for systematic review and meta-analysis (PRISMA) statement. In our narrative data synthesis, we will consider risk of bias of individual reviews, focusing mainly on the conclusions of the highest quality reviews using the assessment of multiple systematic reviews (AMSTAR) checklist. Disagreements during search, selection, data extraction, and risk of bias assessment will be resolved through discussion and/or consultation of a third reviewer.
  
  
  BACKGROUND
  PROSPERO CRD42015030132.
authors.affiliation: Department of Pediatrics, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. sizzle.vanterpool@maastrichtuniversity.nl.|Department of Neuroscience, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands. sizzle.vanterpool@maastrichtuniversity.nl.
authors.forename: Sizzle F
authors.initials: SF
authors.lastname: Vanterpool
authors.affiliation: Department of Pediatrics, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. k.tomsin@student.maastrichtuniversity.nl.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Tomsin
authors.affiliation: Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI, 53706, USA. lreyes2@wisc.edu.
authors.forename: Leticia
authors.initials: L
authors.lastname: Reyes
authors.affiliation: Department of Pediatrics, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. luc.zimmermann@mumc.nl.|School for Oncology and Developmental Biology (GROW), Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands. luc.zimmermann@mumc.nl.
authors.forename: Luc J
authors.initials: LJ
authors.lastname: Zimmermann
authors.affiliation: Department of Pediatrics, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. b.kramer@maastrichtuniversity.nl.|Department of Neuroscience, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands. b.kramer@maastrichtuniversity.nl.|School for Oncology and Developmental Biology (GROW), Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands. b.kramer@maastrichtuniversity.nl.
authors.forename: Boris W
authors.initials: BW
authors.lastname: Kramer
authors.affiliation: Department of Pediatrics, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. j.been@erasmusmc.nl.|School for Public Health and Primary Care (CAPHRI), Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands. j.been@erasmusmc.nl.|Division of Neonatology, Sophia Children's Hospital, Erasmus University Medical Center, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands. j.been@erasmusmc.nl.
authors.forename: Jasper V
authors.initials: JV
authors.lastname: Been
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010510:Periodontal Diseases / Q000150:complications* / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011256:Pregnancy Outcome; D012306:Risk; D000078202:Systematic Reviews as Topic
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