歯周病の治療と早産のリスクについて

Treatment of periodontal disease and the risk of preterm birth.

• Bryan S Michalowicz
• James S Hodges
• Anthony J DiAngelis
• Virginia R Lupo
• M John Novak
• James E Ferguson
• William Buchanan
• James Bofill
• Panos N Papapanou
• Dennis A Mitchell
• Stephen Matseoane
• Pat A Tschida

抄録

背景:

母親の歯周病は、早産や低体重児出産のリスク増加と関連している。我々は，外科手術を伴わない歯周病治療が早産に及ぼす影響を検討した．

BACKGROUND: 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.

研究方法:

妊娠13週から17週の女性を，21週前にスケーリングとルートプレーニングを受ける群（治療群413例）と，出産後に受ける群（対照群410例）に無作為に割り付けた．また、治療群の患者は、毎月歯の研磨を受け、口腔衛生の指導を受けました。妊娠終了時の妊娠年齢を事前に指定した主要アウトカムとした。副次的な結果は，出生時体重と，妊娠期間に対して小さかった乳児の割合であった．

METHODS: 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.

結果:

追跡調査では，早産（妊娠37週以前）は，治療群では407人中49人（12.0％）に，対照群では405人中52人（12.8％）に発生した（出生数は38人）。歯周病治療によって歯周炎の指標は改善されたが（P＜0.001），早産のリスクには有意な変化はなかった（P＝0.70；治療群と対照群のハザード比，0.93；95％信頼区間［CI］，0.63～1.37）．出生体重（3239g対3258g，P＝0.64）および妊娠期間に対して小さい乳児の出産率（12.7％対12.3％，オッズ比1.04，95％CI，0.68～1.58）については，治療群と対照群の間に有意な差はなかった．自然流産または死産は、対照群の14件に対し、治療群では5件であった（P=0.08）。

RESULTS: 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).

結論:

妊婦の歯周炎の治療は，歯周病を改善し，安全であるが，早産，低出生体重児，胎児発育制限の発生率に有意な変化はない．(ClinicalTrials.gov番号, NCT00066131 [ClinicalTrials.gov].).

CONCLUSIONS: 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].).

Copyright 2006 Massachusetts Medical Society.