Perinatal & Pediatric
Quantifying the Benefits of Preventive Periodontal Care in Pregnancy Using Advanced Causal Inference Methods Ishan Suthar* Ishan Suthar Dr. Anwar Merchant Rokonuzzaman SM
Periodontal disease during pregnancy poses significant risks due to hormonal changes that exacerbate inflammation, potentially leading to adverse outcomes like preterm birth and low birth weight. Few studies have assessed the causal effects of preventive periodontal treatment on perinatal outcomes. Standard methods for analysis of randomized control studies may give biased estimates of exposure effects in the presence of time-varying confounding. G-estimation helps address this limitation.
Data were obtained from Obstetrics and Periodontal Therapy, a longitudinal randomized controlled trial with 823 pregnant women aged 18–44 recruited from urban and suburban clinics. They were randomly assigned to receive non-surgical periodontal treatment. The test group received scaling and root planning treatment before 20 weeks gestation, at 21-24 weeks gestation, and at 29-32 weeks gestation. Periodontal markers including bleeding on probing (BOP), pocket depth (PD ≥ 4 mm and PD ≥ 5 mm), and calcium deposits were evaluated across all visits. G-estimation and inverse probability censor weights were applied to adjust for covariates, time-varying confounders and loss-to-follow-up bias.
Results revealed substantial improvements in periodontal health among treated participants; BOP decreased by 19.05% (95% CI: -19.10 to -19.00, p < 0.0001), PD ≥ 4 mm by 9.56% (95% CI: -9.60 to -9.53, p < 0.0001), PD ≥ 5 mm by 4.15% (95% CI: -4.17 to -4.12, p < 0.0001), and calcium deposits by 8.80% (95% CI: -8.85 to -8.74, p < 0.0001). These reductions highlight the treatment's efficacy in mitigating periodontal disease progression during pregnancy.
This study’s innovative use of g-estimation strengthens the evidence base for causal relationships, providing precise insights into treatment efficacy. Clinically, the findings advocate for integrating preventive periodontal care into prenatal programs, emphasizing its potential to improve both maternal oral health and perinatal outcomes.