摘要：Objectives. We examined whether periodontal treatment or other dental care is associated with adverse birth outcomes within a medical and dental insurance database. Methods. In a retrospective cohort study, we examined the records of 23 441 women enrolled in a national insurance plan who delivered live births from singleton pregnancies in the United States between January 1, 2003, and September 30, 2006, for adverse birth outcomes on the basis of dental treatment received. We compared rates of low birthweight and preterm birth among 5 groups, specifying the relative timing and type of dental treatment received. We used logistic regression analysis to compare outcome rates across treatment groups while adjusting for duration of continuous dental coverage, maternal age, pregnancy complications, neighborhood-level income, and race/ethnicity. Results. Analyses showed that women who received preventive dental care had better birth outcomes than did those who received no treatment ( P < .001). We observed no evidence of increased odds of adverse birth outcomes from dental or periodontal treatment. Conclusions. For women with medical and dental insurance, preventive care is associated with a lower incidence of adverse birth outcomes. Preterm birth and low birthweight in the United States lead to significant infant morbidity and mortality. A preterm, or premature, birth has a gestational age of less than 37 weeks at delivery. Low birthweight is defined as birthweight less than 2500 grams. Approximately 12.5% of women in the United States deliver their babies prematurely, and those who deliver before reaching a gestation period of 32 weeks comprise 1% to 2% of all births. 1 During the neonatal period, low birthweight babies are less likely to survive compared to normal birthweight babies, and those who do survive are at an increased risk of developing respiratory, behavioral, and neurodevelopmental problems. 2 The Institute of Medicine of the National Academies estimates that premature births cost society at least $26 billion annually in the US. 3 Several studies have examined the effect of periodontal treatment on preterm birth and low birthweight outcomes. 4 In 2 randomized controlled trials, Lopez et al. determined that periodontal therapy provided during pregnancy to women with periodontitis or gingivitis reduced the incidence of preterm low birthweight. 5 , 6 A study conducted in India reported that pregnant women who received plaque control instructions and scaling and root planing experienced significantly reduced rates of preterm births and low birthweight infants. 7 In addition, case control, cross-sectional, and longitudinal studies relating periodontal disease and preterm low birthweight have shown that there is an association between the 2 conditions. 4 , 8 – 10 A 2007 meta-analysis confirmed an association between periodontal disease and preterm low birthweight but cautioned that additional studies must be conducted in order to more accurately identify the mechanisms for the association. 8 Conversely, several studies have failed to detect an association between periodontal disease and adverse birth outcomes. 11 – 17 Jeffcoat et al. reported a reduced, albeit not statistically significant, risk of premature birth in women with periodontal disease who received scaling and root planing or dental prophylaxis treatment. 11 Mitchell-Lewis et al. reported a nonsignificant reduction in preterm low birthweight outcomes in women who received basic periodontal therapy during pregnancy. 12 Michalowicz et al. conducted a multicenter trial of 823 women randomized to receive scaling and root planing either before 21 weeks of gestation or after delivery. 16 Periodontitis treatment during pregnancy did not significantly affect rates of preterm birth or low birthweight. Offenbacher et al. conducted a multicenter randomized trial of 1806 women randomized to receive scaling and root planing early in the second trimester or after delivery. 17 In their study, periodontal treatment did not reduce the incidence of preterm delivery. A retrospective examination of health insurance data for women with concomitant medical and dental coverage can contribute to the study of the association between oral conditions and outcomes; however, comprehensive examinations of dental insurance data have rarely included combined medical and dental databases. 18 Certain specific features of health insurance claims data, such as representativeness and generalizability, make the data an important source of information for health services research. 19 Insurance claims data provide information on dental treatment, medical treatment procedures, and medical diagnoses and have been reported to be more closely associated with actual medical record documentation than has self-reported health information garnered from patient surveys. 20 – 22 We examined dental and medical claims data from the Aetna Data Warehouse to determine the association between periodontal treatment, dental prophylaxis, and other dental treatment and 2 adverse birth outcomes: preterm birth and low birthweight. We hypothesized that (1) women receiving preventive care (prophylaxis treatment) during the period of observation would experience improved birth outcomes compared with those receiving no dental treatment and (2) periodontal treatment provided before delivery would be associated with a lower incidence of adverse pregnancy outcomes.
