Chewing xylitol gum prenatally may reduce preterm birth, low birth weight deliveries
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Key takeaways:
- Chewing xylitol gum was associated with fewer preterm and late preterm births.
- Women who chewed xylitol gum also experienced fewer low birth weight deliveries vs. a control group.
Chewing gum containing xylitol before conception and during pregnancy was associated with reduced preterm birth and low birth weight deliveries for women in Malawi, according to cluster-randomized trial data published in Med.
Periodontal disease during pregnancy is associated with delivery of preterm and low birth weight newborns; however, randomized trials of likely efficacious treatments, such as dental scaling and root planning, have not shown significant benefit, Gregory C. Valentine, MD, MEd, FAAP, neonatologist in the department of obstetrics and gynecology in the division of maternal-fetal medicine at the Baylor College of Medicine and the department of pediatrics in the division of neonatology at the University of Washington, and colleagues wrote in the study background.
“These findings show that a simple intervention, such as xylitol-containing chewing gum, may prevent preterm birth and low birth weight babies in Malawi and other low- and middle-income settings worldwide,” Valentine told Healio. “The most surprising finding is how simple the intervention is. Doctors and researchers have been looking for decades to find a way to prevent preterm birth, as prematurity is the leading cause of death and disability for all children under 5 years of age worldwide. Yet, the answer could be as simple as xylitol-containing chewing gum, which costs only a few cents per day.”
The researchers conducted an open-label, cluster-randomized trial with 10,069 pregnant women from eight sites in Malawi from May 2015 to October 2018. Participants received prenatal and oral health education alone (controls; n = 5,520) or usual care plus chewing gum containing xylitol twice daily (n = 4,549). All participants initiated the intervention before 20 weeks’ gestation and continued throughout delivery.
Primary outcomes were preterm birth at less than 37 weeks’ gestation and low birth weight deliveries less than 2,500 g.
Overall, more women in the xylitol group attended at least one dental visit compared with women in the control group (53.7% vs. 35.4%).
Fewer deliveries in the xylitol group were preterm (12.6% vs. 16.5%; RR = 0.76; 95% CI, 0.57-0.99; P = .049) or late preterm (9.9% vs. 13.5%; RR = 0.73; 95% CI, 0.53-0.99; P = .041) vs. the control group. Early preterm birth was observed among 2.7% of deliveries in the xylitol group and 3% in the control group, but this was not significant.
In addition, low birth weight deliveries occurred in fewer deliveries in the xylitol vs. control group (8.9% vs. 12.9%; RR = 0.7; 95% CI, 0.49-0.99; P = .044). When assessing low vs. very low birth weight (1,500 g or lower) neonates, researchers observed fewer very low birth weight deliveries in the xylitol vs. control group (0.6% vs. 0.8%).
“In this all-comers — low risk, not screened for periodontal disease — study, the number needed to treat was 26 and the cost per person for the entirety of pregnancy was about $31 USD, ranging from $23.96 to $113.86 per person for the duration of last menstrual period to 37 weeks’ gestation,” Kjersti M. Aagaard, MD, PhD, FACOG, medical director of HCA Healthcare Gulf Coast Division, lead clinician at Texas Maternal Fetal Medicine and the Maternal Fetal Care Center at Boston Children’s Hospital at Harvard Medical School, told Healio.
According to Valentine, it is important to assess whether the findings can be replicated in other settings throughout the world, including the U.S.
“We are currently looking for funding to explore this in the U.S. to see if these findings from Malawi are true in our societal context and health care infrastructure,” Valentine told Healio. “Additionally, we need to confirm the findings with an individually randomized trial design in Malawi as well as [assess] the long-term neurodevelopmental outcomes of the children born during this trial. We must make sure that the children not only survive, but thrive, living lives without increased disability.”
For more information:
Kjersti M. Aagaard, MD, PhD, FACOG, can be reached at kjersti.aagaard@hcahealthcare.com.
Gregory C. Valentine, MD, MEd, FAAP, can be reached at gcvalent@uw.edu.