In the last few decades more has been learned about the impact of oral health on the entire human biological system. And more is being done to reduce factors that lead to an estimated 15 million babiesborn prematurely or preterm (defined as delivery before the 37th week of pregnancy) each year. Preterm babies are at greater risk of experiencing serious health problems.

Due to correlation between preterm births and poor oral care, researchers have looked at various ways to improve dental health during pregnancy, including “deep-teeth cleaning” like scaling and planing to remove plaque and tarter on the teeth and below the gum line, but that hasn't seemed to be very effective.

Results presented at the Society for Maternal-Fetal Medicine’s annual meeting offered hope for the country with the highest number of preterm births in the world: Malawi.

Malwai, in south-central Africa, is poor and most Malawians live in rural locations, which makes extensive dental care a challenge. A novel study found it may not be needed to reduce preterm births. The cluster randomized trial enrolled participants from eight health centers over 10 years and included 10,069 women. Participants enrolled voluntarily and consented to participation before they became pregnant or within 20 weeks of becoming pregnant. All of the eight health centers provided health care messages promoting oral health care and preterm birth prevention and care, but half of the eight centers were randomized to also provide xylitol chewing gum to the enrolled research participants. Xylitol is a naturally occurring alcohol found in fruits and vegetables and is commonly used as a sugar substitute in chewing gum. 

All participants received perinatal and oral health education, including things they could do to help lower the chance of delivering a baby prematurely. In the four centers not in the control group, 4,549 enrolled participants also received the xylitol chewing gum and instructed to chew the gum for 10 minutes, ideally twice a day, throughout pregnancy.

Out of the 9,670 participants who were available for contact during the <six years of follow-up, results showed a significant reduction in preterm birth among those who chewed the xylitol containing gum (12.6 percent vs. 16.5 percent) and fewer low birth weight babies, those weighing 5.5 pounds or less (8.9 percent vs. 12.9 percent). Participants also saw an improvement in their oral health.

“Using xylitol chewing gum as an intervention prior to 20 weeks of pregnancy reduced preterm births, and specifically late preterm births between 34 to 37 weeks,” says the study’s lead author Kjersti Aagaard, MD, PhD, a Professor in Maternal-Fetal Medicine and Vice Chair of Obstetrics&Gynecology at Texas Children’s and Baylor College of Medicine in Houston. “When we analyzed by birth weight, instead of estimated gestational age at delivery, we similarly showed a significant improvement in the birth weight with one-third fewer low birth weight babies being born.

"What’s unique about our study is that we used a readily available, inexpensive, and palatable means to reduce the risk of a baby being born too soon or too small. There is some real science behind the choice of xylitol chewing gum to improve oral health, and our novel application to improving birth outcomes is exciting. This has been a labor of love with our colleagues in Malawi, and we were honored to work side-by-side to demonstrate that xylitol chewing gum in early or pre-pregnancy improved oral health by reducing periodontal disease in pregnancy, which was strongly associated with our observed reduction of preterm and low birthweight birth in Malawi. This fits with longstanding evidence linking oral health with preterm births.”

The next step, they say, is to conduct studies in other parts of the world, including in the U.S., to determine whether this invention will be effective in settings where there may be a lower burden of preterm birth tied to oral health.