Chewing a sugar-free gum daily reduced preterm births in a large study in Malawi. The oral intervention was inspired by past research linking poor oral health and preterm birth. The gum contains xylitol — a chemical that can boost oral health — in place of regular sugar.
Among women who chewed the xylitol gum, 549 out of 4,349 pregnancies, or 12.6 percent, were preterm, researchers reported February 3 at the Society for Maternal-Fetal Medicine’s Annual Pregnancy Meeting. That’s a 24 percent reduction compared with the group who didn’t receive the gum. Among those women, 878 out of 5,321 pregnancies, or 16.5 percent, of the babies were born before 37 weeks.
The oral health of gum users also improved. About 4,000 of the women had an initial dental exam and a later checkup. The women who chewed the gum had less periodontal disease, a condition in which the tissue surrounding the teeth becomes infected and inflamed, compared with those who didn’t get the chewing gum.
“The findings are very encouraging,” says Kim Boggess, a maternal-fetal medicine specialist at the University of North Carolina School of Medicine in Chapel Hill who was not involved with the study. The researchers “are approaching a very complex problem in a low-resource area by trying to use a low-tech, easily applicable intervention.” It would take more research to see if this could work in other settings, she says.
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For the new study, researchers enrolled around 10,000 women across eight health centers in the greater Lilongwe area of Malawi before they were pregnant or in early pregnancy. All of the women received tailored information on pregnancy, preventing preterm birth and improving oral health from community health workers. Roughly half of the women also received the gum.
The study was part of a decade-long project in the region surrounding Lilongwe, which has a preterm birth rate estimated at 19.3 percent, one of the highest globally. First, the research team talked with community members to learn what problems related to pregnancy the community was concerned about and wanted to solve.
In the Chichewa language spoken in Malawi, preterm birth is kuchila masika asankwane, which means “born too soon.” In focus groups conducted early in the project, “all participants knew of many women who had suffered ‘born too soon,’” says team member Kjersti Aagaard, a maternal-fetal medicine specialist at the Baylor College of Medicine and Texas Children’s Hospital in Houston. Babies born prematurely can have complications that impair their lungs, neurodevelopment and more, with long-term health risks, and they are more likely to die in their first year of life than babies born to term.
Along with learning about the community’s perceptions of preterm birth, researchers also assessed the rate of cavities and gum disease among pregnant and postpartum women, which was in the 70 percent range. And they asked the community if chewing xylitol gum was “something that would be palatable — both truly palatable as well as acceptable,” Aagaard says.
Studies finding a link between periodontal disease and preterm birth go back a couple of decades. The inflammatory disease has also been associated with atherosclerosis and other ailments (SN: 4/6/16). The diversity and size of the microbial community in the mouth is second only to the gut. With periodontal disease, there is a shift in the composition of that oral microbial community, giving way to bacteria that cause inflammation and damage gum tissue. From there, the bacteria may enter the bloodstream to reach other organs, perhaps including the placenta.
Chewing xylitol gum appears to be a check on that shift in the oral microbial community. Previous studies have shown that chewing xylitol gum leads to fewer cavities and suggest it can reduce inflammation. Aagaard and her colleagues are planning more research on what’s going on at the microbial level to understand how better oral health reduces preterm birth.
The team also wants to track the neurodevelopment of the children born early and those born on time in the study. “No matter how cost-effective an intervention may be, we still want to make sure you’re making a difference in somebody’s life,” Aagaard says, “and the ultimate outcome is how do those kiddos do.”