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SEATTLE — Chewing gum with xylitol appears to lower the risk of preterm birth, a new study reveals. The findings help provide an affordable and simple measure for improving oral health care and preventing pregnancy complications.
Preterm birth is the number one cause of death for children under five years. It is a serious problem, especially in countries like Malawi, where 20% of all births are preterm. The research results are published in the journal Med.
“It surprised us all that such a simple intervention could have such a dramatic effect,” says Greg Valentine, an associate professor of pediatrics at the University of Washington School of Medicine, in a media release.
Xylitol is a sugar alcohol sweetener often added to gum, lozenges, and candies. It helps reduce harmful bacteria in the mouth and promotes oral health by lowering the risk of gum disease. According to the researchers, gum disease is linked to a two to three-fold higher risk for preterm birth and low birthweight delivery.
While the exact trigger explaining how periodontal disease affects preterm birth weight is unclear, one theory is that it is inflammation sparked by gum disease. Another idea is that bacteria from the mouth travel through the bloodstream to other bodily organs. One millimeter of dental plaque has 100 million microbes, including harmful bacteria.
Past research on xylitol shows it helps stop the growth of bacteria often found in gum disease. Additionally, the ingredient is effective in dampening inflammation in gum tissues.
The Prevention of Prematurity and Xylitol trial enrolled people before they got pregnant and in early pregnancy, which was defined as being 20 weeks or less. From May 2015 to October 2018, the researchers followed the pregnancy journeys of more than 10,000 women living in Malawi. A total of 4,549 people were randomly assigned to chew xylitol gum, while 5,520 women served as the control group receiving medication and traditional counseling.
In Malawi, a country with one of the highest rates of preterm birth worldwide, results showed that chewing xylitol gum led to a 24% decrease in preterm birth and a 30% drop in low-birthweight babies compared to pregnant women who did not chew gum.
“Basically, we know that periodontal disease is associated with preterm birth,” says Valentine. “This is particularly significant in Malawi, since about 70% of the pregnant individuals suffer from gum disease.”
People in Malwai often lack the resources to help prevent gum disease, such as deep cleaning to remove plaque from under the gum tissue and access to toothbrushes and toothpaste. There’s also a constant shortage of supplies, healthcare workers, and clean running water. According to the researchers, chewing gum would be an easy and cheap option to improve oral health in Malwai and other low-income countries.
The authors are also leading another trial in Malawi that follows 1,000 children born during this trial to study their neurodevelopmental state between the ages of four and eight. Results from that trial will be ready by 2027. Additionally, another study will examine xylitol gum interventions among pregnant women living in low-income communities in Seattle.
Paper Summary
Methodology
This study aimed to reduce preterm and low-birthweight births using xylitol gum among pregnant women in Malawi. Researchers conducted a cluster-randomized trial involving 10,069 pregnant women from eight health centers. The centers were split into two groups: one received standard prenatal care with oral health messages, while the other added xylitol gum. Women in the xylitol group chewed gum twice daily starting early in pregnancy. The researchers compared outcomes using statistical models to account for variations between the groups and locations.
Key Results
The study found that chewing xylitol gum during pregnancy helped reduce the chances of having a baby too early or with a low birth weight. Women in the gum group saw about a 24% drop in premature births and a 30% reduction in very low-birthweight babies compared to those who only got oral health advice. This means that for every 26 women using the gum, one preterm birth was prevented. Additionally, fewer babies in the gum group died shortly after birth. Importantly, the gum didn’t cause any harmful side effects.
Study Limitations
Only about a third of women in the xylitol group fully followed the gum-chewing schedule. Since participants knew their group, it might have influenced their behavior (Hawthorne effect). Fewer health centers in the study might have affected the confidence in the results. Findings may not apply to areas with better oral health or lower rates of preterm birth. Only 10% of participants completed two recommended dental check-ups.
Discussion & Takeaways
This study highlights the potential of xylitol gum as a low-cost, accessible way to improve pregnancy outcomes in resource-limited settings. By reducing preterm births and low-birthweight deliveries, xylitol gum could lower infant deaths and healthcare costs. However, further research in other populations and under stricter conditions is needed to confirm the results.
Key takeaway: A simple habit, like chewing xylitol gum, may offer big benefits for maternal and infant health, especially in areas where dental care is hard to access.
Funding & Disclosures
The study was funded by the E.W. Al Thrasher Foundation and USAID Saving Lives at Birth Grand Challenges Grant, with additional support from Texas Children’s Hospital and the Baylor Foundation Malawi. The authors declared no conflicts of interest, ensuring unbiased research findings.
