Can xylitol gum reduce preterm birth?

Chewing gum with xylitol is known to prevent tooth decay, but it could also reduce preterm births and improve birth weight, according to a study published in the American Journal of Obstetrics & Gynecology.

A group led by researchers at Baylor College of Medicine studied preterm births and birth-weight outcomes in more than 10,000 women in Melawi who received perinatal and oral health education alone or both education and daily xylitol chewing gum.

"Perinatal xylitol chewing gum use resulted in a significant [preterm birth] reduction and fewer < 2500g neonates," wrote first author Dr. Kjersti Aagaard, PhD, and colleagues (Am J Obstet Gynecol, January 2022, Vol. 226:1, supplement, p. S777).

Xylitol chewing gum has been shown to reduce dental caries, but its ability to improve periodontal health and, in turn, reduce preterm births has been unknown, according to the authors. In this study, the group hypothesized that daily xylitol gum use starting before conception and in early pregnancy could reduce periodontitis and prevent preterm births.

The researchers undertook a cluster randomized trial in Malawi, where rates of preterm births are among the highest in the world (22%). They enrolled 10,069 women from eight health centers spanning a 79-km urban-rural region in Lilongwe.

The study was conducted over six years, following participants through 28 days postpartum. Women at the centers were randomized to the intervention group (with gum) and compared to women randomized to the control group (education alone). A total of 9,670 outcomes were available at follow-up.

Perinatal xylitol chewing gum use resulted in a significant reduction in preterm births (12.6% versus 16.5%). This statistic was largely attributed to a decline in late preterm births between 34 weeks and just shy of 37 weeks (9.9% versus 13.5%), according to the authors.

In addition, chewing xylitol gum before conception and in early pregnancy led to a lower percentage of newborns weighing under 2,500 g, or roughly 5.5 lb (8.9% versus 12.9%). The authors also observed a significant reduction of periodontitis in the xylitol gum cohort among 4,220 subjects compliant with dental visits.

"To prevent a case of [preterm birth], 26 patients would need to chew daily xylitol gum at an estimated retail cost of $1,087," Aagaard and colleagues concluded.