XYLITOL-containing chewing gum use during pregnancy significantly reduced the occurrence of preterm births and low-birthweight deliveries in a large randomised trial conducted in Malawi, a high-prevalence setting for adverse neonatal outcomes. This intervention demonstrated both efficacy and affordability, suggesting its potential utility in low-resource settings.
This cluster-randomised controlled trial involved 10,069 pregnant participants across eight health centres in and around Lilongwe, Malawi. Centres were paired based on delivery volumes and randomised to either an intervention group using xylitol gum twice daily from early pregnancy alongside standard prenatal care or an active control group receiving education and routine care. The primary outcomes assessed were the rates of preterm births (<37 weeks gestation) and low-birthweight deliveries (<2,500 g). Data from over 95% of participants were included in the analyses.
Among the intervention group, preterm births occurred in 12.6% of cases compared with 16.5% in the control group, yielding a relative risk (RR) of 0.76 (95% confidence interval [CI]: 0.57–0.99). Low-birthweight deliveries were also significantly lower in the xylitol gum group at 8.9% versus 12.9% in controls (RR 0.70, 95% CI: 0.49–0.99). Neonatal deaths were reduced in the intervention group (0.2% vs. 0.4%; RR 0.41, 95% CI: 0.19–0.89), with no significant adverse effects reported.
These findings highlight xylitol chewing gum as a simple, low-cost intervention that could address significant maternal and neonatal health challenges in resource-limited settings. The reduction in preterm and low-birthweight deliveries, coupled with fewer neonatal demises, underscores its potential to improve outcomes where traditional periodontal disease treatments have shown limited efficacy. Future clinical practice could consider incorporating xylitol gum into prenatal care protocols, particularly in regions with high rates of adverse neonatal outcomes. Further studies may explore the mechanisms and broader applicability of this intervention across diverse populations.
Reference
Valentine GC et al. A cluster randomized trial of xylitol chewing gum for prevention of preterm birth: The PPaX trial. Med. 2024; DOI:10.1016/j.medj.2024.10.016.
