Maternal Periodontal Disease and Adverse Pregnancy Outcomes

Periodontal disease, a chronic inflammatory condition of the gums and supporting tissues, has emerged as a significant contributor to obstetric complications worldwide. Epidemiological evidence links maternal periodontitis with increased risks of preterm birth, low birth weight and pre-eclampsia, suggesting that oral pathogens and inflammatory mediators may reach the placenta and foetal unit via the bloodstream. Mechanistic studies indicate that translocated bacteria and their by-products provoke local vascular pathology, trigger pro-inflammatory cytokine cascades and alter placental immune homeostasis. Despite heterogeneity in study designs and treatment protocols, there is consensus that maintaining periodontal health before and during pregnancy offers a practical avenue for reducing adverse outcomes. Integrating dental care into prenatal services and advancing targeted interventions, including host-modulation therapies and microbiome restoration, hold promise for improving maternal and neonatal health on a global scale.

Research from Nature Portfolio

Recent advances have harnessed machine-learning algorithms to exploit profiles of the prenatal oral microbiome for early prediction of preterm birth. A random forest classifier trained on mouthwash-derived 16S rRNA data achieved balanced accuracies above 75 %, demonstrating the potential of oral microbial signatures as non-invasive biomarkers. Complementing this, a systematic review and meta-analysis of oral microflora during pregnancy revealed that while overall microbial diversity remains stable, specific taxa such as Porphyromonas gingivalis are enriched in women who deliver preterm. The study also showed that routine prenatal dental care reduces carriage of key pathogens, underscoring the dual role of the oral microbiome in risk stratification and modifiable clinical intervention.

Maternal Periodontal Disease and Adverse Pregnancy Outcomes publication trend

The graph below shows the total number of articles in maternal periodontal disease and adverse pregnancy outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Periodontal disease: Chronic infection of the gums and tooth-supporting structures marked by inflammation and tissue destruction.

Preterm birth: Delivery occurring before 37 completed weeks of gestation.

Pre-eclampsia: A multisystem hypertensive disorder of pregnancy, characterised by high blood pressure and organ dysfunction after 20 weeks’ gestation.

Placental microbiome: The community of microorganisms residing within placental tissues.

Toll-like receptor (TLR): A class of innate immune receptors that detect conserved microbial molecules and initiate inflammatory signalling.

Random forest classifier: An ensemble machine-learning algorithm that builds multiple decision trees to improve predictive accuracy.

References

1. Relationship between periodontal disease and preterm low birth weight: systematic review. Pan African Medical Journal (2016).
2. Periodontal Treatment for Preventing Adverse Pregnancy Outcomes: A Meta- and Trial Sequential Analysis. PLOS ONE (2015).
3. Mechanisms Involved in the Association between Periodontitis and Complications in Pregnancy. Frontiers in Public Health (2015).
4. Relationship between Periodontitis and Pre-Eclampsia: A Meta-Analysis. PLOS ONE (2013).
5. Predicting preterm birth using machine learning techniques in oral microbiome. Scientific Reports (2023).
6. Oral microflora and pregnancy: a systematic review and meta-analysis. Scientific Reports (2021).
7. Placental TLR recognition of salivary and subgingival microbiota is associated with pregnancy complications. Microbiome (2024).
8. The bidirectional relationship between periodontal disease and pregnancy via the interaction of oral microorganisms, hormone and immune response. Frontiers in Microbiology (2023).
9. Nisin, a Probiotic Bacteriocin, Modulates the Inflammatory and Microbiome Changes in Female Reproductive Organs Mediated by Polymicrobial Periodontal Infection. Microorganisms (2024).