The relationship between periodontal disease and low birth weight, preterm delivery and preeclampsia: A narrative review of descriptive studies

Document Type : Review Article


1 Assistant Professor, Department of Prosthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Resident, Department of Oral and Maxillofacial Radiology, School of Dentistry, Isfahan (khorasgan) Branch, Islamic Azad university, Isfahan, Iran.

3 Resident, Department of Oral and Maxillofacial Radiology, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

4 Assistant professor, Department of Oral and Dental Diseases, School of Dentistry, Ardabil University of Medical Sciences, Ardabil, Iran.

5 Assistant Professor, Department of Periodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.


Introduction: Very limited studies have been performed on the relationship between periodontal disease and its effect on pregnancy outcomes; therefore, this study was performed aimed to investigate the relationship between periodontal disease and low birth weight, preterm delivery, preterm delivery with low birth weight and preeclampsia.
Methods: This review study was performed by searching for the articles published in the period 2000 to 2020 with searching for the keywords of pregnancy, outcome, adverse, low weight, birth, abortion, preterm delivery, preeclampsia and periodontal in Pubmed, Scopus, Science Direct and Cochrane and Google Scholar and Embase in English language (lack of Persian article).
Results: A total of 47 articles entered the final stage and found the relationship between periodontal disease and low birth weight, preterm delivery, preterm delivery with low birth weight and preeclampsia that can increase the risk of these complications.
Conclusion: Periodontal diseases can increase the risk of low birth weight, preterm delivery, preterm delivery with low birth weight and preeclampsia


  1. Govindasamy R, Periyasamy S, Narayanan M, Balaji VR, Dhanasekaran M, Karthikeyan B. The influence of nonsurgical periodontal therapy on the occurrence of adverse pregnancy outcomes: A systematic review of the current evidence. Journal of Indian Society of Periodontology 2020; 24(1):7.
  2. Penova-Veselinovic B, Keelan JA, Wang CA, Newnham JP, Pennell CE. Changes in inflammatory mediators in gingival crevicular fluid following periodontal disease treatment in pregnancy: relationship to adverse pregnancy outcome. Journal of reproductive immunology 2015; 112:1-0.
  3. Cota LO, Guimaraes AN, Costa JE, Lorentz TC, Costa FO. Association between maternal periodontitis and an increased risk of preeclampsia. Journal of periodontology 2006; 77(12):2063-9.
  4. Takeuchi N, Ekuni D, Irie K, Furuta M, Tomofuji T, Morita M, et al. Relationship between periodontal inflammation and fetal growth in pregnant women: a cross-sectional study. Archives of gynecology and obstetrics 2013; 287(5):951-7.
  5. Reed SG, Manz MC, Snipe SM, Ohshima M, Wagner CL. Feasibility study of a salivary occult blood test to correlate with periodontal measures as indicators of periodontal inflammation in a population of pregnant women. Journal of oral science 2015; 57(1):55-8.
  6. Stadelmann PF, Eick S, Salvi GE, Surbek D, Mohr S, Bürgin W, et al. Increased periodontal inflammation in women with preterm premature rupture of membranes. Clinical oral investigations 2015; 19(6):1537-46.
  7. Perunovic ND, Rakic MM, Nikolic LI, Jankovic SM, Aleksic ZM, Plecas DV, et al. The association between periodontal inflammation and labor triggers (elevated cytokine levels) in preterm birth: A cross‐sectional study. Journal of periodontology 2016; 87(3):248-56.
  8. Vogt M, Sallum AW, Cecatti JG, Morais SS. Factors associated with the prevalence of periodontal disease in low-risk pregnant women. Reproductive health 2012; 9(1):1-8.
  9. Laine MA. Effect of pregnancy on periodontal and dental health. Acta Odontologica Scandinavica 2002; 60(5):257-64.
  10. Bobetsis YA, Barros SP, Offenbacher S. Exploring the relationship between periodontal disease and pregnancy complications. The Journal of the American Dental Association 2006; 137:S7-13.
  11. Offenbacher S, Lin D, Strauss R, McKaig R, Irving J, Barros SP, et al. Effects of periodontal therapy during pregnancy on periodontal status, biologic parameters, and pregnancy outcomes: a pilot study. Journal of periodontology 2006; 77(12):2011-24.
  12. Armitage GC. Bi‐directional relationship between pregnancy and periodontal disease. Periodontology 2000. 2013; 61(1):160-76.
  13. Michalowicz BS, Gustafsson A, Thumbigere‐Math V, Buhlin K. The effects of periodontal treatment on pregnancy outcomes. Journal of clinical periodontology 2013; 40:S195-208.
  14. Kaur M, Geisinger ML, Geurs NC, Griffin R, Vassilopoulos PJ, Vermeulen L, et al. Effect of intensive oral hygiene regimen during pregnancy on periodontal health, cytokine levels, and pregnancy outcomes: a pilot study. Journal of periodontology 2014; 85(12):1684-92.
  15. Sanz M, Kornman K, Working Group 3 of the Joint EFP/AAP Workshop. Periodontitis and adverse pregnancy outcomes: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. Journal of periodontology 2013; 84:S164-9.
  16. Fiorini T, Susin C, Da Rocha JM, Weidlich P, Vianna P, Moreira CH, et al. Effect of nonsurgical periodontal therapy on serum and gingival crevicular fluid cytokine levels during pregnancy and postpartum. Journal of periodontal research 2013; 48(1):126-33.
  17. Xiong X, Buekens P, Vastardis S, Stella MY. Periodontal disease and pregnancy outcomes: state-of-the-science. Obstetrical & gynecological survey 2007; 62(9):605-15.
  18. Cobb CM, Kelly PJ, Williams KB, Babbar S, Angolkar M, Derman RJ. The oral microbiome and adverse pregnancy outcomes. International journal of women's health 2017; 9:551.
  19. Boggess KA, Lieff S, Murtha AP, Moss K, Beck J, Offenbacher S. Maternal periodontal disease is associated with an increased risk for preeclampsia. Obstetrics & Gynecology 2003; 101(2):227-31.
  20. Horton AL, Boggess KA, Moss KL, Beck J, Offenbacher S. Periodontal disease, oxidative stress, and risk for preeclampsia. Journal of periodontology 2010; 81(2):199-204.
  21. Shetty M, Shetty PK, Ramesh A, Thomas B, Prabhu S, Rao A. Periodontal disease in pregnancy is a risk factor for preeclampsia. Acta obstetricia et gynecologica Scandinavica 2010; 89(5):718-21.
  22. Haghdoost M, Mousavi S, Gol MK, Montazer M. Frequency of Chlamydia trachomatis infection in spontaneous abortion of infertile women during first pregnancy referred to tabriz university of medical sciences by nested PCR method in 2015. International Journal of Women's Health and Reproduction Sciences 2019; 7(4):526-30.
  23. Kessous R, Weintraub AY, Sergienko R, Lazer T, Press F, Wiznitzer A, et al. Bacteruria with group-B streptococcus: is it a risk factor for adverse pregnancy outcomes?. The Journal of Maternal-Fetal & Neonatal Medicine 2012; 25(10):1983-6.
  24. Dzowela T, Komolafe OO, Igbigbi A. Prevalence of group b Streptococcus colonization in antenatal women at the Queen Elizabeth Central Hospital, Blantyre–a preliminary study. Malawi Medical Journal 2005; 17(3):97-9.
  25. Yeo A, Smith MA, Lin D, Riché EL, Moore A, Elter J, et al. Campylobacter rectus mediates growth restriction in pregnant mice. Journal of periodontology 2005; 76(4):551-7.
  26. Oliveira AM, de Oliveira PA, Cota LO, Magalhães CS, Moreira AN, Costa FO. Periodontal therapy and risk for adverse pregnancy outcomes. Clinical oral investigations 2011; 15(5):609-15.
  27. Madianos PN, Bobetsis YA, Offenbacher S. Adverse pregnancy outcomes (APO s) and periodontal disease: pathogenic mechanisms. Journal of clinical periodontology 2013; 40:S170-80.
  28. Mendz GL. Adverse Pregnancy Outcomes Associated with Three Gram-negative Bacteria Found at Low Frequencies in Female Genital Microbiomes. Challenges in Disease and Health Research 2021; 5:113-29.
  29. Youngstein T, Hoffmann P, Gül A, Lane T, Williams R, Rowczenio DM, et al. International multi-centre study of pregnancy outcomes with interleukin-1 inhibitors. Rheumatology 2017; 56(12):2102-8.
  30. Chatterjee P, Chiasson VL, Bounds KR, Mitchell BM. Regulation of the anti-inflammatory cytokines interleukin-4 and interleukin-10 during pregnancy. Frontiers in immunology 2014; 5:253.
  31. Dashash M, Nugent J, Baker P, Tansinda D, Blinkhorn F. Interleukin-6-174 genotype, periodontal disease and adverse pregnancy outcomes: a pilot study. Journal of Clinical Immunology 2008; 28(3):237-43.
  32. Chen R, Huang X, Li B. Pregnancy outcomes and factors affecting the clinical effects of cervical cerclage when used for different indications: A retrospective study of 326 cases. Taiwanese Journal of Obstetrics and Gynecology 2020; 59(1):28-33.
  33. Han YS, Ha EH, Park HS, Kim YJ, Lee SS. Relationships between pregnancy outcomes, biochemical markers and pre-pregnancy body mass index. International Journal of Obesity 2011; 35(4):570-7.
  34. Manau C, Echeverria A, Agueda A, Guerrero A, Echeverria JJ. Periodontal disease definition may determine the association between periodontitis and pregnancy outcomes. Journal of clinical periodontology 2008; 35(5):385-97.
  35. Ercan E, Eratalay K, Deren O, Gur D, Ozyuncu O, Altun B, et al. Evaluation of periodontal pathogens in amniotic fluid and the role of periodontal disease in pre-term birth and low birth weight. Acta Odontologica Scandinavica 2013; 71(3-4):553-9.
  36. Santa Cruz I, Herrera D, Martin C, Herrero A, Sanz M. Association between periodontal status and pre‐term and/or low‐birth weight in S pain: clinical and microbiological parameters. Journal of periodontal research 2013; 48(4):443-51.
  37. Thakur RK, Yadav BK, Sultana R, Afridi SK, Das D, Sahoo SK. Influence of periodontal infection as a possible risk factor for preterm low birth weight. Journal of Pharmacy & Bioallied Sciences 2020; 12(Suppl 1):S613.
  38. Tellapragada C, Eshwara VK, Bhat P, Acharya S, Kamath A, Bhat S, et al. Risk factors for preterm birth and low birth weight among pregnant Indian women: a hospital-based prospective study. Journal of Preventive Medicine and Public Health 2016; 49(3):165.
  39. Wazir SS, Arora P, Ghosh S, Bhagat V, Khurana S, Mahanta S. Influence of maternal periodontal health as a risk factor for low-birth-weight infants in Terai population of Nepal. Journal of education and health promotion 2019; 8.
  40. Tellapragada C, Eshwara VK, Acharya S, Bhat P, Kamath A, Vishwanath S, et al. Prevalence of clinical periodontitis and putative periodontal pathogens among South Indian pregnant women. International journal of microbiology 2014; 2014.
  41. Wang YL, Liou JD, Pan WL. Association between maternal periodontal disease and preterm delivery and low birth weight. Taiwanese Journal of Obstetrics and Gynecology 2013; 52(1):71-6.
  42. Chambrone L, Guglielmetti MR, Pannuti CM, Chambrone LA. Evidence grade associating periodontitis to preterm birth and/or low birth weight: I. A systematic review of prospective cohort studies. Journal of clinical periodontology 2011; 38(9):795-808.
  43. Fogacci MF, Cardoso EOC, Barbirato DDS, de Carvalho DP, Sansone C. No association between periodontitis and preterm low birth weight: a case-control study. Arch Gynecol Obstet 2018; 297(1):71-76.
  44. Agueda A, Ramón JM, Manau C, Guerrero A, Echeverría JJ. Periodontal disease as a risk factor for adverse pregnancy outcomes: a prospective cohort study. Journal of clinical periodontology 2008; 35(1):16-22.
  45. Baskaradoss JK, Geevarghese A, Kutty VR. Maternal periodontal status and preterm delivery: a hospital based case–control study. Journal of periodontal research 2011; 46(5):542-9.
  46. George A, Dahlen HG, Blinkhorn A, Ajwani S, Bhole S, Ellis S, et al. Evaluation of a midwifery initiated oral health-dental service program to improve oral health and birth outcomes for pregnant women: A multi-centre randomised controlled trial. International journal of nursing studies 2018; 82:49-57.
  47. Leal AS, de Oliveira AE, Brito LM, Lopes FF, Rodrigues VP, Lima KF, et al. Association between chronic apical periodontitis and low-birth-weight preterm births. Journal of endodontics 2015; 41(3):353-7.
  48. Ha JE, Jun JK, Ko HJ, Paik DI, Bae KH. Association between periodontitis and preeclampsia in never‐smokers: a prospective study. Journal of clinical periodontology 2014; 41(9):869-74.
  49. Lopera Rodriguez JA, Rocha Olivera E. Preeclampsia: su asociación con infecciones periodontales y urinarias según trimestre del embarazo. CES Medicina 2016; 30(1):14-25.
  50. Boggess KA. Choosing the left fork: Steven Offenbacher and understanding maternal periodontal disease and adverse pregnancy outcomes. Journal of Periodontology 2020; 91:S40-4.