References (Periodontal Disease and Pregnancy: Implications for Maternal and Fetal Health)

Choudhury, P. et al. Periodontal Disease and Pregnancy Outcome: A Correlative Study. Int. J. Dent. Res. Dev. 7, 45–52 (2017).
Poor gingival health during pregnancy is associated with adverse outcomes, including preterm birth and low birth weight. Significant differences in gingival index and birth weight were observed between affected and healthy mothers, highlighting the impact of periodontal inflammation on pregnancy outcomes.

Marcuschamer, E., Hawley, C. E., Speckman, I., María, R., Romero, D., Nart, J. et al. A lifetime of normal hormonal events and their impact on periodontal health. Número 23, 12–25 (2009).
Hormonal fluctuations across a woman’s life—puberty, menstruation, pregnancy, and menopause—affect periodontal tissues, gingival immune responses, and inflammation, usually in transient and self-limiting ways, but occasionally warrant clinical attention.

ÅŞen, S. C., Saygun, N. I., Koca, A. O., Özcan, E. Evaluation of the periodontal status of a patient diagnosed with Sheehan syndrome: A case report. Int. Dent. Res. 11, Suppl. 1, 308–311 (2021).
Hormonal deficiencies in Sheehan syndrome lead to bone loss and compromised periodontal health. This case highlights how systemic hormonal disorders can exacerbate alveolar bone resorption, gingival bleeding, and tooth mobility.

Sha, Y. q., Huang, Z., Chen, Z. b., Kang, J., He, L., Yu, X. q. Association between periodontitis and preterm low birth weight. Beijing da xue xue bao. Yi xue ban 41, 1–9 (2009).
Periodontitis is a risk factor for preterm low birth weight (PLBW), potentially through bacteremia or systemic inflammation. Oral hygiene and periodontal treatment may reduce this risk.

NCT02315222. Dietary Supplements and Periodontal Wound Healing. https://clinicaltrials.gov/show/NCT02315222 (2014).
Dietary supplements containing antioxidants, vitamins, and coenzyme Q10 may improve periodontal healing and reduce systemic inflammation in patients receiving non-surgical periodontal therapy.

Lassi, Z. S., Imam, A. M., Dean, S. V., Bhutta, Z. A. Preconception care: Preventing and treating infections. Reprod. Health 11, S3–S4 (2014).
Screening and treatment of infections—including periodontal disease—before pregnancy reduce adverse maternal and neonatal outcomes.

Murali, R., Ramamurthy, J. Evaluation of the relationship between maternal periodontitis and preterm low birth weight infants: A case control study. Indian J. Public Health Res. Dev. 10, 11–17 (2019).
Maternal periodontitis is associated with preterm labor and low birth weight. Clinical parameters including plaque index, bleeding index, probing depth, and attachment loss correlate with pregnancy outcomes.

Jain, M. N., Suragimath, G., Varma, S. A., Zope, S. A., R, A. S. A retrospective study to assess and correlate maternal periodontal status with term of pregnancy and weight of newborn. Int. J. Reprod. Contracept. Obstet. Gynecol. 6, 3456–3462 (2017).
Periodontal disease in pregnant women is significantly associated with preterm low birth weight infants. Early detection and treatment of periodontitis may improve pregnancy outcomes.

Andonova, I., Iliev, V., Živković, N., Sušić, E., Bego, I., Kotevska, V. Can oral anaerobic bacteria cause adverse pregnancy outcomes? Prilozi 36, 1–10 (2015).
Higher levels of Porphyromonas gingivalis, Fusobacterium nucleatum, and Actinomyces actinomycetemcomitans in pregnant women are associated with preterm birth, suggesting a role of periodontal pathogens in adverse pregnancy outcomes.

Govindaraju, P., Venugopal, S., Shivakumar, M., Sethuraman, S., Ramaiah, S., Mukundan, S. Maternal periodontal disease and preterm birth: A case-control study. J. Indian Soc. Periodontol. 19, 5–12 (2015).
Maternal periodontitis correlates with shortened gestational age and low birth weight. Poor periodontal status may be an independent risk factor for preterm birth.

Tanneeru, S., Taraka, N., Rao, R., Mahendra, J., Mahendra, L. Red Complex Bacteria in Preeclamptic Pregnant Women with and without Periodontal Disease: A Cross Sectional Microbiological Study. Res. J. Pharm. Biol. Chem. Sci. (2020).
Presence of red complex bacteria (Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola) is elevated in preeclamptic pregnant women, highlighting a potential link between periodontal pathogens and pregnancy complications.

Heimonen, A., Rintamaki, H., Furuholm, J., Janket, S. J., Kaaja, R., Meurman, J. H. Postpartum oral health parameters in women with preterm birth. Acta Odontol. Scand. 66, 345–352 (2008).
No significant differences in periodontal health were observed between preterm and full-term mothers in this cohort, suggesting established systemic risk factors are more predictive than oral health alone.

Mannem, Satheesh & Chava, VijayK. The relationship between maternal periodontitis and preterm low birth weight: A case-control study. Contemp. Clin. Dent. 2, 104–52 (2011).
Maternal periodontitis was significantly associated with preterm delivery and low birth weight. Plaque index, bleeding index, probing depth, and clinical attachment loss were higher in cases than controls, suggesting periodontal disease as a risk factor for preterm labor.

Mayer, Y., Levin, L., Oettinger-Barak, O., & Machtei, E. Pregnancy and periodontal disease—Is there a relation? Refuat Hapeh Vehashinayim 25, 1–? (2008).
Review indicates that periodontal disease may influence pregnancy complications such as low birth weight, preterm delivery, and preeclampsia. Emphasizes the need for careful periodontal diagnosis and treatment before and during pregnancy.

Caracho, Rafaela Aparecida, Foratori-Junior, Gerson Aparecido, Fusco, Nathalia dos Santos, Jesuino, Bruno Gualtieri, Missio, Alana Luiza Trenhago, & Sales-Peres, Silvia Helena de Carvalho. Systemic conditions and oral health-related quality of life of pregnant women of normal weight and who are overweight. Int. Dent. J. 70, 4 (2020).
Overweight pregnant women had higher prevalence of periodontitis, arterial hypertension, and poorer oral health-related quality of life compared to normal-weight women, highlighting the systemic impact of periodontal disease.

Moss, Kevin L., Serlo, Adam D., Offenbacher, Steven, Beck, James D., Mauriello, Sally M., & White, Raymond P. The oral and systemic impact of third molar periodontal pathology. J. Oral Maxillofac. Surg. 65, 9 (2007).
Visible third molars were associated with higher prevalence of moderate/severe periodontal disease, increased mean probing depths, and elevated risk of preterm birth or high serum CRP postpartum, indicating systemic implications of localized oral pathology.

Andonova, Irena, Iliev, Vasil, & Živković, Nikica. Periodontal disease and risk for pre-term birth: A case-control study. Serb. J. Exp. Clin. Res. 16, 1 (2015).
Chronic periodontitis was significantly associated with preterm delivery. Risk of preterm birth increased in women with attachment loss ≥4 mm. Suggests periodontal prevention and therapy as part of prenatal care.

Alchalabi, H. A., Habashneh, R. Al, Jabali, O. Al, & Khader, Y. S. Association between periodontal disease and adverse pregnancy outcomes in a cohort of pregnant women in Jordan. Clin. Exp. Obstet. Gynecol. 40, 3 (2013).
Periodontal disease was linked to increased risk of preeclampsia, preterm birth, and low birth weight in healthy Jordanian women.

Mookhtiar, Hussain, Ahmed, Osama, Shaikh, Romaan, Syed, Eemaan, Fatema, Farooqui Mehvish, & Shaikh, Imadoddin. Investigating the understanding and attitudes of medical practitioners towards the interlink between periodontitis and systemic diseases: A cross-sectional questionnaire survey. J. Dent. Specialties 11, 2 (2023).
Medical specialists’ awareness of periodontal disease and its systemic impact varies; referral rates are suboptimal. Emphasizes need for improved education on periodontal-systemic links.

Farrell, S., Ide, M., & Wilson, R. F. The relationship between maternal periodontitis, adverse pregnancy outcome and miscarriage in never smokers. J. Clin. Periodontol. 33, 2 (2006).
Some measures of periodontal disease were associated with late miscarriage, but no association with preterm birth or low birth weight was observed.

Belibasakis, Georgios N., Bostanci, Nagihan, Marsh, Philip D., & Zaura, Egija. Applications of the oral microbiome in personalized dentistry. Arch. Oral Biol. 104 (2019).
The oral microbiome, including Porphyromonas gingivalis and Fusobacterium nucleatum, plays a key role in periodontal disease and systemic health, supporting personalized preventive and therapeutic approaches.

Cetin, I., Pileri, P., Villa, A., Calabrese, S., Ottolenghi, L., & Abati, S. Pathogenic mechanisms linking periodontal diseases with adverse pregnancy outcomes. Reprod. Sci. 19, 6 (2012).
Periodontal pathogens can disseminate to the placenta, triggering inflammatory responses that may lead to preterm labor or low birth weight. Mechanistic evidence links periodontal disease with adverse pregnancy outcomes.

Vogt, Marianna, Sallum, Antonio W., Cecatti, José G., & Morais, Sirlei S. Factors associated with the prevalence of periodontal disease in low-risk pregnant women. Reprod. Health 9, 1 (2012).
High prevalence of periodontal disease in low-risk Brazilian pregnant women is linked to gingival bleeding, advanced gestational age, and obesity, supporting early oral health interventions in prenatal care.

Yoshida, Sumiko, Hatasa, Masahiro, Ohsugi, Yujin, et al. Porphyromonas gingivalis administration induces gestational obesity, alters gene expression in the liver and brown adipose tissue in pregnant mice, and causes underweight in fetuses. Front. Cell. Infect. Microbiol. 11 (2022).
Administration of P. gingivalis altered maternal metabolism, liver function, and fetal growth in mice, highlighting systemic effects of periodontopathic bacteria during pregnancy.

Tefiku, Urim, Popovska, Mirjana, Cana, Amella, et al. Determination of the role of Fusobacterium nucleatum in the pathogenesis in and out the mouth. Prilozi (Maked. Akad. Nauk. Umet.) 41, 1 (2020).
F. nucleatum is a key pathogen in periodontal disease and is associated with systemic conditions including pathological pregnancy, preeclampsia, and colorectal cancer.

Oliveira, Luisa Jardim Corrêa de, Cademartori, Mariana Gonzalez, Sfreddo, Camila Silveira, et al. Factors associated with periodontal diseases in pregnancy: Findings of the 2015 Pelotas Birth Cohort Study. Braz. Oral Res. 37 (2023).
Periodontal disease and gingivitis in pregnant women were associated with low education, calculus, smoking, and poor oral hygiene.

Horton, Amanda L., Boggess, Kim A., Moss, Kevin L., et al. Periodontal disease early in pregnancy is associated with maternal systemic inflammation among African American women. J. Periodontol. 79, 7 (2008).
Moderate/severe periodontal disease was linked to elevated CRP levels in African American women, suggesting systemic inflammatory responses.

Wijaksana, I. Komang Evan & Megasari, Ni Luh Ayu. Knowledge and practice on periodontal health among women residing in rural area of Bali Province, Indonesia. World J. Adv. Res. Rev. 20, 3 (2023).
Periodontal disease awareness and oral hygiene practices are low among rural women, highlighting the need for targeted education to prevent adverse pregnancy outcomes.

Oliveira, Luisa Jardim Corrêa de, Cademartori, Mariana Gonzalez, Sfreddo, Camila Silveira, et al. Factors associated with periodontal diseases in pregnancy: Findings of the 2015 Pelotas Birth Cohort Study. Braz. Oral Res. 37 (2023).
Periodontal disease and gingivitis in pregnant women were significantly associated with low education, dental calculus, smoking, and poor oral hygiene. The study emphasizes the importance of preventive oral care and education during pregnancy to reduce systemic complications.

Ruma, Michael, Boggess, Kim, Moss, Kevin, Jared, Heather, Murtha, Amy, Beck, James, Offenbacher, Steven. Maternal periodontal disease, systemic inflammation, and risk for preeclampsia. Am. J. Obstet. Gynecol. 198, 4 (2008).
Maternal periodontal disease combined with elevated C-reactive protein (CRP) levels increases the risk of preeclampsia. Women with periodontal disease and systemic inflammation exhibited a significantly higher adjusted risk (RR 5.8), highlighting the role of oral infection in triggering systemic inflammatory pathways during pregnancy.

Seymour, Robin A. Does periodontal treatment improve general health? Dent. Update 37, 4 (2010).
Periodontal therapy can extend benefits beyond oral health, including improved glycemic control in diabetics, reduced systemic inflammation, and potential reduction of adverse pregnancy outcomes. The article underscores the systemic relevance of maintaining periodontal health.

Ganganna, Aruna, Devishree, G. Opinion of dentists and gynecologists on the link between oral health and preterm low birth weight: 'Preconception care - Treat beyond the box'. J. Indian Soc. Pedod. Prev. Dent. 35, 1 (2017).
The study revealed that dentists are more aware than gynecologists about the impact of periodontal disease on preterm low birth weight (PTLB). Only a small proportion of gynecologists referred women to dentists preconception, indicating a gap in integrated care that could prevent adverse pregnancy outcomes.

Penmetsa, Gautami S., Meghana, K., Bhavana, P., Venkatalakshmi, M., Bypalli, Vivek, Lakshmi, B. Awareness, attitude and knowledge regarding oral health among pregnant women: A comparative study. Niger. Med. J. 59, 6 (2018).
Awareness of the link between periodontal disease and adverse pregnancy outcomes was low among pregnant women, irrespective of dental visits. The study highlights the need for targeted educational programs to improve oral hygiene and knowledge during pregnancy.

Seraphim, Ana Paula Castilho Garcia, Chiba, Fernando Yamamoto, Pereira, Renato Felipe, Mattera, Maria Sara de Lima Coutinho, Moimaz, Suzely Adas Saliba, Sumida, Doris Hissako. Relationship among periodontal disease, insulin resistance, salivary cortisol, and stress levels during pregnancy. Braz. Dent. J. 27, 2 (2016).
Pregnant women with periodontitis had higher blood glucose, insulin resistance, and perceived stress levels compared to those with healthy gums. This study highlights how periodontal disease can exacerbate systemic metabolic stress during pregnancy, underlining its broader health implications.

Adimora, Ethel Ebere, Somtoochukwu, Ochiagha Clara, Frederica, Obodoechi Ijeoma. Relationship between nutritional status and periodontal disease among pregnant women attending Abakpa Nike Health Center, Enugu, Nigeria. J. Clin. Images Med. Case Rep. 3, 4 (2022).
Poor nutritional status and unhealthy body weight were associated with higher prevalence of periodontal disease, especially gingivitis, during pregnancy. The study emphasizes the interplay between systemic health, nutrition, and oral inflammatory conditions.

Seymour, R. A. Is gum disease killing your patient? Br. Dent. J. 206, 10 (2009).
Periodontal disease increases systemic risks, including adverse pregnancy outcomes, diabetes, and coronary heart disease. Controlling periodontal inflammation can improve overall health and reduce systemic complications.

Ahmed, Nashida, Haque, Munwar Ul, Humayun, Arsalan, Soomro, Tahmina, Mallah, Manthar Ali, Aslam, Reema. Epidemiology of maternal periodontal disease and preterm birth among patients attending selected hospitals in Dhaka City. Pak. J. Med. Health Sci. 17, 2 (2023).
Periodontal disease severity correlated with higher risk of preterm birth. Regular dental visits and early management of periodontal infections were identified as protective measures, highlighting the importance of oral care in prenatal programs.

Amran, Abdullah G., Alhajj, Mohammed Nasser, Ariffin, Zaihan, Al-Sosowa, Abeer A., Abdulghani, Ehab A., Sallam, Nadhem M., Almekhlafi, Osamah M. Risk factors associated with periodontal diseases among Yemeni adult patients. Cumhuriyet Dent. J. 25, 1 (2022).
Age, smoking, and oral hygiene practices were significant determinants of periodontal disease. The study stresses patient education and preventive interventions to reduce systemic and reproductive health risks.

Chen, Piaopiao, Hong, Feiruo, Yu, Xuefen. Prevalence of periodontal disease in pregnancy: A systematic review and meta-analysis. J. Dent. 125 (2022).
Periodontal disease affects approximately 40% of pregnant women. Prevalence of bleeding on probing (BOP), probing depth (PD ≥4 mm), and clinical attachment loss (CAL ≥4 mm) were highest in the second trimester, emphasizing the need for early screening and preventive care.

Gümüş, Pinar, Emingil, Gülnur, Öztürk, Veli Özgen, Belibasakis, Georgios N., Bostanci, Nagihan. Oxidative stress markers in saliva and periodontal disease status: Modulation during pregnancy and postpartum. BMC Infect. Dis. 15, 1 (2015).
Pregnancy alters the oxidant/antioxidant balance in saliva. Elevated oxidative stress in pregnant women with periodontal disease may contribute to adverse pregnancy outcomes, highlighting the value of early periodontal monitoring.

Govindasamy, Rohini, Periyasamy, Sugavanesh, Narayanan, Mohan, Balaji, Venkateshwarapuram, Dhanasekaran, Manikandan, Karthikeyan, Balakrishnan. The influence of nonsurgical periodontal therapy on the occurrence of adverse pregnancy outcomes: A systematic review. J. Indian Soc. Periodontol. 24, 1 (2020).
Nonsurgical periodontal therapy is safe during pregnancy and may reduce, but not completely prevent, adverse pregnancy outcomes such as preterm birth and low birth weight. Preconception interventions may be more effective.

Patel, Ruchir B., Batra, Sahil, Halemani, Shweta, Rao, Aditya G., Agarwal, Manvi Chandra, Gajjar, Shreya K., Kakkad, Dinta. Maternal periodontitis prevalence and its relationship with preterm and low-birth weight infants: A hospital-based research. J. Pharm. Bioallied Sci. 16 (2024).
Maternal periodontitis was significantly associated with preterm and low-birth weight newborns. Early detection and treatment during pregnancy can reduce the risks of adverse pregnancy outcomes.

Starzyńska, Anna, Wychowański, Piotr, Nowak, Maciej, Sobocki, Bartosz Kamil, Jereczek-Fossa, Barbara Alicja, Słupecka-Ziemilska, Monika. Association between maternal periodontitis and development of systemic diseases in offspring. Int. J. Mol. Sci. 23, 5 (2022).
Maternal periodontitis may influence pregnancy course, leading to preeclampsia, preterm delivery, and low birth weight. Epigenetic alterations in offspring could predispose them to systemic diseases later in life.

Jiang, Hong, Xiong, Xu, Su, Yi, Zhang, Yiming, Wu, Hongqiao, Jiang, Zhijun, Qian, Xu. A randomized controlled trial of pre-conception treatment for periodontal disease to improve periodontal status during pregnancy and birth outcomes. BMC Pregnancy Childbirth 13 (2013).
Pre-conception periodontal treatment improved oral health during pregnancy and could potentially reduce adverse pregnancy outcomes, suggesting that intervention prior to conception may be more effective than treatment during gestation.

Paju, Susanna, Oittinen, Juha, Haapala, Henna, Asikainen, Sirkka, Paavonen, Jorma, Pussinen, Pirkko J. Porphyromonas gingivalis may interfere with conception in women. J. Oral Microbiol. 9, 1 (2017).
Detection of P. gingivalis and elevated salivary antibodies were associated with difficulty in conception, suggesting that pathogenic oral bacteria can influence reproductive outcomes.

Sanz, Mariano, Kornman, Kenneth. Periodontitis and adverse pregnancy outcomes: Consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J. Clin. Periodontol. 40, SUPPL. 14 (2013).
Maternal periodontitis may influence fetal-maternal health via direct bacterial translocation or systemic inflammation. Periodontal therapy is safe but, when given during pregnancy, does not significantly reduce preterm birth or low birthweight.

Chen, Jhih Jhen, Wu, Dai Rong, Lin, Wei Szu, Chen, I. Chieh, Liu, Jeng Fen, Chen, Hui Ling, Lin, Ching Heng. Impact of Scaling and Periodontal Treatment during Pregnancy on the Risk of Adverse Birth Outcomes. J. Pers. Med. 12, 137 (2022).
Scaling or periodontal treatment before or during pregnancy reduces the risk of low birthweight, highlighting the importance of maternal periodontal care prior to conception.

Cobb, Charles M., Kelly, Patricia J., Williams, Karen B., Babbar, Shilpa, Angolkar, Mubashir, Derman, Richard J. The oral microbiome and adverse pregnancy outcomes. Int. J. Womens Health 9, 1–12 (2017).
Periodontal pathogens such as Fusobacterium nucleatum and Porphyromonas gingivalis may contribute to preterm birth and preeclampsia through bacteremia, inflammatory mediator release, or colonization of vaginal microbiome. Preventing periodontal disease can reduce systemic inflammatory burden.

Bobetsis, Yiorgos A., Graziani, Filippo, Gürsoy, Mervi, Madianos, Phoebus N. Periodontal disease and adverse pregnancy outcomes. Periodontol. 2000 83, 1–18 (2020).
Periodontal pathogens can reach the feto-placental unit, but therapy during the second trimester is often too late to prevent adverse outcomes. Preconception interventions may be more effective in improving maternal and neonatal health.

Figueiredo, Marina Guim Otsuka Padovan, Takita, Stefanie Yaemi, Dourado, Bianca Maria Ramos, Mendes, Helderjan de Souza, Terakado, Erick Olsen, Nunes, Hélio Rubens de Carvalho, Fonseca, Cátia Regina Branco da. Periodontal disease: Repercussions in pregnant woman and newborn health—A cohort study. PLoS ONE 14, e0225036 (2019).
Severe periodontal disease during pregnancy increases the risk of fetal growth restriction, vulvovaginitis, and premature rupture of membranes.

Wen, Xingyue, Fu, Xiangqing, Zhao, Chongjun, Yang, Lei, Huang, Ruijie. The bidirectional relationship between periodontal disease and pregnancy via the interaction of oral microorganisms, hormone and immune response. Front. Microbiol. 14, 1070917 (2023).
Pregnancy increases susceptibility to periodontal disease via hormonal and immune changes, while periodontal disease can exacerbate adverse pregnancy outcomes through inflammation and microbial dysbiosis.

Minervini, Giuseppe, Basili, Manuele, Franco, Rocco, Bollero, Patrizio, Mancini, Maura, Gozzo, Lucia, Romano, Giovanni Luca, Marrapodi, Maria Maddalena, Gorassini, Francesca, D’Amico, Cesare, Pedullà, Eugenio, Fiorillo, Luca. Periodontal Disease and Pregnancy: Correlation with Underweight Birth. Eur. J. Dent. 17, 4 (2023).
Periodontal disease may correlate with underweight births; maintaining oral hygiene and health during pregnancy is essential to reduce risk.

Alotaibi, Yazeed, Khan, Nubesh. A survey on the Awareness of Interrelationship of Periodontal Disease and Systemic Health Among Qassim Population. Med. Forum Mon. 34, 11 (2023).
Awareness of the relationship between periodontal and systemic health is high in Qassim population, though knowledge regarding effects on pregnancy, cardiac disease, and hypertension remains limited.