Increasing evidence implicates periodontal disease as a factor associated with such systemic disorders as myocardial infarction, stroke, and diabetes. Adverse pregnancy outcomes also have been associated with periodontal disease. They include preterm birth, low birth weight, miscarriage, and preeclampsia. The authors undertook a comprehensive database review to identify existing evidence that supports a relationship between persistent subclinical infection of periodontal origin and adverse pregnancy outcomes. The 25 studies accepted for review included 13 case-control (including cross-sectional) studies, 9 cohort studies, and 3 controlled trials, 2 of which were randomized. The studies were carried out in 14 countries.
In all, 8 of the 25 studies suggested an association between periodontal disease and an increased risk of adverse pregnancy outcomes. Odds ratios ranged from 1.10 to 20.0. Seven other studies yielded no evidence of such an association. Two case-control studies suggested that periodontal disease is a risk factor for preterm low birth weight. Two clinical trials, one of them randomized, indicated that the risk may be reversed by oral prophylaxis and treatment. A study that failed to support an association between periodontal disease and either preterm birth or low birth weight did suggest a connection with pregnancy loss at 12 to 24 weeks gestation. A correlation analysis pointed to a relationship between decreased birth weight or gestational age and more severe periodontal disease.
Although the observational studies analyzed do not consistently implicate periodontal disease in adverse pregnancy outcomes, several studies do suggest the possibility of such an association. Randomized, controlled trials are in progress to determine whether periodontal treatment will lower rates of some adverse pregnancy outcomes. In addition, studies are needed to detect any association between periodontal disease and an increased risk of preeclampsia, gestational diabetes, early pregnancy loss, or restricted intrauterine growth.