Maternal Periodontal Infection and Risk of Adverse Pregnancy Outcomes: A Systematic Review

Despite decades of research, adverse pregnancy outcomes remain a significant public health problem. Although, adverse pregnancy outcomes increase risk of maternal and infant morbidity and mortality, the etiology of these outcomes is often unknown. Among other social and biological determinants, periodontal disease has been identified as a potential risk factor. However, the literature is inconsistent and unclear about the true association, and previous reviews have been limited in terms of study location and type of adverse pregnancy outcome. Therefore, the purpose of this study was to determine the relationship between maternal periodontal infection and risk of various adverse pregnancy outcomes, (specifically, preterm birth, low birth weight, small-for-gestational age and infant mortality) and adverse maternal outcomes (preeclampsia and gestational diabetes) in domestic and international studies. We conducted an extensive review of OVID (Medline) and PubMed from 1950 - December 31, 2008 to identify all studies published in English which examined this association. After exclusions we selected 61 articles, 44 international and 17 U.S. based studies. Thirty-nine articles reported a statistically significant association between maternal periodontal infection and at least one adverse pregnancy outcome. Six out of nine intervention studies reported statistically significant reductions in risk of adverse pregnancy outcomes following periodontal infection intervention. We found a consistent association between maternal periodontal infection and adverse pregnancy outcomes, regardless of study design, population and location. Thus, prenatal care should include oral health care examinations to help identify and treat possible periodontal disease and prevent adverse pregnancy outcomes.