ORAL HEALTH IN PREGNANT WOMEN AND OBSTETRIC COMPLICATIONS: A NARRATIVE REVIEW OF EVIDENCE ON PRETERM BIRTH, LOW BIRTH WEIGHT, PREECLAMPSIA, AND GESTATIONAL DIABETES MELLITUS

Abstract

Background and Objectives: Periodontitis affects approximately 40% of pregnant women worldwide, although prevalence estimates vary considerably depending on diagnostic criteria and population characteristics  [7]. Periodontal disease is considered a potentially modifiable risk factor for adverse pregnancy outcomes (APOs). This narrative review examines the current evidence linking maternal periodontal disease to four major obstetric complications: preterm birth (PTB), low birth weight (LBW), preeclampsia (PE) and gestational diabetes mellitus (GDM). A secondary aim was to assess the clinical evidence for periodontal treatment as a preventive strategy during pregnancy. Methods: A narrative synthesis of literature published between January 2015 and April 2025 was conducted using PubMed/MEDLINE, Cochrane Library, Google Scholar, Embase and Web of Science. Systematic reviews, meta-analyses, randomised controlled trials (RCTs), prospective cohort studies and case-control studies were included. Quality appraisal was performed using AMSTAR-2, the Newcastle-Ottawa Scale and the Cochrane Risk of Bias 2.0 tool. Results: Consistent epidemiological associations were identified for all four outcomes. Effect sizes ranged from OR 1.67–4.28 for PTB, OR 1.82–2.53 for LBW and OR 1.83 for GDM, whereas the evidence for preeclampsia was classified as suggestive. Two mechanistic pathways were characterised: direct hematogenous translocation of periodontal pathogens to the fetoplacental unit and an indirect systemic inflammatory cascade mediated by IL-1β, IL-6, TNF-α and prostaglandin E2. Intervention trials demonstrated that non-surgical scaling and root planing (SRP) is safe for pregnant women but does not produce a consistent, statistically significant reduction in APO rates. Conclusions: Maternal periodontitis is significantly associated with PTB, LBW, GDM and PE through biologically plausible mechanisms. However, causal inference is hampered by heterogeneous disease definitions, residual confounding and inconsistent RCT results. Integration of oral health screening into antenatal care protocols and standardisation of periodontal diagnostic criteria in obstetric research are priority recommendations.