Periodontitis and Adverse Pregnancy Outcomes: Mechanistic Evidence

ABSTRACT

Periodontal diseases, including both gingivitis and periodontitis, occur commonly among pregnant individuals. Both gingivitis and periodontitis are associated with adverse pregnancy outcomes (APOs) such as early pregnancy loss, preterm birth, preeclampsia, low birth weight, and stillbirth. This review highlights that the strongest mechanistic evidence linking periodontal diseases with APOs involves the domains of systemic inflammation, including increased pro‐inflammatory cytokines and activation of matrix metalloproteases associated with preterm labor, and microbial translocation involving hematogenous dissemination of periodontopathic bacteria to the fetoplacental unit. Yet, other mechanistic domains remain underexplored, including maladaptive myelopoiesis with alterations of neutrophil activity, immune player trafficking with autoantibody development, masticatory dysfunction‐diet interactions that may further increase risk of critical vitamin and nutritional deficiencies related to both periodontitis and APOs, and functional dysregulation of the oral microbiome including generation of nitric oxide that could impact pregnancy outcomes. Additionally, specific underlying vulnerabilities unique to pregnancy such as increased hormone production such as progesterone and cortisol likely impact the risk of periodontal diseases in pregnancy. By delving into these critical mechanistic domains, this review reveals both current understanding and critical areas for future research to overcome deficits in knowledge pertaining to how periodontal diseases in pregnancy lead to APOs. Elucidating these novel insights can promote scientific advancement, facilitate the development of novel interventions that prevent and/or treat periodontal diseases in pregnancy, and concurrently improve the lives and well‐being of pregnant individuals and their children worldwide.