, Volume 100, Issue 2, pp 232–240

Periodontal disease as a risk factor for adverse pregnancy outcomes: a systematic review and meta-analysis of case–control studies

  • Stefano Corbella
  • Silvio Taschieri
  • Luca Francetti
  • Francesca De Siena
  • Massimo Del Fabbro
Original Article


Periodontal disease is a highly prevalent group of illnesses of microbial etiology, whose consequence is a severe breakdown of tooth-supporting structures. A link between periodontal infection and several systemic conditions, among which adverse pregnancy outcomes, has been suggested in the recent years. The aim of this review based on case–control studies was to evaluate if periodontal disease could be considered as a risk factor for preterm birth, low birth-weight and preterm low birth-weight. An electronic search (via Pubmed) was performed for case–control studies investigating the relationship between periodontal disease and adverse pregnancy outcomes. From the initially retrieved 417 articles, 17 case–control studies, accounting for a total of 10,148 patients, were included in the review and in the meta-analysis. The estimated odds ratio was 1.78 (CI 95%: 1.58, 2.01) for preterm birth, 1.82 (CI 95%: 1.51, 1.20) for low birth-weight and 3.00 (CI 95%: 1.93, 4.68) for preterm low birth-weight. Despite the results of the analysis of pooled data suggested a link between periodontal diseases and adverse pregnancy outcomes, the presence of important confounders, whose effect could not be addressed, prevents a validation of the meta-analysis outcomes. Further more accurate investigations based on individual data analysis could give a better insight into the topic of the present review.


Periodontal diseases Periodontitis Risk factor Meta-analysis Adverse pregnancy outcomes 


  1. 1.
    Sanz M, Quirynen M. Advances in the aetiology of periodontitis. Group A consensus report of the 5th European Workshop in Periodontology. J Clin Periodontol. 2005;32(Suppl 6):54–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Heitz-Mayfield LJ. Disease progression: identification of high-risk groups and individuals for periodontitis. J Clin Periodontol. 2005;32(Suppl 6):196–209.PubMedCrossRefGoogle Scholar
  3. 3.
    Ioannidou E, Malekzadeh T, Dongari-Bagtzoglou A. Effect of periodontal treatment on serum C-reactive protein levels: a systematic review and meta-analysis. J Periodontol. 2006;77(10):1635–42.PubMedCrossRefGoogle Scholar
  4. 4.
    Airlla-Mansson S, Soder B, Kari K, Meurman JH. Influence of combinations of bacteria on the levels of prostaglandin E2, interleukin-1beta, and granulocyte elastase in gingival crevicular fluid and on the severity of periodontal disease. J Periodontol. 2006;77(6):1025–31.CrossRefGoogle Scholar
  5. 5.
    Hasan A, Sadoh D, Palmer R, Foo M, Marber M, Lehner T. The immune responses to human and microbial heat shock proteins in periodontal disease with and without coronary heart disease. Clin Exp Immunol. 2005;142(3):585–94.PubMedGoogle Scholar
  6. 6.
    Lockhart PB, Brennan MT, Thornhill M, Michalowicz BS, Noll J, Bahrani-Mougeot FK, Sasser HC. Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia. J Am Dent Assoc. 2009;140(10):1238–44.PubMedGoogle Scholar
  7. 7.
    Slattery MM, Morrison JJ. Preterm delivery. Lancet. 2002;360(9344):1489–97.PubMedCrossRefGoogle Scholar
  8. 8.
    Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371(9606):75–84.PubMedCrossRefGoogle Scholar
  9. 9.
    McCormick MC. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med. 1985;312(2):82–90.PubMedCrossRefGoogle Scholar
  10. 10.
    Romero R, Espinoza J, Kusanovic JP, Gotsch F, Hassan S, Erez O, Chaiworapongsa T, Mazor M. The preterm parturition syndrome. BJOG. 2006;113(Suppl 3):17–42.PubMedGoogle Scholar
  11. 11.
    Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med. 2000;342(20):1500–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Sandros J, Papapanou PN, Nannmark U, Dahlen G. Porphyromonas gingivalis invades human pocket epithelium in vitro. J Periodontal Res. 1994;29(1):62–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Nakano K, Nemoto H, Nomura R, Inaba H, Yoshioka H, Taniguchi K, Amano A, Ooshima T. Detection of oral bacteria in cardiovascular specimens. Oral Microbiol Immunol. 2009;24(1):64–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, McKaig R, Beck J. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol. 1996;67(10 Suppl):1103–13.PubMedGoogle Scholar
  15. 15.
    Heimonen A, Janket Sj, Kaaja R, Ackerson TK, Muthukrishnan P, Meurman JH. Oral inflammatory burden and periodontal disease. J Periodontol. 2009;80:884–91.PubMedCrossRefGoogle Scholar
  16. 16.
    Ebersole J, Novak MJ, Michalowicz BS, Hodges JS, Steffen MJ, Ferguson JE, Diangelis A, Buchanan W, Mitchell DA, Papapanou PN. Systemic immune responses in pregnancy and periodontitis: relationship to pregnancy outcomes in the obstetrics and periodontal therapy (OPT) study. J Periodontol. 2009;80:953–60.PubMedCrossRefGoogle Scholar
  17. 17.
    Michalowicz BS, Novak MJ, Hodges JS, DiAngelis A, Buchanan W, Papapanou PN, Mitchell DA, Ferguson JE, Lupo V, Bofill J, Matseoane S, Steffen M, Ebersole JL. Serum inflammatory mediators in pregnancy: changes after periodontal treatment and association with pregnancy outcomes. J Periodontol. 2009;80:1731–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Pretorius C, Jagatt A, Lamont RF. The relationship between periodontal disease, bacterial vaginosis, and preterm birth. J Perinat Med. 2007;35(2):93–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Michalowicz BS, Durand R, Maternal periodontal disease and spontaneous preterm birth. Periodontol 2000 2007;44:103–12.Google Scholar
  20. 20.
    Bobetsis YA, Barros SP, Offenbacher S. Exploring the relationship between periodontal disease and pregnancy complications. J Am Dent Assoc. 2006;137(Suppl):7S–13S.PubMedGoogle Scholar
  21. 21.
    Jeffcoat MK, Geurs NC, Reddy MS, Goldenberg RL, Hauth JC. Current evidence regarding periodontal disease as a risk factor in preterm birth. Ann Periodontol. 2001;6(1):183–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Wimmer G, Pihlstrom BL. A critical assessment of adverse pregnancy outcome and periodontal disease. J Clin Periodontol. 2008;35(8 Suppl):380–97.PubMedCrossRefGoogle Scholar
  23. 23.
    Polyzos NP, Polyzos IP, Mauri D, Tzioras S, Tsappi M, Cortinovis I, Casazza G. Effect of periodontal disease treatment during pregnancy on preterm birth incidence: a metaanalysis of randomized trials. Am J Obstet Gynecol. 2009;200(3):225–32.PubMedCrossRefGoogle Scholar
  24. 24.
    Polyzos NP, Polyzos IP, Zavos A, Valachis A, Mauri D, Papanikolaou EG, Tzioras S, Weber D, Messinis IE. Obstetric outcomes after treatment of periodontal disease during pregnancy: systematic review and meta-analysis. BMJ. 2010;341:c7017.PubMedCrossRefGoogle Scholar
  25. 25.
    Matevosyan NR. Periodontal disease and perinatal outcomes. Arch Gynecol Obstet. 2011;283(4):675–86.Google Scholar
  26. 26.
    Khader YS, Ta’ani Q. Periodontal diseases and the risk of preterm birth and low birth weight: a meta-analysis. J Periodontol. 2005;76(2):161–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Rakoto-Alson S, Tenenbaum H, Davideau JL. Periodontal diseases, preterm births, and low birth weight: findings from a homogeneous cohort of women in Madagascar. J Periodontol. 2010;81(2):205–13.PubMedCrossRefGoogle Scholar
  28. 28.
    Ryu JI, Oh K, Yang H, Choi BK, Ha JE, Jin BH, Kim HD, Bae KH. Health behaviors, periodontal conditions, and periodontal pathogens in spontaneous preterm birth: a case-control study in Korea. J Periodontol. 2010;81(6):855–63.PubMedCrossRefGoogle Scholar
  29. 29.
    Guimaraes AN, Silva-Mato A, Miranda Cota LO, Siqueira FM, Costa FO. Maternal periodontal disease and preterm or extreme preterm birth: an ordinal logistic regression analysis. J Periodontol. 2010;81(3):350–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Vogt M, Sallum AW, Cecatti JG, Morais SS. Periodontal disease, some adverse perinatal outcomes in a cohort of low risk pregnant women. Reprod Health. 2010;7:29.PubMedCrossRefGoogle Scholar
  31. 31.
    Cruz SS, Costa Mda C, Gomes-Filho IS, Rezende EJ, Barreto ML, Dos Santos CA, Vianna MI, Passos JS, Cerqueira EM. Contribution of periodontal disease in pregnant women as a risk factor for low birth weight. Community Dent Oral Epidemiol. 2009;37(6):527–33.PubMedCrossRefGoogle Scholar
  32. 32.
    Nabet C, Lelong N, Colombier ML, Sixou M, Musset AM, Goffinet F, Kaminski M. Maternal periodontitis and the causes of preterm birth: the case–control Epipap study. J Clin Periodontol. 2010;37(1):37–45.PubMedCrossRefGoogle Scholar
  33. 33.
    Goepfert AR, Jeffcoat MK, Andrews WW, Faye-Petersen O, Cliver SP, Goldenberg RL, Hauth JC. Periodontal disease and upper genital tract inflammation in early spontaneous preterm birth. Obstet Gynecol. 2004;104(4):777–83.PubMedCrossRefGoogle Scholar
  34. 34.
    Jarjoura K, Devine PC, Perez-Delboy A, Herrera-Abreu M, D’Alton M, Papapanou PN. Markers of periodontal infection and preterm birth. Am J Obstet Gynecol. 2005;192(2):513–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Radnai M, Gorzo I, Nagy E, Urban E, Novak T, Pal A. A possible association between preterm birth and early periodontitis. A pilot study. J Clin Periodontol. 2004;31(9):736–41.PubMedCrossRefGoogle Scholar
  36. 36.
    Radnai M, Gorzo I, Urban E, Eller J, Novak T, Pal A. Possible association between mother’s periodontal status and preterm delivery. J Clin Periodontol. 2006;33(11):791–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Siqueira FM, Cota LO, Costa JE, Haddad JP, Lana AM, Costa FO. Intrauterine growth restriction, low birth weight, and preterm birth: adverse pregnancy outcomes and their association with maternal periodontitis. J Periodontol. 2007;78(12):2266–76.PubMedCrossRefGoogle Scholar
  38. 38.
    Wood S, Frydman A, Cox S, Brant R, Needoba S, Eley B, Sauve R. Periodontal disease and spontaneous preterm birth: a case control study. BMC Pregnancy Childbirth. 2006;6:24.PubMedCrossRefGoogle Scholar
  39. 39.
    Mumghamba EG, Manji KP. Maternal oral health status and preterm low birth weight at Muhimbili National Hospital, Tanzania: a case-control study. BMC Oral Health. 2007;7:8.PubMedCrossRefGoogle Scholar
  40. 40.
    Agueda A, Ramon JM, Manau C, Guerrero A, Echeverria JJ. Periodontal disease as a risk factor for adverse pregnancy outcomes: a prospective cohort study. J Clin Periodontol. 2008;35(1):16–22.PubMedGoogle Scholar
  41. 41.
    Lopez NJ, Smith PC, Gutierrez J. Higher risk of preterm birth and low birth weight in women with periodontal disease. J Dent Res. 2002;81(1):58–63.PubMedCrossRefGoogle Scholar
  42. 42.
    Marin C, Segura-Egea JJ, Martinez-Sahuquillo A, Bullon P. Correlation between infant birth weight and mother’s periodontal status. J Clin Periodontol. 2005;32(3):299–304.PubMedCrossRefGoogle Scholar
  43. 43.
    Offenbacher S, Boggess KA, Murtha AP, Jared HL, Lieff S, McKaig RG, Mauriello SM, Moss KL, Beck JD. Progressive periodontal disease and risk of very preterm delivery. Obstet Gynecol. 2006;107(1):29–36.PubMedCrossRefGoogle Scholar
  44. 44.
    Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999;4(1):1–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Goldenberg RL, Goepfert AR, Ramsey PS. Biochemical markers for the prediction of preterm birth. Am J Obstet Gynecol. 2005;192(5 Suppl):S36–46.PubMedCrossRefGoogle Scholar
  46. 46.
    Han YW, Redline RW, Li M, Yin L, Hill GB, McCormick TS. Fusobacterium nucleatum induces premature and term stillbirths in pregnant mice: implication of oral bacteria in preterm birth. Infect Immun. 2004;72(4):2272–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Han YW, Ikegami A, Bissada NF, Herbst M, Redline RW, Ashmead GG. Transmission of an uncultivated Bergeyella strain from the oral cavity to amniotic fluid in a case of preterm birth. J Clin Microbiol. 2006;44(4):1475–83.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of The Nippon Dental University 2011

Authors and Affiliations

  • Stefano Corbella
    • 1
  • Silvio Taschieri
    • 1
  • Luca Francetti
    • 1
  • Francesca De Siena
    • 1
  • Massimo Del Fabbro
    • 1
  1. 1.Department of Health Technologies, IRCCS Istituto Ortopedico Galeazzi, Dental clinicUniversity of MilanMilanItaly

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