Inflammatory Response in Oral Biofilm during Pregnancy: A Systematic Review

Abstract

Understanding the inflammatory response in oral biofilm during pregnancy and its association with oral and maternal health is essential for identifying biomarker patterns that may serve as markers of pregnancy-related complications. We aimed to conduct a systematic review of the available literature to assess: (1) inflammatory responses in oral biofilm during pregnancy, (2) the association between inflammatory responses in oral biofilm during pregnancy and maternal, oral or systemic conditions, (3) changes in the response of inflammatory biomarkers found in the oral biofilm during different pregnancy stages, and (4) the value of other risk factors such as nutrition and lifestyle. PubMed, Web of Science and Cochrane Library were systematically searched from inception until April 2022. From 5441 records, 39 studies were included for qualitative assessment. The oral biofilm in pregnant women was associated with increased inflammatory biomarkers when compared to non-pregnant women. Levels of inflammatory biomarkers in the oral biofilm were found to be highest in pregnant women with systemic conditions. Increased inflammatory biomarkers in the oral biofilm were also associated with worse oral health outcomes. Given the importance of nutrition and lifestyle for pregnancy and oral health outcomes and the fact that these factors were largely excluded in the included studies, future research should consider a holistic view of the mother during pregnancy to capture physiological, hormonal, immunologic, and metabolic changes in the context of inflammatory responses.

Oral Manifestations in Pregnant Women: A Systematic Review

“…The production of progesterone and estrogen increases, causing increased dilatation of vessels in the gingival area [3]. This hormonal alteration, together with the changes that originate due to the oral microflora or oral hygiene of pregnant women, can lead to the appearance of bleeding and inflammation or affect temporomandibular disorders, among other manifestations [4][5][6][7].…”

Efficacy of Sonic-Powered and Manual Toothbrushes on Plaque-Induced Gingivitis in Pregnant Women: A Randomized Controlled Trial

“…Plaque-induced gingivitis in pregnant women is a common inflammatory periodontal disease that appears from the second or third month of pregnancy with an overall prevalence of 30 to 100% [2][3][4][5][6]. Gingivitis during pregnancy can manifest as swelling, redness, increased volume and gingival sensitivity, but more especially through bleeding, indicating damaged vascularization [7].…”

Prevalence, Severity of Extension, and Risk Factors of Gingivitis in a 3-Month Pregnant Population: A Multicenter Cross-Sectional Study

“…The systemic risk or modifying factors affect the immune response to bacterial biofilm and drive vascular and gingival changes that may contribute to heightened gingival inflammation resulting in exaggerated or "hyper" inflammation in response to relatively small levels of oral biofilm [8]. Although the exact etiology is not fully understood, even without changes in the amount of oral biofilm present, the inflammation of the periodontal tissues due to the dysbiosis of the biofilm increases dramatically in severity during the course of a normal pregnancy [9].…”