The bidirectional relationship between periodontal disease and pregnancy via the interaction of oral microorganisms, hormone and immune response

Abstract

Periodontal disease has been suggested to be linked to adverse pregnancy outcomes such as preterm birth, low birth weight, and preeclampsia. Adverse pregnancy outcomes are a significant public health issue with important clinical and societal repercussions. This article systematically reviews the available epidemiological studies involving the relationship between periodontal disease and adverse pregnancy outcomes over the past 15 years, and finds a weak but independent association between adverse pregnancy outcomes and periodontal disease. The bidirectional association and the potential mechanisms are then explored, focusing on three possible mechanisms: inflammatory reaction, oral microorganisms and immune response. Specifically, elevated systemic inflammation and increased periodontal pathogens with their toxic products, along with a relatively suppressed immune system may lead to the disruption of homeostasis within fetal-placental unit and thus induce adverse pregnancy outcomes. This review also explains the possible mechanisms around why women are more susceptible to periodontal disease. In conclusion, pregnant women are more likely to develop periodontal disease due to hormonal changes, and periodontal disease has also been suspected to increase the incidence of adverse pregnancy outcomes. Therefore, in order to lessen the risk of adverse pregnancy outcomes, both obstetricians and dentists should pay attention to the development of periodontal diseases among women during pregnancy.

Maternal periodontitis may cause lower birth weight in children: genetic evidence from a comprehensive Mendelian randomization study on periodontitis and pregnancy

“…Some infectious diseases may disturb the Th17/Treg proportion, leading to increased Th1/Th17 cell numbers and activity. The Th1 response activates decidual macrophages, which release excessive TNF-α and nitric oxide, detrimental to the fetus [ 39 , 40 ]. The potential biological mechanism is depicted in Fig.…”

“…As a semi-allograft, the fetus carries external DNA from the father, which must be tolerated by the mother throughout pregnancy [38]. Unfortunately, periodontal microbe infections trigger a shift in the maternal immune response toward a pathogenic inflammatory response, disrupting the maternal-fetal interface's homeostasis [39]. Some infectious diseases may disturb the Th17/Treg proportion, leading to increased Th1/Th17 cell numbers and activity.…”

The NFκB Signaling Pathway Is Involved in the Pathophysiological Process of Preeclampsia

“…However, periodontal disease during pregnancy is significantly associated with unfavorable short- and long-term offspring outcomes, which may be due to epigenetic changes 57 . Early diagnosis and treatment of periodontal disease in the first trimester or even before conception may be helpful in preventing and effectively minimising problems with conception and obstetrical issues 59 60 .…”

Monotonic Trend of Oral Health During the COVID-19 Pandemic Period in Caraga Region, Philippines

“…Other factors include hormonal changes in females, certain medical conditions, medications, and genetic predisposition (Ababneh et al 2012). Wen et al (2023) suggest that hormonal changes during pregnancy contribute to the association between periodontal disease and adverse pregnancy outcomes, including preterm birth and low birth weight. The disruption of the fetal-placental unit caused by elevated systemic inflammation, increased periodontal pathogens, and a suppressed immune system are proposed mechanisms underlying these unfavorable outcomes.…”