Periodontitis and adverse pregnancy outcomes: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases.

BACKGROUND: Pregnancy sometimes has adverse outcomes including low birthweight (<2500 g), pre-term birth (<37 weeks), growth restriction, pre-eclampsia, miscarriage and/or stillbirth. Maternal periodontitis directly and/or indirectly have potential to influence the health of the foetal-maternal unit. AIMS: To assess the epidemiological evidence for the impact of periodontal disease on adverse pregnancy outcomes and to identify potential underpinning mechanisms. EPIDEMIOLOGY: Low birthweight, pre-term birth and pre-eclampsia have been associated with maternal periodontitis exposure. However, the strength of the observed associations is modest and seems to vary according to the population studied, the means of periodontal assessment and the periodontal disease classification employed. BIOLOGICAL MECHANISMS: Two major pathways have been identified, One direct, in which oral microorganisms and/or their components reach the foetal-placental unit and one indirect, in which Inflammatory mediators circulate and impact the foetal-placental unit.
INTERVENTIONS: Although periodontal therapy has been shown to be safe and leads to improved periodontal conditions in pregnant women, case-related periodontal therapy, with or without systemic antibiotics does not reduce overall rates of pre-term birth and low birthweight. GUIDELINES: Given the current evidence, various treatment strategies could be evaluated that consider specific target populations, as well as timing and intensity of treatment.