{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T16:09:21Z","timestamp":1782835761031,"version":"3.54.5"},"reference-count":42,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2021,6,26]],"date-time":"2021-06-26T00:00:00Z","timestamp":1624665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Harvard School of Dental Medicine Initiative to Integrate Oral Health and Medicine"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>While a number of studies have explored the link between periodontal disease and adverse pregnancy outcomes, both epidemiological studies and intervention trials have reached contradictory results with relatively small sample sizes. Utilizing large-scale claims data, we aim to investigate the association between maternal periodontal disease and adverse pregnancy outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Utilizing large-scale claims data, we aim to investigate the association between maternal periodontal disease and adverse pregnancy outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using de-identified claims data from a national commercial insurer in the USA, records of all observed pregnancies from 2015 to 2019 were included in this retrospective cohort study. Adverse pregnancy outcomes, including low birthweight (LBW) of the newborn, preterm birth (PTB) and spontaneous abortion, were primary outcomes. To evaluate the association between periodontal disease and pregnancy outcomes, logistic mixed-effect model was estimated with periodontal disease status, age, existing clinical conditions of mothers and geographic location as covariates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Out of 748 792 observed pregnancy records, 18.66% resulted in adverse pregnancy outcomes; 5.92% in LBW, 14.46% in PTB and 2.22 % in spontaneous abortion. Adjusting for individual-level risk factors, periodontal disease was significantly associated with maternal complications with odds ratios of 1.19 (95% CI:1.15, 1.24) for any adverse pregnancy outcomes, 1.10 (95% CI:1.03, 1.17) for LBW, 1.15 (95% CI:1.10, 1.19) for PTB and 1.34 (95% CI:1.23, 1.46) for spontaneous abortions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Maternal periodontal disease may be associated with an increased risk of maternal complications and neonatal morbidity. A timely diagnosis and treatment of periodontal disease during pregnancy should be encouraged by considering oral health as part of routine prenatal care.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/fampra\/cmab037","type":"journal-article","created":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T02:07:19Z","timestamp":1616724439000},"source":"Crossref","is-referenced-by-count":13,"title":["Association between maternal periodontal disease and adverse pregnancy outcomes: an analysis of claims data"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4001-7638","authenticated-orcid":false,"given":"Sung Eun","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Choudhary","sequence":"additional","affiliation":[{"name":"Office of Global and Community Health, Harvard School of Dental Medicine, Boston, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M","family":"Ahern","sequence":"additional","affiliation":[{"name":"Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Palmer","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, Harvard Medical School, Boston, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane R","family":"Barrow","sequence":"additional","affiliation":[{"name":"Office of Global and Community Health, Harvard School of Dental Medicine, Boston, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,6,26]]},"reference":[{"issue":"10","key":"2021070818540233100_CIT0001","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1177\/0022034512457373","article-title":"Prevalence of periodontitis in adults in the United States: 2009 and 2010","volume":"91","author":"Eke","year":"2012","journal-title":"J Dent Res"},{"key":"2021070818540233100_CIT0002","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1902\/jop.1996.67.10s.1103","article-title":"Periodontal infection as a possible risk factor for preterm low birth weight","volume":"67 (suppl 10S)","author":"Offenbacher","year":"1996","journal-title":"J Periodontol"},{"issue":"9","key":"2021070818540233100_CIT0003","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.2169\/internalmedicine.56.7322","article-title":"Periodontal treatment and the risks of cardiovascular disease in patients with type 2 diabetes: a retrospective cohort study","volume":"56","author":"Peng","year":"2017","journal-title":"Intern Med"},{"issue":"12","key":"2021070818540233100_CIT0004","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1016\/S2213-8587(18)30038-X","article-title":"Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial","volume":"6","author":"D\u2019Aiuto","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"1","key":"2021070818540233100_CIT0005","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1177\/002203450208100113","article-title":"Higher risk of preterm birth and low birth weight in women with periodontal disease","volume":"81","author":"L\u00f3pez","year":"2002","journal-title":"J Dent Res"},{"issue":"9","key":"2021070818540233100_CIT0006","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1111\/j.1600-051X.2004.00564.x","article-title":"A possible association between preterm birth and early periodontitis. A pilot study","volume":"31","author":"Radnai","year":"2004","journal-title":"J Clin Periodontol"},{"issue":"8","key":"2021070818540233100_CIT0007","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1111\/j.1600-051X.2005.00781.x","article-title":"Association between periodontitis and low birth weight: a case-control study","volume":"32","author":"Moliterno","year":"2005","journal-title":"J Clin Periodontol"},{"issue":"1","key":"2021070818540233100_CIT0008","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1902\/annals.1998.3.1.206","article-title":"Poor periodontal health of the pregnant woman as a risk factor for low birth weight","volume":"3","author":"Dasanayake","year":"1998","journal-title":"Ann Periodontol"},{"issue":"5","key":"2021070818540233100_CIT0009","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1177\/154405910208100505","article-title":"Maternal periodontal disease and preterm low birthweight: case-control study","volume":"81","author":"Davenport","year":"2002","journal-title":"J Dent Res"},{"key":"2021070818540233100_CIT0010","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/j.1749-6632.2001.tb03804.x","article-title":"Understanding preterm labor","volume":"943","author":"Challis","year":"2001","journal-title":"Ann N Y Acad Sci"},{"issue":"2","key":"2021070818540233100_CIT0011","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1111\/j.1471-0528.2005.00827.x","article-title":"Periodontal disease and adverse pregnancy outcomes: a systematic review","volume":"113","author":"Xiong","year":"2006","journal-title":"BJOG"},{"issue":"3","key":"2021070818540233100_CIT0012","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.bpobgyn.2007.01.005","article-title":"Periodontal disease and pregnancy outcomes: exposure, risk and intervention","volume":"21","author":"Clothier","year":"2007","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"issue":"9","key":"2021070818540233100_CIT0013","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1111\/j.1600-051X.2005.00759.x","article-title":"Is there an association between periodontal disease, prematurity and low birth weight? A population-based study","volume":"32","author":"Lunardelli","year":"2005","journal-title":"J Clin Periodontol"},{"issue":"3","key":"2021070818540233100_CIT0014","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1111\/j.1600-051X.2005.00661.x","article-title":"Correlation between infant birth weight and mother's periodontal status","volume":"32","author":"Marin","year":"2005","journal-title":"J Clin Periodontol"},{"issue":"2","key":"2021070818540233100_CIT0015","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1111\/j.1600-051X.2005.00670.x","article-title":"Periodontal infections and pre-term low birth weight: a case-control study","volume":"32","author":"Buduneli","year":"2005","journal-title":"J Clin Periodontol"},{"issue":"5","key":"2021070818540233100_CIT0016","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1016\/j.ajog.2005.11.059","article-title":"Maternal periodontal disease in early pregnancy and risk for a small-for-gestational-age infant","volume":"194","author":"Boggess","year":"2006","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"2021070818540233100_CIT0017","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1111\/j.1600-051X.2004.00630.x","article-title":"Periodontitis, a marker of risk in pregnancy for preterm birth","volume":"32","author":"D\u00f6rtbudak","year":"2005","journal-title":"J Clin Periodontol"},{"issue":"7","key":"2021070818540233100_CIT0018","doi-asserted-by":"crossref","first-page":"875","DOI":"10.14219\/jada.archive.2001.0299","article-title":"Periodontal infection and preterm birth: results of a prospective study","volume":"132","author":"Jeffcoat","year":"2001","journal-title":"J Am Dent Assoc"},{"issue":"6","key":"2021070818540233100_CIT0019","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1111\/j.1600-051X.2005.00722.x","article-title":"Relationship between maternal periodontal disease and low-birth-weight pre-term infants","volume":"32","author":"Moreu","year":"2005","journal-title":"J Clin Periodontol"},{"issue":"1","key":"2021070818540233100_CIT0020","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/01.AOG.0000190212.87012.96","article-title":"Progressive periodontal disease and risk of very preterm delivery","volume":"107","author":"Offenbacher","year":"2006","journal-title":"Obstet Gynecol"},{"issue":"8","key":"2021070818540233100_CIT0021","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1902\/jop.2003.74.8.1214","article-title":"Periodontal disease and preterm birth: results of a pilot intervention study","volume":"74","author":"Jeffcoat","year":"2003","journal-title":"J Periodontol"},{"issue":"8","key":"2021070818540233100_CIT0022","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1902\/jop.2002.73.8.911","article-title":"Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: a randomized controlled trial","volume":"73","author":"L\u00f3pez","year":"2002","journal-title":"J Periodontol"},{"issue":"1","key":"2021070818540233100_CIT0023","doi-asserted-by":"crossref","first-page":"23","DOI":"10.4103\/0970-4388.22831","article-title":"Effects of periodontal treatment phase I on birth term and birth weight","volume":"24","author":"Sadatmansouri","year":"2006","journal-title":"J Indian Soc Pedod Prev Dent"},{"issue":"18","key":"2021070818540233100_CIT0024","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1056\/NEJMoa062249","article-title":"Treatment of periodontal disease and the risk of preterm birth","volume":"355","author":"Michalowicz","year":"2006","journal-title":"N Engl J Med"},{"issue":"3","key":"2021070818540233100_CIT0025","first-page":"199","article-title":"Update on prenatal care","volume":"89","author":"Zolotor","year":"2014","journal-title":"Am Fam Physician"},{"issue":"2","key":"2021070818540233100_CIT0026","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/j.1600-051X.2005.00884.x","article-title":"The relationship between maternal periodontitis, adverse pregnancy outcome and miscarriage in never smokers","volume":"33","author":"Farrell","year":"2006","journal-title":"J Clin Periodontol"},{"issue":"5","key":"2021070818540233100_CIT0027","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1038\/sj.bdj.4811620","article-title":"A prospective study to investigate the relationship between periodontal disease and adverse pregnancy outcome","volume":"197","author":"Moore","year":"2004","journal-title":"Br Dent J"},{"issue":"2","key":"2021070818540233100_CIT0028","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1902\/jop.2005.76.2.161","article-title":"Periodontal diseases and the risk of preterm birth and low birth weight: a meta-analysis","volume":"76","author":"Khader","year":"2005","journal-title":"J Periodontol"},{"key":"2021070818540233100_CIT0029","doi-asserted-by":"crossref","first-page":"215","DOI":"10.11604\/pamj.2016.24.215.8727","article-title":"Relationship between periodontal disease and preterm low birth weight: systematic review","volume":"24","author":"Teshome","year":"2016","journal-title":"Pan Afr Med J"},{"issue":"10","key":"2021070818540233100_CIT0030","doi-asserted-by":"crossref","first-page":"e297","DOI":"10.1371\/journal.pmed.0040297","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration","volume":"4","author":"Vandenbroucke","year":"2007","journal-title":"PLoS Med"},{"issue":"2","key":"2021070818540233100_CIT0031","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.amepre.2014.04.001","article-title":"Impact of periodontal therapy on general health: evidence from insurance data for five systemic conditions","volume":"47","author":"Jeffcoat","year":"2014","journal-title":"Am J Prev Med"},{"issue":"7","key":"2021070818540233100_CIT0032","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.2105\/AJPH.87.7.1113","article-title":"Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis","volume":"87","author":"O\u2019Campo","year":"1997","journal-title":"Am J Public Health"},{"key":"2021070818540233100_CIT0033","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.ssmph.2016.08.005","article-title":"Bias with respect to socioeconomic status: A closer look at zip code matching in a pneumococcal vaccine effectiveness study","volume":"2","author":"Link-Gelles","year":"2016","journal-title":"SSM Popul Health"},{"key":"2021070818540233100_CIT0034","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1186\/1472-6963-14-355","article-title":"Adjusting for geographic variation in observational comparative effectiveness studies: a case study of antipsychotics using state Medicaid data","volume":"14","author":"Root","year":"2014","journal-title":"BMC Health Serv Res"},{"key":"2021070818540233100_CIT0035","article-title":"Estimated median age at first marriage","author":"United States Census Bureau","year":"2020"},{"key":"2021070818540233100_CIT0036","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1034\/j.1600-0757.2002.03005.x","article-title":"Periodontitis-systemic disease associations in the presence of smoking\u2013causal or coincidental?","volume":"30","author":"Hujoel","year":"2002","journal-title":"Periodontol 2000"},{"issue":"10194","key":"2021070818540233100_CIT0037","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0140-6736(19)31146-8","article-title":"Oral diseases: a global public health challenge","volume":"394","author":"Peres","year":"2019","journal-title":"Lancet"},{"key":"2021070818540233100_CIT0038","article-title":"Oral health: an essential component of primary care","author":"Hummel"},{"issue":"8","key":"2021070818540233100_CIT0039","first-page":"1139","article-title":"Oral health during pregnancy","volume":"77","author":"Silk","year":"2008","journal-title":"Am Fam Physician"},{"issue":"3","key":"2021070818540233100_CIT0040","first-page":"1","article-title":"Timing and adequacy of prenatal care in the United States, 2016","volume":"67","author":"Osterman","year":"2018","journal-title":"Natl Vital Stat Rep"},{"issue":"4","key":"2021070818540233100_CIT0041","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/S0033-3549(04)50052-3","article-title":"Assessing the role and effectiveness of prenatal care: history, challenges, and directions for future research","volume":"116","author":"Alexander","year":"2001","journal-title":"Public Health Rep"},{"issue":"8","key":"2021070818540233100_CIT0042","doi-asserted-by":"crossref","first-page":"e00130817","DOI":"10.1590\/0102-311x00130817","article-title":"Barriers and facilitators to dental care during pregnancy: a systematic review and meta-synthesis of qualitative studies","volume":"34","author":"Rocha","year":"2018","journal-title":"Cad Saude Publica"}],"container-title":["Family Practice"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/fampra\/advance-article-pdf\/doi\/10.1093\/fampra\/cmab037\/38828967\/cmab037.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/fampra\/advance-article-pdf\/doi\/10.1093\/fampra\/cmab037\/38828967\/cmab037.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T02:24:47Z","timestamp":1625797487000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/fampra\/advance-article\/doi\/10.1093\/fampra\/cmab037\/6309962"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,26]]},"references-count":42,"URL":"https:\/\/doi.org\/10.1093\/fampra\/cmab037","relation":{},"ISSN":["1460-2229"],"issn-type":[{"value":"1460-2229","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,26]]},"article-number":"cmab037"}}