1http://dx.doi.org/10.20396/bjos.v21i00.8665385 Volume 21 2022 e225385 Letter to the Editor Braz J Oral Sci. 2022;21:e225385 1 Department of Pediatric Dentistry, Othodontics and Public Health. Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil. Corresponding author: Gerson Aparecido Foratori-Junior Department of Pediatric Dentistry, Othodontics and Public Health. Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil. e-mail: gerson.foratori@usp.br Phone: +551199766-7202 Editor: Dr Altair A. Del Bel Cury Received: April 20, 2021 Accepted: June 14, 2021 Obesity during pregnancy and its oral repercussions: what is the current evidence? Gerson Aparecido Foratori-Junior1 , Silvia Helena de Carvalho Sales-Peres1,* Dear editor, Periodontal medicine is a field that has been in evidence in recent years due to the increased number of diseases and conditions that have been linked to periodontitis1. A systematic review on periodontal medicine indicated 57 different conditions that may be associated with peri- odontal disease, among them, the pregnancy2. During pregnancy, physiological, immunological and hormonal changes occur in the women’s body. Con- sidering the high levels of estrogen and progesterone and the reduced antimicrobial activity of peripheral neutrophils, pregnant women are more prone to acute periodontal inflammation even with a small amount of dental plaque3. Obesity is a chronic and inflammatory disease that has been considered one of the biggest public health prob- lems4. In Brazil, 63.3% and 30.2% of women are consid- ered with overweight and obesity, respectively5. There is strong evidence to associate obesity with periodontitis6-8. This association is explained by the adipose tissue of overweight patients secret- ing inflammatory mediators, such as TNF-α, IL-6, adiponectin, leptin and resistin, reducing the host’s immune response and causing a generalized inflam- matory state of the body6-8. Therefore, in the presence https://orcid.org/0000-0003-4760-8948 https://orcid.org/0000-0003-3811-7899 2 Foratori-Junior et al. Braz J Oral Sci. 2022;21:e225385 of dental plaque, obese patients present an exacerbated inflammatory response of the periodontal tissues. Considering the synergistic effect of pregnancy and obesity on periodontal tissues, previous studies have investigated the association of these outcomes in pregnant women9-20. Most of them showed a positive association between maternal excessive weight and periodontitis9-18,20, and also associated maternal overweight with other systemic disorders, such as arterial hypertension and gestational diabetes mellitus, which in turn may further damage periodontal tissues. Foratori-Junior et al.17 (2020) conducted a longitudinal study in which they evaluated overweight/obese women during the 2nd and 3rd trimesters of pregnancy and also after delivery. The authors pointed out that overweight/obese women had a higher prevalence of periodontitis during pregnancy and this condition remained even with the reduction of hormone levels after childbirth. It is important to highlight that some limitations were found among those studies that sought to assess the association of these outcomes during pregnancy. Most of them had a cross-sectional design, which makes it impossible to understand the cause-and-effects relationship between the outcomes. In addition, they differ in rela- tion to the sample size, cutoff points of the BMI to classify excessive weight and, mainly, to the classification for periodontitis. These divergences make it difficult to compare studies. It is known that maternal periodontitis may result in negative perinatal outcomes, being associated with a doubled risk of prematurity21 and with low birth weight22. Therefore, the holistic care of women during pregnancy is necessary, considering their systemic involvement. As future perspectives, it is expected that population-based longitudinal studies will be conducted in order to better understand the association of obesity and periodon- titis during pregnancy. In addition, studies at biological levels are also important, aiming to identify the plausible pathophysiological mechanisms of the association of these outcomes and, possibly, to identify biomarkers that serve as instruments for us to adopt adequate protocols in the management of periodontitis during pregnancy in women affected by obesity Acknowledgements The authors would like to thank the Coordination for the Improvement of Higher Edu- cation Personnel (CAPES - Finance Code 001) and the São Paulo Research Founda- tion (FAPESP; #2015/25421-4; #2018/13990-2; # 18/25934-0; #2018/20626-5) for the financial support to some of the studies mentioned in this letter. References 1. Beck JD, Papapanou PN, Philips KH, Offenbacher S. Periodontal medicine: 100 years of progress. J Dent Res. 2019 Sep;98(10):1053-62. doi: 10.1177/0022034519846113. 3 Foratori-Junior et al. Braz J Oral Sci. 2022;21:e225385 2. Monsarrat P, Blaizot A, Kémoun P, Ravaud P, Nabet C, Sixou M, et al. Clinical research activity in periodontal medicine: a systematic mapping of trial registers. J Clin Periodontol. 2016 May;43(5):390-400. doi: 10.1111/jcpe.12534. 3. Silva de Araujo Figueiredo C, Gonçalves Carvalho Rosalem C, Costa Cantanhede AL, Abreu Fonseca Thomaz ÉB, Fontoura Nogueira da Cruz MC. Systemic alterations and their oral manifestations in pregnant women. J Obstet Gynaecol Res. 2017 Jan;43(1):16-22. doi: 10.1111/jog.13150. 4. Foratori-Junior GA, Andrade FJP de, Mosquim V, Peres M de CS, Chaim EA, Sales-Peres SH de C. Association of metabolic syndrome with oral and systemic conditions in morbidly obese patients. Braz J Oral Sci. 2019 Apr;18:e191484. doi: 10.20396/bjos.v18i0.8655299. 5. Brazilian Institute of Geography and Statistics. [National Health Survey 2019: Primary health care and anthropometric information]. Rio de Janeiro: Brazilian Institute of Geography and Statistics; 2020. 57p. Portuguese. 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Reprod Sci. 2018 Oct;25(10):1474-84. doi: 10.1177/1933719117749758. 15. Fusco NDS, Foratori-Junior GA, Missio ALT, Jesuino BG, Sales-Peres SHC. Systemic and oral conditions of pregnant women with excessive weight assisted in a private health system. Int Dent J. 2019 Dec;69(6):472-9. doi: 10.1111/idj.12507. 16. Caracho RA, Foratori-Junior GA, Fusco NDS, Jesuino BG, Missio ALT, Sales-Peres SHC. Systemic conditions and oral health-related quality of life of pregnant women of normal weight and who are overweight. Int Dent J. 2020 Aug;70(4):287-95. doi: 10.1111/idj.12547. 17. Foratori-Junior GA, da Silva BM, da Silva Pinto AC, Honório HM, Groppo FC, de Carvalho Sales-Peres SH. Systemic and periodontal conditions of overweight/obese patients during pregnancy and after delivery: a prospective cohort. 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