The association between periodontal disease and adverse pregnancy outcomes: a bibliometric analysis from 2000 to 2023

Abstract

Background: Periodontal disease (PD) refers to a chronic inflammatory disorder affecting the supporting tissues of the teeth triggered by bacterial infection and is recognized to promote systemic inflammation, leading to dysfunction in specific organs. Adverse pregnancy outcomes (APOs), including preterm birth, small for gestational age infants, gestational diabetes and preeclampsia, are linked to pregnancy complications. Recently, the correlation between periodontal disease and adverse pregnancy outcomes has garnered global attention. However, bibliometric studies in this area remain limited. This study aimed to visualize knowledge framework and research trends concerning the relationship between periodontal disease and adverse pregnancy outcomes from 2000 to 2023 through bibliometric approaches.

Methods: On September 22, 2024, articles and reviews on the connection between periodontal disease and adverse pregnancy outcomes were retrieved from the Web of Science Core Collection (WOSCC). CiteSpace [6.3.R1 (64-bit) Advanced] was used to perform knowledge mapping and bibliometric studies.

Results: Over the past 23 years, 932 articles from 73 countries were collected, with the U.S. contributing over one-third (355), followed by Brazil (85) and India (59). The literature in this field has experienced multiple growth phases since 2000, with particularly rapid growth observed after 2019. The University of North Carolina (n = 34, 3.65%) is the leading institution in terms of publication output, primarily representing the U.S. Notably, the Journal of Periodontology and the American Journal of Obstetrics and Gynecology are the most frequently cited journals in the fields of periodontology and obstetrics, respectively. These publications are authored by 94 researchers, with Steven Offenbacher being both the most productive and most highly cited author, making significant contributions to the field. A visual analysis of keywords identifies "oral microbiota," "oral health," "adverse pregnancy outcomes," and "global burden" as emerging research hotspots in exploring the correlation between periodontal disease and adverse pregnancy outcomes.

Conclusions: This first bibliometric and visual analysis of periodontal disease and adverse pregnancy outcomes offers a concise overview of the field and suggests future research should focus on risk factors, high-risk populations, oral microbiota, mechanisms, interventions, and international collaboration.

Keywords: adverse pregnancy outcomes; bibliometric analysis; bidirectional; periodontal disease; risk factors.

Figure 1

Flowchart of the search strategy.

Figure 2

The number of published studies over time.

Figure 3

Cooperation network map of countries/regions. After standardizing the sample literature (932 publications), the data were imported into the software CiteSpace for analysis of the selected database, with the time period set from 2000 to 2023. The analysis item was set to “Country,” and a co-occurrence map of countries corresponding to studies on the relationship between PD and APOs was generated. The size of the nodes represents the number of publications, and the connections between nodes represent collaborations. The different colors represent the years of collaboration. The outermost purple rings indicate the levels of betweenness centrality (BC), with nodes of high BC considered as key points in the research field [g-index (k = 8), N = 73 (number of network nodes), E = 117 (number of connections), Density = 0.0674 (network density)].

Figure 4

Cooperation network map of institutions. After normalizing the sample literature (932 publications), the data was imported into CiteSpace for analysis. The selected time period spanned from 2000 to 2023, with the analysis focused on the “institution” level to construct a co-occurrence network map of institutions researching the relationship between PD and APOs. Node size represents the number of publications, while the links between nodes indicate collaborative efforts. Different colors represent the years of cooperation. The outermost purple ring denotes the level of centrality, with high centrality nodes considered key points in the research field. The network parameters are as follows: g-index (k = 4), N = 121 (number of network nodes), E = 140 (number of connections), and Density = 0.0193 (network density).

Figure 5

Cooperation network map of authors. After normalizing the sample literature (932 publications), the data was imported into CiteSpace for analysis. The selected time period spanned from 2000 to 2023, with the analysis focused on the “author” level to construct a co-occurrence network map of authors researching the relationship between PD and APOs. Node size represents the number of publications by each author, while the links between nodes indicate collaborative efforts. Different colors represent the years of cooperation. The network parameters are as follows: g-index (k = 2), N = 94 (number of network nodes), E = 85 (number of connections), and Density = 0.0194 (network density).

Figure 6

Co-citation network map of authors. After normalizing the sample literature (932 publications), the data was imported into CiteSpace for analysis. The selected time period spanned from 2000 to 2023, and the analysis focused on the “Author Co-citation Network” to construct a co-citation network map of authors researching the relationship between PD and APOs. Node size represents the number of citations each author received, while the links between nodes indicate co-citations within the same paper. Different colors represent the years in which the citations occurred. The network parameters are as follows: g-index (k = 1), N = 172 (number of network nodes), E = 424 (number of connections), and Density = 0.0288 (network density).

Figure 7

Co-cited network map of documents. After normalizing the sample literature (932 publications), the data were imported into CiteSpace for analysis. The selected time period spanned from 2000 to 2023, with the analysis focusing on “documents” to construct a co-citation network map of literature related to the relationship between PD and APOs. Node size represents the number of citations each document received, while links between nodes indicate that the documents were co-cited in the same paper. The different colors indicate the years in which citations occurred. The outermost purple ring signifies the degree of centrality, with nodes of high centrality regarded as key elements in the research field. The network parameters are as follows: g-index (k = 2), N = 186 (number of network nodes), E = 284 (number of connections), and Density = 0.0165 (network density).

Figure 8

Co-cited network map of journals. After normalizing the sample literature (932 publications), the data were imported into CiteSpace for analysis. The selected time period spanned from 2000 to 2023, with the analysis focusing on “journals” to construct a co-citation network map of journals related to the relationship between PD and APOs. Node size represents the number of citations each journal received, while links between nodes indicate co-citation in the same paper. The different colors indicate the years in which citations occurred. The outermost purple ring signifies the degree of centrality, with nodes of high centrality regarded as key elements in the research field. The network parameters are as follows: g-index (k = 3), N = 180 (number of network nodes), E = 361 (number of connections), and Density = 0.0224 (network density).

Figure 9

Keywords co-occurrence network map. After normalizing the sample literature (932 publications), the data was imported into CiteSpace for analysis. The selected time period spanned from 2000 to 2023, focusing on the “keywords” level to construct a co-occurrence network map of keywords related to the relationship between PD and APOs. Node size represents the frequency of keyword occurrences, while links between nodes indicate co-occurrence between different keywords. The years of occurrence are represented by different colors. The degree of centrality is shown by the outermost purple ring; nodes with high centrality are regarded as important locations in the research field. The network parameters are as follows: g-index (k = 7), N = 191 (number of network nodes), E = 289 (number of connections), and Density = 0.0159 (network density).

Figure 10

Keywords cluster network map.

Figure 11

Keywords timeline network map. This figure illustrates the evolutionary trends of keywords related to PD and APOs from 2000 to 2023. In the figure, nodes represent keywords, with the size of each node indicating the frequency of the keyword, and the color representing the time of the keyword's first appearance. Links between nodes indicate co-occurrence relationships between the keywords.

Figure 12

Keyword time zone map. In this figure, nodes represent keywords, with the size of each node indicating the frequency of the keyword, and the color representing the time of the keyword's first appearance. Links between nodes indicate co-occurrence relationships between the keywords.

Figure 13

Top 20 keywords with the strongest citation bursts. The red line represents years when keywords burst, and the blue line indicates years when keywords were used less frequently. Burst strength reflects the occurrence times of keywords in a certain period. Each keyword burst lasts for a minimum duration of 3 years.

Figure 14

(A) The number of adverse pregnancy outcomes (APOs) associated with gingivitis or periodontitis and periodontal disease (including both gingivitis and periodontitis, without significant distinction), respectively. (B) Quantitative statistics for each study design on PD and APOs. (C) Articles on the role of each key pathogen in APOs Types of studies and quantitative statistics. (D) The number of studies on risk (including independent risk of APOs, independent risk of PD, common risk of APOs and PD, and correlation risk of APOs and PD). (E) Quantitative statistics on ways to prevent APOs. (F) Classification of articles on the correlation between each type of APO and periodontal disease.