Sugarless Gum May Have the Potential to Prevent Preterm Births – A Study Finds

A recent research study has revealed that xylitol, a plant- and fruit-based sugar substitute, could hold the key to preventing periodontal disease-induced pregnancy-related disorders among women, particularly preterm births. The efficacy of xylitol to prevent preterm birth stems from its inherent prebiotic properties that prevent the growth of harmful, disease-causing bacteria.

By Dr. Mehmood Asghar

Oral health disorders, including tooth decay and periodontal disease, are associated with many systemic illnesses such as heart disease, diabetes, Alzheimer’s, respiratory diseases, and osteoporosis – the so-called oral-systemic link (Assiri et al., 2020; Brittany Ashenfelter et al., 2021). These are significant, potentially life-threatening diseases that affect women across their lifespans.

Periodontal Disease and Pregnancy-related Disorders

Another serious risk factor among women with oral diseases is preterm or low-weight birth. It has been estimated that over 40% of pregnant women have some form of periodontal disease, making them at-risk of developing pregnancy-related complications, including preterm birth, which is the leading cause of neonatal morbidity in the United States, costing approximately $26.2 billion annually. A recent systematic review showed that periodontitis doubled the risk of preterm birth in women of child-bearing age (Manrique‐Corredor et al., 2019). According to the American College of Obstetricians and Gynecologists, preterm birth is more prevalent among African American mothers who smoke or utilize public assistance programs.

Although optimal oral hygiene maintenance and regular dental checkups are the first-line defenses against pregnancy-related complications caused due to oral disorders, the lack of access to dental healthcare among disadvantaged and poor populations is a significant hurdle in preventing preterm or low-weight births among pregnant women. However, a recent research study has shown a ray of hope; something as simple and inexpensive as sugarless chewing gum may hold the key in preventing periodontal disease-induced pregnancy-related disorders.

Sugarless Chewing Gum and Preterm Birth Prevention

This study, conducted on women belonging to the African country of Malawi, showed slightly decreased rates of premature births among women who chewed a xylitol-based sugarless gum compared to women who didn’t. According to one of the researchers, Dr. Kjersti Aagaard, an obstetrician and gynecologist at Houston's Baylor College of Medicine, Malawi was chosen for this study as this country has high rates of preterm births – over 20% of children being born prematurely.

How Was the Study Conducted?

The researchers enrolled 10,000 women from Malawi over six years, where some women joined before getting pregnant while others were enrolled in the first half of pregnancy. At four health centers, participating women were given oral hygiene instructions and were asked to chew a xylitol-based gum twice a day. At four other centers, a control group of women only received oral hygiene instructions.

The Interesting Results

Interestingly, the rate of preterm births before 37 weeks was lower in women who chewed the gum (14%) than in the control population (17%). However, another interesting finding was the decreased risk of late preterm births – between 34 and 37 weeks of pregnancy. This finding is clinically relevant as research suggests that late preterm birth babies are at a higher risk of developing medical complications like feeding difficulties, respiratory problems, and developmental disorders.

What's So Special About Sugarless Chewing Gum?

Researchers in this study added xylitol as a sugar substitute in the chewing gum. Xylitol, a constituent of various plants and fruits, is commonly used as a sugar substitute. Besides, it has also been shown to possess prebiotic properties, meaning that it stimulates the growth of healthy bacteria in the body. Furthermore, the current study has shown that xylitol can alter the makeup of bacteria in the oral cavity – replacing the harmful bacteria with more beneficial ones. Although it is unknown how xylitol prevents preterm births, it is believed xylitol-based gums can prevent the growth of disease-causing bacteria, which besides causing periodontitis and other systemic illnesses, also cross the placental barrier under favorable conditions to cause pregnancy-related complications.

The Conclusion

The promising results of this study have paved the way forward to finding more effective methods to overcome pregnancy disorders caused by dental diseases. Furthermore, the existing body of proof suggests that regular dental visits during pregnancy can reduce the risk of preterm births. So, it would be logical to combine a preventive oral health regimen with the use of xylitol-based sugarless gums during pregnancy.

Author: Dr. Mehmood Asghar is a dentist by profession and an Assistant Professor of Dental Biomaterials at the National University of Medical Sciences, Pakistan. Dr. Asghar received his undergraduate and postgraduate dental qualifications from the National University of Science and Technology (NUST). He is also currently pursuing a Ph.D. in Restorative Dentistry from Malaysia. Apart from his hectic clinical and research activities, Dr. Asghar likes to write evidence-based, informative articles for dental professionals and patients. Dr. Asghar has published several articles in international, peer-reviewed journals.


Assiri, K. I., Sandeepa, N. C., Asiri, R. S., Mulawi, S. A., Najmi, S. M., & Srivastava, K. C. (2020). Assessment of oral–systemic disease association amongst dental patients: A retrospective panoramic radiographic study. The Journal of Contemporary Dental Practice, 21(7), 748-755.

Brittany Ashenfelter, M., AAS, L., & CDA, E. (2021). The oral systemic link between periodontal disease and systemic disease. Dental Assistant, 90(4), 10-13.

Manrique‐Corredor, E. J., Orozco‐Beltran, D., Lopez‐Pineda, A., Quesada, J. A., Gil‐Guillen, V. F., & Carratala‐Munuera, C. (2019). Maternal periodontitis and preterm birth: Systematic review and meta‐analysis. Community dentistry and oral epidemiology, 47(3), 243-251.

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