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Objectives The objective of this study was to examine the association between the oral microbiome and pregnancy outcomes, specifically healthy or preterm low birth weight (PLBW) in individuals with and without periodontal disease (PD). Material and methods In this prospective clinical trial, we recruited 186 pregnant women, 17 of whom exhibited PD and delivered PLBW infants (PD-PLBW group). Of the remaining women, 155 presented PD and delivered healthy infants; 18 of these subjects with similar periodontal condition and age matched to the PD-PLBW group, and they became the PD-HD group. From the total group, 11 women exhibited healthy gingiva and had a healthy delivery (HD) and healthy infants (H-HD group), and 3 exhibited healthy gingiva and delivered PLBW infants (H-PLBW group). Periodontal parameters were recorded, and subgingival plaque and serum were collected during 26–28 gestational weeks. For the plaque samples, microbial abundance and diversity were accessed by 16S rRNA sequencing. Results Women with PD showed an enrichment in the genus  Porphyromonas ,  Treponema , and  Filifactor , whereas women with healthy gingiva showed an enrichment in  Streptococcus ,  Actinomyces , and  Corynebacterium , independently of the birth status. Although no significant difference was found in the beta diversity between the 4 groups, women that had PLBW infants presented a significantly lower abundance of the genus  Neisseria , independently of PD status. Conclusion Lower levels of  Neisseria  align with preterm low birth weight in pregnant women, whereas a higher abundance of  Treponema, Porphyromonas ,  Fretibacterium , and  Filifactor  and a lower abundance of  Streptococcus  may contribute to periodontal disease during pregnancy. Clinical relevance The oral commensal  Neisseria  have potential in the prediction of PLBW.

Clinical study showing a lower abundance of Neisseria in the oral microbiome aligns with low birth weight pregnancy outcomes