Pregnant women with periodontitis have a threefold higher risk of preeclampsia than those without gum disease, according to a review that strengthens the evidence for an association.

In addition, the latest studies suggest more women may be at risk than previously thought, say the researchers led by the Charles Perkins Centre Nepean at the University of Sydney.

Unlike previous studies, the latest review shows the risk of preeclampsia — defined as blood pressure at or above 140/90mmHg plus proteinuria after 20 weeks’ gestation — is not limited to women with several concomitant clinical signs of periodontitis.

High blood pressure was associated with pocket depth or clinical attachment loss alone, whereas a 2013 meta-analysis found an association only in participants who had more than one sign.