Background <p>Periodontal disease is a highly prevalent inflammatory condition that tends to worsen during pregnancy due to hormonal, vascular, and immune changes. Emerging data suggests that poor maternal periodontal health may influence pregnancy outcomes, yet it often remains overlooked and uncared in routine antenatal care.</p> Objectives <p>This review was written to summarize the global and Indian burden of periodontal disease in pregnancy, explain its biological mechanisms, and evaluate its association with adverse perinatal outcomes, along with available preventive and treatment strategies.</p> Methods <p>A targeted search of PubMed, Google Scholar, and Embase (2015 onwards) was conducted. Of 206 articles screened, 44 met eligibility criteria and were included. Studies describing epidemiology, pathophysiology, diagnostic features, maternal–foetal effects, and treatment outcomes were reviewed. Select earlier studies were added for diagnostic and therapeutic clarity.</p> Results <p>Globally, pregnancy-related gingivitis affects majority of women, with periodontitis prevalence varying widely across regions, including India. Periodontal inflammation may elevate systemic cytokines and bacterial endotoxins, contributing to preeclampsia, gestational diabetes, preterm birth, low birth weight, and foetal growth restriction. Non-surgical periodontal therapy in the second trimester is safe and may modestly reduce preterm birth and low birth weight, though findings vary across studies.</p> Conclusion <p>Maternal periodontal disease is a modifiable risk factor with important implications for pregnancy outcomes. Integrating oral health screening, counselling, and timely periodontal care into antenatal services could support healthier maternal and neonatal outcomes. Further well-designed trials are needed to define the magnitude of benefit from treatment.</p>