Background: Studies on the possible influence of periodontal disease on preterm birth (PB) and/or low birth weight (LBW) remain inconclusive especially due to the difficulty of assessing the numerous pregnancy risk factors. The aim of this study is to compare periodontal parameters in non‐smoking pregnant women in Madagascar.Methods: A cohort study with 204 pregnant women (mean age: 25.6 years) was conducted in public prenatal care health clinics in Madagascar. Socioeconomic and obstetric information was obtained. Periodontal parameters, such as periodontal probing depth and clinical attachment loss (AL), were recorded during the second semester of pregnancy.Results: The mean gestational age was 37.8 weeks. At delivery, 42 newborns (20.6%) were PBs (<37 weeks) and 22 newborns (10.8%) were of LBW (<2,500 g). Nine (4.4%) newborns were PBs and of LBW (PLBW), and 149 newborns (73%) were of normal birth. The mean plaque index and papillary bleeding index were significantly higher (P <0.05 and P <0.001, respectively) in the PB group than in the normal birth group. Periodontitis (at least three sites from different teeth with clinical AL ≥4 mm) was significantly associated with PB (P <0.001), LBW (P <0.001), and PLBW (P <0.01). The rates of periodontitis were considerably higher in PB (78.6%), LBW (77.3%), and PLBW (77.8%) groups than in the full‐term (8.6%), normal weight (16.5%), and normal birth (2.7%) groups.Conclusion: The strong association among periodontitis, PB, and LBW in this study highlights the need to consider the periodontal status of pregnant women in Madagascar.