Microbiome Alterations With Xylitol (MAX) in Pregnancy

Inclusion Criteria: * Able to provide informed consent. For those under 18 years of age, consent will additionally be sought from the parent or guardian. * A singleton at \<20 weeks' gestation (based on ultrasound or best obstetric measurement) * Planning to deliver at Area 25 health center. * Willing to chew two pieces of gum thrice daily for 5 minutes after the morning, day and evening meals throughout pregnancy. * Willing to undergo at least two dental exams including oral microbiota sampling at study enrolment \<20 weeks of pregnancy, 28-30 weeks, at delivery/within 48 hours and 4-6 weeks after giving birth. * Willing to have at least two vaginal sampling at study enrolment \<20 weeks of pregnancy, 28-30 weeks, at delivery/within 48 hours and 4-6 weeks after giving birth. * Able to speak Chichewa or English. * Cognitively aware enough to be able to participate in the study. * Willing to consent to all required aspects of protocol including allowing collection of placenta specimens, infant oral swab and meconium/stool sampling at birth/within 48 hours and 4-6 weeks after. Exclusion Criteria: * Those who upon screening and enrolment but dislike the taste of the gum and state they will not chew the gum throughout pregnancy. * Gravidae with known or suspected non-viable pregnancy (including life threatening congenital anomalies such as cardiac, neurological or others). * Pregnant individual has a life-threatening diagnosis such as cancer requiring treatment during pregnanc…