title: Gingival changes during pregnancy: III. Impact of clinical, microbiological, immunological and socio-demographic factors on gingival inflammation.
abstract: OBJECTIVE
  To identify predictor variables involved in exacerbated gingival inflammation associated with pregnancy.
  
  
  METHODS
  In this cohort study, 48 pregnant and 28 non-pregnant women without periodontitis were included. The pregnant women were evaluated in the first, second and third trimester and at 3 months postpartum, whilst the non-pregnant women were evaluated twice, with a 6-month interval. At each visit, clinical [plaque index (PlI) and gingival index (GI)], hormonal (salivary progesterone and estradiol), immunological [gingival crevicular fluid interleukin-1β, interleukin-6, tumour necrosis factor-α (TNF-α) and prostaglandin-E(2) ] and microbiological (periodontal pathogens culture) evaluations were performed. Statistical analysis was undertaken using exhaustive chi-square automatic interaction detection (exhaustive CHAID) to analyse the predictive value of the independent outcomes to develop pregnancy GI.
  
  
  RESULTS
  PlI was the strongest predictor implicated in the GI throughout pregnancy and after delivery. During the second and third trimesters the presence of Porphyromonas gingivalis significantly contributed to the worsening of gingival inflammation. When compared with the non-pregnant group, significant differences were found in TNF-α amounts and concentrations and in the third trimester site-specific GI.
  
  
  CONCLUSIONS
  Bacterial challenge to the gingival tissues, both quantitatively (PlI) and qualitatively (harbouring P. gingivalis) appears to affect the level of gingival inflammation observed during pregnancy.
authors.affiliation: Section of Periodontology, School of Dentistry, Complutense University of Madrid, Spain. anacarrillodea@gmail.com
authors.forename: Ana
authors.initials: A
authors.lastname: Carrillo-de-Albornoz
authors.forename: Elena
authors.initials: E
authors.lastname: Figuero
authors.forename: David
authors.initials: D
authors.lastname: Herrera
authors.forename: Pedro
authors.initials: P
authors.lastname: Cuesta
authors.forename: Antonio
authors.initials: A
authors.lastname: Bascones-Martínez
mesh_terms: D000328:Adult; D000465:Algorithms; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003663:Decision Trees; D003773:Dental Plaque / Q000382:microbiology*; D003774:Dental Plaque Index; D015232:Dinoprostone / Q000378:metabolism; D004958:Estradiol / Q000378:metabolism; D005260:Female; D005883:Gingival Crevicular Fluid / Q000737:chemistry* / Q000276:immunology; D005891:Gingivitis / Q000276:immunology / Q000382:microbiology* / Q000523:psychology; D006801:Humans; D053583:Interleukin-1beta / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D015999:Multivariate Analysis; D010512:Periodontal Index; D016966:Porphyromonas gingivalis / Q000502:physiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology / Q000382:microbiology* / Q000523:psychology; D011264:Pregnancy Trimesters; D011374:Progesterone / Q000378:metabolism; D011446:Prospective Studies; D012463:Saliva / Q000737:chemistry; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D055815:Young Adult
chemical_list: D053583:Interleukin-1beta; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D011374:Progesterone; D004958:Estradiol; D015232:Dinoprostone