Periodontal Disease In Pregnant Women Research Articles

A Case Control Study to Identify the Risk Factors of Periodontitis in Pregnant Women in District Faisalabad

Good oral health is the indicator of good general health of an individual. Poor oral hygiene is the most important factor to cause dental diseases. Advanced stage of gum disease is called periodontitis. Periodontal disease affects the gum and jaw bone. Gingival health is compromised during pregnancy due to hormonal changes. This is called pregnancy gingivitis which is initial stage of periodontitis. Method: A matched case control study was conducted to identify the risk factors of periodontitis during pregnancy. Study duration was three months and it was conducted in tertiary care hospitals of Faisalabad (Madina teaching hospital, D.H.Q, Allied hospital). Cases were matched on the bases of month of pregnancy and number of pregnancy with control. Study sample was 282 (141 cases and 141 controls). Data were collected through questionnaire which comprises of two sections one is demographic data and one is questions related risk factors. Findings: Data were entered on SPSS software value was less than 0.05 and confidence interval was 95%. Multi logistic regression test was apply to identify the potential risk factors of periodontitis. Results have shown the different risk factors which can cause periodontitis. The most significant risk factors e.g. family history, systemic illness in which diabetes and hypertension were most common, poor eating habits due to lack of knowledge about oral health were common. Results will share with the health authorities of concerned hospitals.

Oral health status of pregnant women in Kumamoto Prefecture

As part of Kumamoto RAINBOW Project, which is a multifaceted implementation for the prevention of premature labor, we investigated pregnant women's oral health status and assessed the effects of dental care and oral hygiene instruction. We examined the oral health status of pregnant women both in the first and the second half of pregnancy in Kumamoto Prefecture from 2012 to 2014. The Community Periodontal Index (CPI) was used to assess the periodontal condition, and women having periodontal pockets with a depth ≥4 mm were defined as suffering from periodontitis. This project covered the cost of dental checkups. Of the 20,702 pregnant women enrolled in this project, 9,527 (46.0%) received dental checkups during the first half of pregnancy. The response rate of dental examinations in Kumamoto City (63.3%), the capital city of Kumamoto Prefecture, was significantly higher than that of the other local areas (32.0%). In Kumamoto City, 4,890 women (83.4%) had dental examinations at the city office when they received a maternal handbook. Three thousand forty-five women (32.0%) had periodontitis. Among 1,605 women who received oral examinations twice at dental clinics, 698 received nonsurgical interventions. Dental interventions significantly decreased the prevalence of periodontitis in pregnant women (55.1% to 45.1%). Dental examinations without interventions also significantly decreased the prevalence of periodontitis (44.6% to 39.9%). Pregnant women living in Kumamoto City had higher rate of visits to dental clinics for checkups than those in other areas. Periodontitis was found in one-third of pregnant women. Not only dental interventions, but also dental examinations improve pregnant women's oral health status.

Periodontal health status and salivary parameters in pregnancy

Background: Pregnancy is considered a major risk factor for development and progression of periodontal disease. There are hormonal changes in both estrogen and progesterone hormones in addition to bacterial effect and poor oral hygiene that will enhance development of periodontal disease in pregnant women. Materials and methods: Seventy subjects were enrolled in the study, the subjects with an age range (20-35) years old without any history of systemic disease. The subjects were divided into 20 non-pregnant women they represent the control group (G I), 30 pregnant women with gingivitis (GII) and 20 pregnant women with periodontitis (GIII).All periodontal parameters (plaque index, gingival index, bleeding on probing, probing pocket depth and clinical attachment level) were recorded and 5ml of unstimulated saliva was collected for each subject. The collected saliva was centrifuged and clear supernatant was collected and kept frozen until biochemical analysis of salivary enzymes which included ALP, LDH and salivary Calcium. Results: No significant difference in the mean value of salivary ALP between GI and G II, while there is high significant difference between GI and GIII. There was significant difference in the salivary LDH and Ca levels between control group and group II, while there is highly significant difference of salivary LDH and Ca between group I and group III.There was significant difference in the number of bleeding sites, and probing pocket depth (PPD) among all groups. There was increase in the total number of all scores of PPD (score 1,2 and 3) GII and GIII compared to GI. Conclusions: Thepregnant women revealed more periodontal disease conditions (gingivitis and periodontitis) due to hormonal changes superimposed with microbial infection. Salivary enzymes (ALP, LDH) and salivary calcium are considered as good biochemical markers of periodontal tissue destruction and can be used to evaluate the effect of pregnancy on periodontal health status.

“Thinking Healthy” in Pregnancy: a Comment on Christian et al.

Increasing work shows that self-rated health correlates with actual health status, although the mechanisms through which this occurs remain unclear [1]. Christian et al.[2] explored this relationship in pregnant women by examining how perceived health status is associated with a number of objective health and demographic variables with an eye toward future work aimed at understanding how these relationships might affect birth outcome and infant health. The findings are consistent with existing literature in many ways, but importantly, there are components of the work which are of special relevance to understanding the mechanism(s) that may connect self-rated health to objective measures of health. An especially interesting inclusion is considering periodontal disease in pregnant women as a potential factor in perceived health status. One reason for exploring this connection is other work associating periodontal inflammation with low birth weight [3] and preterm birth [4]. Moreover, although data connecting periodontal disease to increases in circulating inflammatory cytokines is equivocal [5, 6], recent work has connected elevated serum inflammatory markers to shortened gestational age at birth [7], suggesting that examining the relationship between periodontal disease, circulating inflammatory markers, and birth outcome would be a worthwhile pursuit. To my knowledge, the Christian et al. study is the first to attempt to examine these factors together, although, regrettably, the frequency of preterm birth in the sample (9 out of 101) was too small for the analysis of these connections. Nevertheless, this approach is an important one, which should be pursued further. The oral health component of the study did yield an interesting finding that, along with others in the project, contributes to a better understanding of the factors which contribute to how a pregnant woman assesses her own health. Although periodontal disease was not associated with poorer self-rated health, women reporting bleeding gums assessed their own health status less positively than women who did not have bleeding gums, suggesting that environmental cues may play a role in self-assessment of health status. Consistent with this, the authors also found that higher BMI was associated with lower self-rated health. Of special interest is the finding that African-American women rated their health as excellent more often than Caucasian women, which, the authors suggest, might be due to relatively higher frequency of significant illness in the African-American community overall. This, again, suggests that external reference points may play a role in self-rated health for pregnant women and could provide targets for education or intervention. In conclusion, I echo the authors' assertion that understanding relationships between self-rated and actual health during pregnancy is important because prenatal visits are an ideal time to encourage positive health behaviors. Not only are pregnant women a “captive audience” as a result of being in the clinic with some frequency, but they also have raised awareness of how their behavior affects their unborn infant. This intriguing study underscores the need for more work in this area, especially given the increasing evidence that early experiences have lasting effects on development and across the lifespan[8].

Evaluation of socio-demographic variables affecting the periodontal health of pregnant women in Chandigarh, India

Background:The literature is replete with reports that pregnant women have an increased level of periodontal disease as compared with non-pregnant women of the same age. There are many studies correlating the effect of periodontal disease on the adverse pregnancy outcomes. The development of periodontal diseases during pregnancy can be influenced by factors such as preexisting oral conditions, general health, and socio-cultural background. There is very little data studying the effect of socio-demographic factors on the periodontal health of pregnant women. This study evaluated the periodontal status of a sample of pregnant women of Chandigarh and adjoining areas. The study also investigated the relationship between these variables and a series of demographic and clinical variables.Materials and Methods:The participants were 190 pregnant women attending Gynecology and Obstetrics outpatient department of Government Medical College and Hospital, Chandigarh. The participants were examined for their periodontal health and various socio-demographic variables were recorded on performas designed for the purpose of study. Statistical analysis was done.Results:The results revealed that the mean bleeding index scores and probing depth increased with statistical significance when the socio-economic status was lower (P<0.05). No significant differences were found in bleeding index scores and mean probing depth among different categories of profession, education, place of residence, and trimester of pregnancy (P>0.1). The plaque index was not significantly associated with the socio-economic status, profession, place of residence, and trimester of pregnancy (P>0.1).Conclusion:In the population of pregnant women investigated under this study, the clinical and socio-demographic characteristics showed non-significant correlation except socio-economic status which showed statistically significant correlation with bleeding on probing and pocket depth. Further studies may be required in Indian population to determine the association of periodontal diseases in pregnant women with socio-demographic variables.

Relationship between periodontal inflammation and fetal growth in pregnant women: a cross-sectional study

Periodontal disease in pregnant women, evaluated by probing pocket depth (PPD) or clinical attachment level (CAL), significantly increases the risk of subsequent preterm birth (PB) and/or low birth weight (LBW). However, PPD and CAL do not always reflect current periodontal tissue inflammation. Therefore, assessment of bleeding on probing index (BOP), an indicator of periodontal inflammation, may be appropriate. The objective of this cross-sectional study was to investigate the relationship between periodontal inflammation and fetal growth in pregnant women after periodontal treatment. We recruited 203 pregnant women (mean age 31.8±4.5years), including 20 subjects with periodontal inflammation and 183 periodontally healthy controls, after periodontal treatment. Fetal growth parameters as well as periodontal conditions were recorded. Perinatal gestational age was 39.4±1.3weeks; 8 subjects had a PB and 12 had an infant with a LBW. Results of multiple stepwise regression analysis indicated that birth length was negatively correlated with BOP% (β=-0.175; p=0.002). Fetal femur length, and birth length and weight among mothers with low periodontal inflammation were significantly higher than those among mothers with high periodontal inflammation (p<0.05). The LBW rate in the high periodontal inflammation group was significantly higher than that in the low periodontal inflammation group (p<0.05). These results suggest that periodontal inflammation is correlated with fetal femur length, birth weight, and birth length.

Maternal periodontal status and preterm delivery: a hospital based case-control study

Recent studies have presented evidence that periodontal disease in pregnant women may be a determining factor for preterm delivery. However, this finding has not been consistently observed. The present investigation was carried out to explore the association between maternal periodontal disease and preterm delivery in the state of Kerala, India. The case-control study had a sample of 300 (100 cases and 200 controls) postpartum women over 18 years of age. Cases were women who had undergone spontaneous preterm delivery (< 37 wk of gestation) and controls were women who delivered at term (≥ 37 wk of gestation). Standard, clinical and periodontal examinations were performed at the maternity wards, and the existence of an association between periodontal disease and preterm delivery was evaluated by means of a multivariate logistic regression model that also considered other risk factors for preterm delivery. Periodontitis was diagnosed in 25% of the mothers in the case group and in 14.5% of the mothers in the control group. Logistic regression analysis indicated a risk of nearly threefold for preterm delivery in mothers with periodontitis [adjusted odds ratio (OR(a) ) = 2.72; 95% confidence interval (CI): 1.68-6.84]. The other factors significantly associated with preterm birth were physical exertion (OR(a) = 2.80; 95% CI: 1.18-6.65), a previous history of preterm birth (OR(a) = 2.65; 95% CI: 1.20-5.83) and previous abortion/death of infant (OR(a) = 4.08; 95% CI: 1.56-10.65). Periodontal disease is a possible risk factor for preterm delivery in this population.

Contribution of periodontal disease in pregnant women as a risk factor for low birth weight

There would appear to be a positive association between mothers with periodontal disease and low birth-weight children.

109: Predictors of periodontal disease in pregnant women

109: Predictors of periodontal disease in pregnant women

Contribution of periodontal disease in pregnant women as a risk factor for low birth weight

Starting in the 1990s, several authors sought to investigate the hypothesis that periodontitis during pregnancy may contribute towards the birth of low-weight children. However, this relationship is still not well established. The aim of this study was to evaluate whether this oral infection is associated with this gestational event. This was a case-control study among 548 puerperae, of whom 164 were the mothers of low-weight live births (case group) and 384 were the mothers of live births of normal gestational weight (control group). They were selected at two public hospital units in two municipalities in the State of Bahia. From interviews and data gathered using live birth cards or birth certificates, information was obtained regarding age, height, previous diseases, marital status, socioeconomic situation, smoking and alcohol use. Mothers who presented at least four teeth on which one or more sites had a probing depth of greater than or equal to 4 mm, clinical attachment loss of greater than or equal to 3 mm and bleeding on probing, at the same site, were deemed to present periodontal disease. The data were analysed by stratification from logistic regression. Periodontal disease was diagnosed in 42.7% of the case group and 30% of the control group. A statistically significant association was found between periodontal disease and low birth weight (unadjusted OR = 1.74; 95% CI: 1.19-2.54), particularly among mothers with low schooling levels (adjusted OR = 2.30; 95% CI: 1.14-4.6). The findings suggest an association between periodontal disease and low birth weight among mothers with low education levels.

Evaluation of plasma C-reactive protein levels in pregnant women with and without periodontal disease: A comparative study.

Background and Objectives:Circulating C-reactive protein (CRP) levels are a marker of systemic inflammation and are associated with periodontal disease, a chronic bacterial infection associated with elevation of proinflammatory cytokines and prostaglandins. CRP has been associated with adverse pregnancy outcomes, including preterm delivery, preeclampsia, and intrauterine growth restriction. Furthermore, periodontal disease has been associated with increased risk of preterm low birth weight, low birth weight, and preterm birth. The present study was conducted to assess plasma CRP levels in pregnant women with and without periodontal disease; to evaluate the effect of periodontal therapy on the incidence of preterm delivery; and to compare the incidence of preterm delivery in pregnant women with and without periodontal disease.Materials and Methods:A total of 90 pregnant women aged between 18-35 years with gestational age between 12-28 weeks were recruited and divided into three equal groups (control group, study group, treatment group) of 30 each. Blood samples were taken for estimation of C-reactive protein levels from all groups at 12-20 weeks of gestation, determined using ultrasensitive turbidimetric immunoassay (QUANTIA-CRP US). The treatment group comprised plaque control, scaling, and root planning and daily rinsing with 0.2% chlorhexidine mouth before 28 weeks of gestation.Results:The mean value of C-reactive protein levels in subjects with periodontal disease was higher compared to control group i.e., 1.20 ± 0.247 mg/dl and 1.22 ± 0.250 mg/dl, respectively, compared to 0.713 ± 0.139 mg/ dl (P = 0.001). The mean value of CRP levels before treatment was greater than the mean value after treatment i.e., 1.22 ± 0.25 compared to 0.84 ± 0.189 (P < 0.001). The incidence of preterm delivery (< 37 weeks) was 31.7% in the periodontal disease group (study group) compared to 8.3% in the control group (P = 0.001). The incidence of preterm delivery in the treatment group was 15.0% compared to 31.7% in the nontreatment group (study group).Conclusion:The findings from the study suggest that periodontal disease in pregnant women is associated with increased C- reactive protein levels in early pregnancy, incidence of preterm delivery is higher in pregnant women with periodontal disease compared to healthy controls, periodontal therapy during pregnancy reduces plasma CRP levels and there is decrease in incidence of preterm delivery after periodontal therapy.

Screening for periodontitis in pregnant women with salivary enzymes

To develop a test for the screening of pregnant women for periodontitis using saliva prior to a dental examination. A cross-sectional research design was employed. Whole unstimulated saliva was collected from 221 pregnant women prior to a dental examination at the Amagasaki Public Health Office and levels of activity of lactate dehydrogenase (LDH) and alkaline phosphatase (ALP), and of occult blood in the saliva were measured. The data were compared with Community Periodontal Index of Treatment Needs (CPITN) scores. The diagnostic performance of LDH, ALP, and occult blood was determined in terms of sensitivity, specificity, and the area under receiver operating characteristics (ROC) curves. The optimal combination of parameters for screening periodontitis was determined at maximum sensitivity and specificity. Periodontitis (CPITN 3, 4) in 19 women (8.6%) and gingivitis (CPITN 1, 2) in 129 women (58.4%) were observed. The activity levels of LDH and ALP were significantly higher in the pregnant women with periodontitis than those with gingivitis or a healthy periodontium. To distinguish between the pregnant women with periodontitis and the others, a cut-off value of 684 IU/L for LDH and of 75 IU/L for ALP were determined by a ROC analysis. The test combining LDH, ALP, and occult blood showed the highest diagnostic performance; with a sensitivity value of 0.90, specificity value of 0.62, positive predictive value of 0.18, and negative predictive value of 0.98. A test combining the parameters salivary LDH, ALP and occult blood is useful for screening pregnant women for periodontitis.

Periodontal treatment in pregnant women improves periodontal disease but does not alter rates of preterm birth

This was a multicentre randomised controlled trial (RCT). Pregnant women were divided into two groups. Those to whom dental treatment was given had up to four visits of periodontal scaling and root planing using ultrasonic and hand instruments, with local anaesthesia as needed. Treatment recipients were also given instruction in oral hygiene and monthly tooth polishing and re-instruction in oral hygiene, with scaling and planing as needed. Control patients received only a brief oral examination at monthly follow-ups but attended the same number of visits as the treatment group. Patients in the control group were offered the same periodontal therapy after delivery. The primary outcome was gestational age at delivery. Secondary outcomes included birth weight, the proportion of infants who were small for gestational age, Apgar scores, and admissions to a neonatal intensive care unit. Preterm birth (before 37 weeks of gestation) occurred in 49 out of 407 women (12.0%) in the treatment group (resulting in 44 live births) and in 52 out of 405 women (12.8%) in the control group (resulting in 38 live births). Although periodontal treatment improved periodontitis measures (P<0.001), it did not significantly alter the risk of preterm delivery [P 0.70; hazard ratio for treatment group versus control group, 0.93; 95% confidence interval (CI), 0.63-1.37]. There were no significant differences between the treatment and control groups in mean babies' birth weights (3239 g versus 3258 g; P 0.64) or in the rate of delivery of infants who were small for gestational age (12.7% versus 12.3%; odds ratio, 1.04; 95% CI, 0.68-1.58). There were five spontaneous abortions or stillbirths in the treatment group, compared with 14 in the control group (P 0.08). Treatment of periodontitis in pregnant women improves periodontal disease and is safe but does not significantly alter rates of preterm birth, low birth weight or foetal growth restriction.

Treatment of Periodontal Disease and the Risk of Preterm Birth

Maternal periodontal disease has been associated with an increased risk of preterm birth and low birth weight. We studied the effect of nonsurgical periodontal treatment on preterm birth. We randomly assigned women between 13 and 17 weeks of gestation to undergo scaling and root planing either before 21 weeks (413 patients in the treatment group) or after delivery (410 patients in the control group). Patients in the treatment group also underwent monthly tooth polishing and received instruction in oral hygiene. The gestational age at the end of pregnancy was the prespecified primary outcome. Secondary outcomes were birth weight and the proportion of infants who were small for gestational age. In the follow-up analysis, preterm birth (before 37 weeks of gestation) occurred in 49 of 407 women (12.0%) in the treatment group (resulting in 44 live births) and in 52 of 405 women (12.8%) in the control group (resulting in 38 live births). Although periodontal treatment improved periodontitis measures (P<0.001), it did not significantly alter the risk of preterm delivery (P=0.70; hazard ratio for treatment group vs. control group, 0.93; 95% confidence interval [CI], 0.63 to 1.37). There were no significant differences between the treatment and control groups in birth weight (3239 g vs. 3258 g, P=0.64) or in the rate of delivery of infants that were small for gestational age (12.7% vs. 12.3%; odds ratio, 1.04; 95% CI, 0.68 to 1.58). There were 5 spontaneous abortions or stillbirths in the treatment group, as compared with 14 in the control group (P=0.08). Treatment of periodontitis in pregnant women improves periodontal disease and is safe but does not significantly alter rates of preterm birth, low birth weight, or fetal growth restriction. (ClinicalTrials.gov number, NCT00066131 [ClinicalTrials.gov].).

Maternal periodontal disease is related to preterm low birth weight delivery in a group of Brazilian women

Article Title and Bibliographic Information Association between periodontitis and low birth weight: a case control study. Moliterno LF, Monteiro B, Figueredo CM, Fischer RG. J Clin Perio 2005;32:886-90. Level of Evidence 3b Purpose/Question To examine the potential association between delivery of preterm, low birth weight infants and periodontitis in pregnant women. Source of Funding Not specified Type of Study/Design Case-control study

Is there an association between periodontal disease, prematurity and low birth weight? A population‐based study

The relationship between periodontal diseases in pregnancy and children born prematurely or with low birth weight has been increasingly investigated, showing inconclusive results. To test the link between periodontal disease in pregnant women and low birth weight or prematurity. A population-based, cross-sectional study was carried out in Southern Brazil. The sample consisted of 449 parturients who were interviewed and examined up to 48 h post-partum. Three outcomes were investigated: low birth weight, prematurity and prematurity and/or birth weight. Periodontal disease, the exposure, was defined as (i) at least one site with a periodontal pocket; (ii) the presence of pockets at four or more sites. Socio-demographic information relating to health and maternal habits was collected through a questionnaire and by hospital medical records. Simple and multiple regression analysis was performed. There was no statistically significant association between periodontal disease and low birth weight. Periodontal pocket was not associated with low birth weight and/or pre-term birth after being adjusted. A periodontal pocket in at least one site was associated with prematurity (odds ratio=2.6; 95% confidence interval 1.0-6.9) even after adjusting for maternal schooling, parity, number of previous children of low birth weight, number of pre-natal consultations and body mass index. After the introduction of variables relating to maternal health during pregnancy, this association disappeared. No association was found between periodontal disease in the mother and the low birth weight. An association between prematurity and periodontal pockets was found but it was confounded by maternal health variables.

Periodontal disease awareness among pregnant women and its relationship with socio‐demographic variables

Certain conditions may have an affect on gingival status and may aggravate pre-existing disease, especially in persons with poor oral hygiene. Pregnancy is one of these conditions. In addition, there is evidence in the literature suggesting an association between periodontal diseases in pregnant women and giving birth to premature, low-birth infants. The purpose of this study was to evaluate the degree of periodontal health knowledge, and awareness, among pregnant women in Jordan. This was carried out by cross-sectional survey using self-administered, structured questionnaires distributed at six maternity care centres in Irbid City. Questionnaire items addressed personal and socio-demographic variables and periodontal health awareness and knowledge of pregnant women. Women (n = 300) were randomly chosen from attendants to these centres. Of the 300 questionnaires distributed, only 275 pregnant women ages 16-45 years with a mean of 29 year responded and were included in the study. Data were analysed by chi-squared test with the level of significance set at (P < 0.05). About one-third of the participants had secondary level of education; it appeared that a minority of the pregnant women had knowledge or ability to identify dental plaque (16.4%) and its harmful effects (22.5%), while most of them (88%) were aware that bleeding gums indicated the presence of periodontal disease. The differences in the responses to knowledge questions were only significant for question number one (What is plaque?) among different educational levels and groups. This study revealed that (71.6%) of the pregnant women knew the main cause of gum disease; however 56% of them do not believe that frequency of teeth brushing should be increased during pregnancy and only 5.1% believed there might be a relationship between gum diseases and premature labour. Knowledge and awareness for pregnant women about their teeth and gingival condition is generally poor. Pregnant women need accurate information about their teeth and oral health. Simple educational preventive programmes on oral self-care and disease prevention before and during pregnancy should be provided to improve oral health.

Untreated periodontitis in pregnant women may increase the risk for a low-birthweight infant

Untreated periodontitis in pregnant women may increase the risk for a low-birthweight infant

Relationship between periodontal disease in pregnant women and the nutritional condition of their newborns.

The purpose of this study was to determine whether maternal periodontal disease (PD) could be associated with the nutritional condition of newborns. After controlling for traditional risk factors for premature childbirth and low birth weight, 69 mothers were selected: 13 were periodontally healthy and 56 had varying stages of PD. They and their newborns formed the study population. PD presence and severity were clinically determined using Russell's periodontal index. The nutritional evaluation of the newborns was determined by Lubchenco's modified growth patterns. A decrease in the average newborn's weight and gestational age was observed as the mother's level of PD increased. Correlation analysis demonstrated a highly significant clinical relationship between more severe PD and lower birth weight (r = -0.49; P < 0.01); a highly significant relationship was also clinically demonstrated between increasing PD severity and decreasing gestational age of the newborn babies (r = -0.59; P < 0.01). There were significant differences in the weight and gestational age of the newborns of mothers with PD. These data suggest that PD in pregnant women could be a clinically significant risk factor for preterm deliveries and low birth weight. There was considerable variability in the results, and these preliminary findings need to be confirmed in larger studies.

Relationships between periodontal health, salivary steroids, and Bacteroides intermedius in males, pregnant and non-pregnant women.

Relationships between four steroids, determined by radio-immunoassay of whole saliva, and clinical and bacteriological parameters were studied in 90 subjects: males, menstruating females, and pregnant females. Pocket depths and both plaque and gingival bleeding scores were recorded. Total counts and percentages of Gram-negative organisms Bacteroides and B. intermedius were determined from anaerobic cultures of subgingival plaque from 9-14 subjects in each group. None of the clinical parameters for the pregnant females differed significantly from those of non-pregnant females, nor did these parameters show any significant correlation with progression of pregnancy. No correlations were detected between bacterial and clinical parameters in the pregnant group. There were no statistically significant differences between the total bacterial counts from the three groups, yet males had significantly higher proportions of Gram-negative bacteria, Bacteroides, and B. intermedius, than did pregnant and non-pregnant females. Proportions of B. intermedius did not differ significantly between the two female groups, nor was there any correlation with progression of pregnancy. While some steroids appeared to affect some clinical or bacteriological parameters in some groups, no obvious patterns consistent with different steroid levels were detected. The results do not indicate that increased hormone levels cause more severe periodontal disease in pregnant women, nor that high salivary steroid levels result in increased recovery of B. intermedius from subgingival plaque.