Clinical Oral Investigations

, Volume 22, Issue 3, pp 1263–1271 | Cite as

Association between high risk for preterm birth and changes in gingiva parameters during pregnancy—a prospective cohort study

  • Anne Brigitte Kruse
  • Anja C. Kuerschner
  • Mirjam Kunze
  • Johan P. Woelber
  • Ali Al-Ahmad
  • Annette Wittmer
  • Kirstin Vach
  • Petra Ratka-Krueger
Original Article



The objective of this study was to investigate clinical and microbiological gingival changes during pregnancy in women without periodontal disease. Additionally, these parameters were to be compared in women with high risk for preterm birth and women with a normal course of pregnancy.

Method and materials

Group I consisted of 40 subjects at high risk for preterm birth, while group II involved 49 subjects with a normal course of pregnancy. The control group (III) was made up of 50 non-pregnant women. Clinical parameters (plaque index, gingival index, probing pocket depths, gingival swelling, bleeding on probing) and microbiological changes were monitored during pregnancy and 2–4 weeks after parturition.


In the high-risk preterm group (I), 19 women could be included in data analysis. This group was compared to 41 women in the normal pregnancy group (II) and 50 non-pregnant women (III). Gingival inflammation was significantly higher in women with high risk for preterm birth (I) compared to non-risk pregnant women (II, p < 0.05). In addition, in this group (I), the subgingival amounts of Fusobacterium nucleatum (> 105) were found to be significantly higher after childbirth compared to non-pregnant women (p < 0.05).


Even without having periodontal disease, women with high risk for preterm birth showed worse clinical values compared to non-risk pregnant and non-pregnant women and an increased detection of Fusobacterium nucleatum after delivery.

Clinical relevance

High risk for preterm birth might be associated with the occurrence of increased gingival inflammation.


Preterm birth Pregnancy Periodontal Gingivitis Microbiology 



The authors like to thank Markus Kaiser, Barbara Dannenhauer, Dr. Julia Blank, Dr. Susanne Proksch, and Prof. Nadine Schlüter for supporting the practical realization and publication of this study.

Authors’ contribution

ACK and PRK developed the research question; ABK, ACK, MK, JPW, AA, KV, and PRK developed the study protocol; ACK, ABK, and JPW conducted the clinical examinations; AA and AW conducted the microbiological analysis; KV conducted the statistical analysis; ABK drafted the primary version of the paper; and ACK, PRK, MK, JPW, AA, and AW finalized the paper and approved the final version.


The study was mainly based on institutional funding, financially supported by the German Society for Dental and Oral Medicine (DGZMK) and supported with products from Glaxo Smith Kline, Braun Oral B©, and Hain Life Science©.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Availability of data and materials

The dataset supporting the conclusions of this article is included within the article and its additional files.

Supplementary material

784_2017_2209_MOESM1_ESM.doc (40 kb)
ESM 1 (DOC 40 kb)
784_2017_2209_MOESM2_ESM.doc (83 kb)
ESM 2 (DOC 83 kb)


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Center for Dental Medicine, Department of Operative Dentistry and PeriodontologyUniversity Freiburg Medical CenterFreiburgGermany
  2. 2.Private Dental Practice, Dres. Kuerschner & KuerschnerFriedrichshafenGermany
  3. 3.Department for Obstetrics and Gynaecology, Division of PerinatologyUniversity Freiburg Medical CenterFreiburgGermany
  4. 4.Institute of Medical Microbiology and Hospital HygieneUniversity Freiburg Medical CenterFreiburgGermany
  5. 5.Department of Medical Biometry and Medical InformaticsUniversity Freiburg Medical CenterFreiburgGermany

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