The PROBE study – Preventing adverse pregnancy and birth outcomes by periodontal treatment during pregnancy

Periodontitis (gum disease) is a common condition of oral inflammation caused by bacteria. Research shows that being pregnant increases the risk of periodontal disease due to normal hormonal changes related to pregnancy. The hormone changes lead to general increased blood flow, which results in swelling of the gums in the periodontium, increasing the risk of plaque retention and risk of gingival infection that may progress to periodontitis if untreated. Furthermore, the systemic inflammation caused by periodontitis during pregnancy followed by metabolic disturbances has been found to be a risk factor for preterm birth, low birth weight (LBW), development of preeclampsia and gestational diabetes (GDM). Such disturbances early in life can cause infant mortality and morbidity with great costs to the individual the family, and to society. In Denmark, the prevalence of periodontitis has not been systematically investigated during pregnancy. The Danish Dental Association provides national data separated on age, region and gender. The data show that only about 60 % of all women in the childbearing age (18-39 years) in Denmark are seeing a dentist on a regular basis. It is expected that the prevalence of periodontitis among those not seeing a dentist on a regular basis is high, more than 50 %.

The overarching aim of the PROBE study is to investigate in pregnant women, who do not seek dental care on a regular basis, with periodontitis whether periodontal treatment during pregnancy can beneficially influence fetal growth, preterm delivery, birth weight and adverse pregnancy outcomes.

The PROBE study is a controlled intervention study aiming to include 600 pregnant women with periodontitis. The women will be recruited from either Holbæk Hospital or Nykøbing Falster Hospital during their routine nuchal translucency scan in week 11-13 of gestation and subsequently be screened for periodontitis by a dentist.

Women, enrolled in the PROBE study, will be treated for their periodontitis either during pregnancy (intervention group) or after giving birth (control group). The included women will be offered up to five treatments over a 4-month period in total. Inflammatory, hormonal and glucose markers will be collected for all 600 women at week 11 to 13 of gestation, week 19-21 of gestation and again at week 35-37 of gestation. Apart from blood samples and the oral clinical measures, demographic information and qualitative questionnaires related to diet, smoking status, physical activity and family status will be collected twice during the study. The first time at baseline (week 11-13 of gestation) and the second time at week 35-37 of gestation

The study is conducted in collaboration with Steno Diabetes Center Zealand and the Gynaecological Obstetric Department at Holbæk Hospital and Nykøbing Falster Hospital.