الفهرس 
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Abstract
gingivitis is the inflammatory condition of the soft tissues surrounding the teeth and the first stage of the periodontal diseases, without early treatment it progress to cause periodontitis which include the destruction of the supporting structures of the teeth, including the periodontal ligament, bone, cementum and soft tissues (Naser et al., 2012).
As regard to pregnancy, it involves complex physical and hormonal changes that have a significant impact on almost every organ system, including the oral cavity. Mainly, there is an increase in the hormones of estrogen and progesterone. These hormones have been found to affect periodontal disease progress and wound healing. In addition that both these hormones lead to increased gingival vascularization and decreased immune response (Alchalabi et al., 2013).
Furthermore, the American academy of periodontology (AAP) reported that about 50% of women experience pregnancy related periodontal disease with prevalence of periodontitis 14% between the 2nd and 8th month of pregnancy as result of increased hormonal level (Eke, 2016).
Clinically periodontitis was defined as the presence of four or more teeth with one or more sites of PD>4mm and CAL>3mm, and being localized in two or three teeth and generalized into four or more teeth, gingivitis was defined when PD<3mm and CAL< 2mm in two to five teeth or at least one site with bleeding on probing and periodontal healthy when PD<2mm and CAL<2mm with no site of gingival bleeding (Borgo et al., 2014).
The development of periodontal diseases during pregnancy can be influenced by factors such as human immunodeficiency virus infection, lack of dental care, poor oral hygiene, smoking, low-educational level, low-employment status, increased age and ethnicity. These contribute to worsened periodontal condition during pregnancy (Onigbinde et al., 2014).
Women who have periodontal disease while pregnant—an estimated one in five pregnant women—have been reported to be at increased risk of adverse pregnancy outcomes (Vanterpool et al., 2016). The 1996 study by Offenbacher and colleagues (2001) suggested that maternal periodontal disease could lead to a seven-fold increased risk of delivering a PLBW infant. In another longitudinal study, Boggess et al. (2003) found a two-fold increased risk for preeclampsia among women with periodontal disease during pregnancy compared with controls (Anil et al., 2015).
As a result the identification of risk factors for periodontitis during pregnancy can help guide and establish early treatment, which can lead to the avoidance of the possible adverse effects of this disease on pregnancy (Onigbinde et al., 2014).
Furthermore, nurses are one of the main providers of antenatal health care services, and play important roles in increasing awareness of oral health and dissemination of information. In addition to, nurses are in a good position to help deliver key oral health messages to pregnant women. In particular, nurses can provide advice on preventive oral health care, including regular dental visits, and can refer pregnant women to dentists for examinations (Sharif et al., 2016). In addition to that the importance of dental care during pregnancy for the health of both the woman and fetus should be emphasized.
The present study aimed to assess risk factors of periodontitis during pregnancy and its effect on pregnancy outcome.
The study design was An exploratory& descriptive study design: it was conducted at all the 2nd and 3rd trimester pregnant women attended El-waleedia health center, Asyut, Egypt for seven months, diagnosed with periodontitis and fulfilling criteria. Data collected started from beginning of August 2017 to February 2018. Purposive sample was used, sample was 91 cases.
Tools of data collection:
- An interview structured questionnaire sheet for general assessment including; general characteristics of the study sample, obstetrical& family history of sample, assessment of periodontal risk factors and lastly assessment of pregnancy outcome.
- An observational checklist for dental health assessment
The results:
The present study showed that the prevalence of periodontitis among the pregnant attended the study setting during data collection period was 28.6%. it was concluded that, various levels of periodontal disease among pregnant women associated with bio sociodemographic characteristics such as age, economic status living or educational level, gestational age, obesity previous dental history and dental hygienic measures (p<0.001 &<0.05). Pregnancy itself may also be associated with an increased risk of periodontal disease. There was a highly significant relationship between periodontal disease and adverse pregnancy outcomes (p<0.001).
Based on the findings of this study, the following recommendations are suggested:
1- An oral health program for pregnant women should be developed and oral health personnel should collaborate with MCH staff carrying out oral health education including demonstrations of tooth brushing techniques.
2- An oral health education, screening and treatment package should be developed to be incorporated in the MCH activities in antenatal clinics .
3- Nursing programs and curriculum need to change to prepare and train nursing graduates with core competencies of oral health access to care issues as they are the main oral health educators and providers.
4- More researches is needed to show the exact relation between periodontal disease and adverse pregnancy outcomes, and the proper treatment and the optimum timing of this treatment which can decrease the adverse pregnancy outcomes