This is a Prospective cohort study with aim of studying  association of Periodontal status and Salivary TNF-alpha level with Gestational Diabetes Mellitus and Adverse pregnancy outcomes in pregnant women.

Periodontitis is a global health problem and is strongly associated with systemic diseases. Prevalence of Gestational diabetes  mellitus is also growing in line with the spread of diabetes mellitus. Chronic inflammation have been implicated in the pathogenesis of GDM. Periodontal Disease is associated with increased level of systemic inflammation mediators and can be a potential risk factor for GDM. Both Periodontal Disease and GDM are associated with increased systemic inflammation, pregnant females suffering from both may have increased risk of developing Adverse Pregnancy Outcomes.

Participant recruitment is going to be done in Department of Obstetrics and Gynaecology,  JNMCH.  100 number of participants in each exposed (periodontitis) and unexposed group (gingivitis and clinically healthy gingiva). Participants during 10th to 14^th weeks of Gestation are screened and grouped based on periodontal condition . Around  24^th to 28^th weeks of Gestation second visit is planned and primary outcome (Gestational Diabetes mellitus) is evaluated. Adverse Pregnancy Outcomes assessment will be done post delivery. Comprehensive oral hygiene instructions will be given to all and oral prophylaxis is administered if deemed necessary. Salivary Samples collection will be done during first and second visit and stored as per standardization later to be assessed for TNF-alpha level estimation.