Of the 231 candidates included in our study, 101(43.72%) had gingival hyperplasia (Figure 1).

The patients’ age ranged from 18 to 43 years with a mean of 29.22 ± 5.73 years. In our study population 51.09 % (118) comprised women aged between 20 - 30 years; 41.55% and 7.36% were 30 - 40 and 40 - 50 years, respectively.

Table 1 shows that most participants were Christian (89.6%), employed

(57.1%), single (54.5%), and had a university level education (60.2%).

Figure 2 shows the gestational profile of our participants. Majority were in the 3^rd trimester (115 or 49.8%). There were 67 (29%) and 49 (21.2%) in the 2^nd and 1^st trimester, respectively. Concomitant pathologies were found in our study population including malaria, gastritis, asthma, and urinary infection. Malaria was the most common (48.8%) as shown in Figure 3.

In assessing oral hygiene, Table 2 depicts practices of our study population. More than half our study population brushed their teeth daily (51.1%), 89.6% used toothpaste, 72.7% practiced both the horizontal and vertical method of brushing, 41.6% changed their tooth brush every 3 months and 36.4% changed toothbrushes only when the filaments where destroyed (Table 2). Additionally, as shown on Table 3 & Table 4, we noted that 56.3% of study participants had not visited a dentist prior to pregnancy. Most did not consult a dentist during pregnancy (92.2%). However, of 18 who consulted a dentist during pregnancy, 50% went for a routine check-up, 27.8% and 22.2% went for bleeding and dental

pain, respectively. We observed that 68.0% of our study population had never carried out scaling and only 10.4% carried out scaling regularly.

Regarding the clinical presentation of gingival hyperplasia during pregnancy, we observed that 93.1% (94) patients who had gingival hyperplasia had a mild-moderate form and 6.9% had a severe form of the disease. Figure 4 illustrates some of our findings.

In terms of scoring plaque and calculus in our study population, majority had no plaque with 19.9% and 31.6% participants having a score of 1 and 2, respectively. Similarly, regarding the calculus index most participants scored zero. However, we reported that 19.9% scored 1 and 25.1% scored 2. In terms of gingival disease stage, we showed that 28.2% and 17.7% of our subjects had stage 2 and 3, respectively. We also noted that, gingival hyperplasia was most frequently found in the 3^rd trimester (60.4%). The frequency in the 1^st trimester was relatively low (8.9%). Finally, we noted that localized gingival hyperplasia was pre-dominant (72.3%) relative to generalized (27.7%) (Figure 5).

Gingival hyperplasia was present in 43.7% of our study population. This result is

similar to the 2006 study of Bengondo et al. in Cameroon who reported a frequency of 46% [13] . This is consistent with the notion that an increase in hormones (estrogen and progesterone) during pregnancy leads to an increase in the influx of fluids in the gum conjunctival tissues, resulting in a tendency to swell, hyper vascularization and a congestive state which is responsible for gingival hyperplasia [14] . Also, both studies were carried out in urban settings and the women were of the same age group. They also had common habits which could justify the similarity in our findings.

The age of our participants varied from 18 - 43 years. These extremes are like those of Naumah et al. in Ghana who reported an age range from 16 to 45 years [15] . This could be justified by the standard reproductive age set by UNICEF which is of 15 - 43 years [16] .

The most represented educational level in our study population was the university level which made up of 60.2% participants. This result is different from that of Diallo et al. in Mali that reported the university level at 16.5% [17] . This variance could be explained by the fact that unlike the Mali study, ours was carried out in Yaoundé which is a metropolis and consequently filled with institutes of tertiary education increasing the likelihood of our study population to have attained this level of education. The study in Mali was carried out in rural areas where education is not advanced. In addition, Raatikaairen et al. carried out a study which showed that highly educated women represented by 52.66% were more likely to go to a reference hospital unlike non-educated women who would more likely go to primary care health centers [18] . Given that the Yaoundé Gyneco-Obstetric and Pediatric Hospital is a reference hospital this could also explain why the educational level of our study population is mostly made up of the university level.

The third trimester was most represented with 115 women (49.8%) of all participants. These results are different from that of Diallo et al. from Mali in 2014 that reported the majority of their study population being in the first trimester [17] . This discrepancy in antenatal care attendance would need an in-depth exploration considering other factors that influence antenatal care in rural versus urban settings in these countries.

The most represented pathology in our study population was malaria at 48.8%. These findings are similar to those of Chukwoucha et al. in Nigeria who found malaria in 57.1% of pregnant women [19] . The high incidence of malaria among pregnant women in these studies is likely due to the similarity in study areas, both studies being carried out in endemic areas of malaria. We did not establish a clear association between gingival hyperplasia and the presence of malaria infection in our study population. However, we can hypothesize that since both afflictions are aggravated by pregnancy a possible underlying common denominator exists. We could also theorize on the possible effect of anti-malaria medicines on the already fragile gingiva in pregnancy. This would require further studies.

In our study, 46.8% brushed their teeth twice daily. These results are different from that of Bengondo et al. in 2006 in Cameroon which reported 32.7% [13] . This could be explained by the fact that majority of patients at the Yaoundé Gyneco-Obstetric and Pediatrics Hospital had a tertiary level of education and thus, were more enlightened on the most appropriate methods of dental hygiene. Nevertheless, a significant proportion of our study participants (51.1%) reported brushing their teeth only once and mostly in the morning which is not ideal. They reported low energy levels, nausea and vomiting as reasons for not brushing enough. This could explain the relatively high frequency of plaque and consequently high rate of gingival hyperplasia.

Our study revealed that only 7.8% of patients visited the dentist while they were pregnant. These results are similar to those of Diallo et al. in Mali in 2014 and Offenbach et al. in the U.S.A. in 2009 [17] [20] . Many reported having no dental problems that would require consulting a dentist. Some also reported busy schedules, fear of dentists, and financial challenges as reasons. Furthermore, some study participants claimed that mild pain or discomfort could be treated at home with simple pain killers or natural remedies.

In our study, 73.2% of gingival hyperplasia was localised while 27.7% was generalized. We also observed that 93.1% of gingival hyperplasia presented itself in the moderate form while 6.9% the severe form. These results are similar to that of Erchick et al. in 2019 in Nepal that found moderate gingival hyperplasia in 79% of the population studied and the severe form in 9.7% [21] . This can be explained by the fact that inadequate brushing techniques make some areas of the mouth more susceptible to developing plaque, thereby affecting the site and severity of gingival hyperplasia. In our study, gingival hyperplasia was more common in the 3^rd and 2^nd trimesters, 60.4% and 30.7%, respectively. This is similar to a study carried out by Silness et al. in 1963 in America that found a high frequency of gingival inflammation in the 3rd trimester [11] . This could be explained by the fact that, estrogen and progesterone levels peak in the last trimester, constituting a more significant hormonal imbalance in the oral cavity leading to aggravation of gingival hyperplasia.