Periodontal Disease Early in Pregnancy is Associated with Maternal Systemic Inflammation Among African American Women

Overview

Journal J Periodontol

Date 2008 Jul 4

PMID 18597593

Citations 12

Authors

Amanda L Horton

Kim A Boggess

Kevin L Moss

Heather L Jared

James Beck

Steven Offenbacher

Affiliations

Soon will be listed here.

Abstract

Background: Maternal periodontal disease is a chronic oral infection with local and systemic inflammatory responses and may be associated with adverse pregnancy outcomes. This study determined whether maternal periodontal disease in early pregnancy is associated with elevated serum C-reactive protein (CRP) levels and whether maternal race influences the relationship between maternal periodontal disease and systemic inflammatory responses.

Methods: A secondary analysis of prospectively collected data from the Oral Conditions and Pregnancy study was conducted. Healthy women at <26 weeks of gestation underwent an oral health examination and had blood collected. Periodontal disease was categorized by clinical criteria, and maternal serum was analyzed for CRP levels using highly sensitive enzyme-linked immunosorbent assay kits. An elevated CRP level was defined as >75th percentile. Demographic and medical data were obtained from the women's charts. Chi-square and multivariable logistic regression models were used to determine maternal factors associated with an elevated CRP. An adjusted odds ratio (OR) for elevated CRP levels was calculated and stratified by race and periodontal disease category.

Results: The median (interquartile) CRP level was 4.8 (0.6 to 15.7) microg/ml, and an elevated CRP level (>75th percentile) was 15.7 microg/ml. African American race and moderate/severe periodontal disease were significantly associated with elevated CRP levels. When stratified by race, moderate/severe periodontal disease remained associated with an elevated CRP level among African American women (adjusted OR: 4.0; 95% confidence interval [CI]: 1.2 to 8.5) but not among white women (adjusted OR: 0.9; 95% CI: 0.2 to 3.6) after adjusting for age, smoking, parity, marital status, insurance status, and weight.

Conclusion: Among African American women, moderate/severe periodontal disease is associated with elevated CRP levels early in pregnancy.

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References

Beck J, Offenbacher S . Systemic effects of periodontitis: epidemiology of periodontal disease and cardiovascular disease. J Periodontol. 2005; 76(11 Suppl):2089-100. DOI: 10.1902/jop.2005.76.11-S.2089. View

Jeffcoat M, Geurs N, Reddy M, Goldenberg R, Hauth J . Current evidence regarding periodontal disease as a risk factor in preterm birth. Ann Periodontol. 2002; 6(1):183-8. DOI: 10.1902/annals.2001.6.1.183. View

Moutsopoulos N, Madianos P . Low-grade inflammation in chronic infectious diseases: paradigm of periodontal infections. Ann N Y Acad Sci. 2006; 1088:251-64. DOI: 10.1196/annals.1366.032. View

Michalowicz B, Hodges J, DiAngelis A, Lupo V, Novak M, Ferguson J . Treatment of periodontal disease and the risk of preterm birth. N Engl J Med. 2006; 355(18):1885-94. DOI: 10.1056/NEJMoa062249. View

DAiuto F, Parkar M, Andreou G, Suvan J, Brett P, Ready D . Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers. J Dent Res. 2004; 83(2):156-60. DOI: 10.1177/154405910408300214. View

Hvilsom G, Thorsen P, Jeune B, Bakketeig L . C-reactive protein: a serological marker for preterm delivery?. Acta Obstet Gynecol Scand. 2002; 81(5):424-9. DOI: 10.1034/j.1600-0412.2002.810509.x. View

Albert M, Ridker P . C-reactive protein as a risk predictor: do race/ethnicity and gender make a difference?. Circulation. 2006; 114(5):e67-74. DOI: 10.1161/CIRCULATIONAHA.106.613570. View

Boggess K, Lieff S, Murtha A, Moss K, Beck J, Offenbacher S . Maternal periodontal disease is associated with an increased risk for preeclampsia. Obstet Gynecol. 2003; 101(2):227-31. DOI: 10.1016/s0029-7844(02)02314-1. View

Belo L, Santos-Silva A, Rocha S, Caslake M, Cooney J, Pereira-Leite L . Fluctuations in C-reactive protein concentration and neutrophil activation during normal human pregnancy. Eur J Obstet Gynecol Reprod Biol. 2005; 123(1):46-51. DOI: 10.1016/j.ejogrb.2005.02.022. View

10.

Xiong X, Buekens P, Fraser W, Beck J, Offenbacher S . Periodontal disease and adverse pregnancy outcomes: a systematic review. BJOG. 2006; 113(2):135-43. DOI: 10.1111/j.1471-0528.2005.00827.x. View

11.

Hillier S, Critchlow C, Stevens C, Roberts M, Wolner-Hanssen P, Eschenbach D . Microbiological, epidemiological and clinical correlates of vaginal colonisation by Mobiluncus species. Genitourin Med. 1991; 67(1):26-31. PMC: 1194609. DOI: 10.1136/sti.67.1.26. View

12.

Lopez R . Periodontal treatment in pregnant women improves periodontal disease but does not alter rates of preterm birth. Evid Based Dent. 2007; 8(2):38. DOI: 10.1038/sj.ebd.6400486. View

13.

Offenbacher S . Maternal periodontal infections, prematurity, and growth restriction. Clin Obstet Gynecol. 2004; 47(4):808-21. DOI: 10.1097/01.grf.0000141894.85221.f7. View

14.

DeFranco E, Teramo K, Muglia L . Genetic influences on preterm birth. Semin Reprod Med. 2007; 25(1):40-51. DOI: 10.1055/s-2006-956774. View

15.

Kinane D . Causation and pathogenesis of periodontal disease. Periodontol 2000. 2001; 25:8-20. DOI: 10.1034/j.1600-0757.2001.22250102.x. View

16.

Gazolla C, Ribeiro A, Moyses M, Oliveira L, Pereira L, Sallum A . Evaluation of the incidence of preterm low birth weight in patients undergoing periodontal therapy. J Periodontol. 2007; 78(5):842-8. DOI: 10.1902/jop.2007.060295. View

17.

Laine M . Effect of pregnancy on periodontal and dental health. Acta Odontol Scand. 2002; 60(5):257-64. DOI: 10.1080/00016350260248210. View

18.

Gilbert G . Racial and socioeconomic disparities in health from population-based research to practice-based research: the example of oral health. J Dent Educ. 2005; 69(9):1003-14. View

19.

Herrera J, Parra B, Herrera E, Botero J, Arce R, Contreras A . Periodontal disease severity is related to high levels of C-reactive protein in pre-eclampsia. J Hypertens. 2007; 25(7):1459-64. DOI: 10.1097/HJH.0b013e3281139ea9. View

20.

Pitiphat W, Joshipura K, Rich-Edwards J, Williams P, Douglass C, Gillman M . Periodontitis and plasma C-reactive protein during pregnancy. J Periodontol. 2006; 77(5):821-5. PMC: 1994911. DOI: 10.1902/jop.2006.050193. View