Periodontal Disease Early in Pregnancy Is Associated With Maternal Systemic Inflammation Among African American Women

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) μg/ml, and an elevated CRP level (>75th percentile) was 15.7 μg/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.

The Emerging Concepts on the Impact of Periodontitis on Systemic Health

“…The results showed that the presence of IgM antibodies to oral pathogens and increased levels of TNF-and 8-isoprostane were associated with increased rates of PTB, and that the combined effects of fetal IgM, C-reactive protein, TNF-, PGE 2 , and 8-isoprostane resulted in a significantly increased risk for PTB (Boggess et al, 2005). An elevated level of CRP among pregnant patients with periodontitis compared to periodontally healthy subjects has been reported by other investigators (Pitiphat et al, 2006;Horton et al, 2008). Studies have shown that elevated levels of serum and placental soluble VEGF receptor-1 are associated with an increased risk of pre-eclampsia (Koga et al, 2003;Romero et al, 2008).…”

Enfermedades periodontales durante el embarazo y su asociación con parto prematuro y bajo peso al nacimiento: Evidencias y controversias

“…No hay evidencias en contra de la prestación de estos cuidados a las madres, lo que sugiere que este tratamiento realmente puede ser beneficioso para ambos. Así mismo, algunos estudios plantean la posibilidad de que en el futuro, la inmunización materna puede ayudar a proporcionar protección al feto durante el embarazo (1,31,35).…”

“…Las bacterias orales y no solo los patógenos periodontales, también se asocian con efectos adversos durante el embarazo (7,26,31).…”

“…Por otra parte, la respuesta fetal mediante IgM es más fuerte en los recién nacidos prematuros que en los recién nacidos a término. Estos estudios microbiológicos e inmunológicos en seres humanos proporcionan un fuerte argumento en favor de esta asociación de causalidad (1,8,31,35).…”

“…La combinación de los mediadores de la inflamación junto con el aumento de la concentración hormonal, puede llegar a constituir un factor de riesgo para la integridad de la unidad fetoplacentaria en mujeres con una respuesta inmunitaria celular reducida como consecuencia del embarazo (9,31,34).…”