title: 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) 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.
  
  
  CONCLUSIONS
  Among African American women, moderate/severe periodontal disease is associated with elevated CRP levels early in pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of North Carolina, Chapel Hill, NC 27599-7516, USA. amanda_horton@med.unc.edu
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Horton
authors.forename: Kim A
authors.initials: KA
authors.lastname: Boggess
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Moss
authors.forename: Heather L
authors.initials: HL
authors.lastname: Jared
authors.forename: James
authors.initials: J
authors.lastname: Beck
authors.forename: Steven
authors.initials: S
authors.lastname: Offenbacher
mesh_terms: D000328:Adult; D001741:Black or African American; D001835:Body Weight; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007249:Inflammation / Q000097:blood; D007348:Insurance, Health; D017533:Marital Status; D008423:Maternal Age; D010510:Periodontal Diseases / Q000097:blood / Q000150:complications*; D010512:Periodontal Index; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood; D047928:Premature Birth; D011446:Prospective Studies; D012907:Smoking; D044465:White People
chemical_list: D002097:C-Reactive Protein