Vol 16, No 3, 2018 281 C-Reactive Protein Levels and Periodontal Diseases During Pregnancy in Malaysian Women Aisah Ahmad a / Zeyad Nazar b / Dasan Swaminathan c Purpose: To investigate the association between plasma CRP levels and periodontal disease during pregnancy. Materials and Methods: Fifty-six pregnant women attending the Antenatal Clinic, UMMC for their first antenatal check-up consented and were recruited for this study: 28 subjects with diseased periodontium (test group) and 28 subjects with healthy periodontium (control). The test group underwent nonsurgical periodontal therapy and the control group was given oral hygiene education. Periodontal parameters and CRP levels were evaluated at baseline and 6 weeks. Pregnancy outcome data were recorded from the Antenatal Clinic, UMMC. Results: Plasma CRP levels in the test group were statistically significantly elevated compared to the control group (8.55 ± 5.28 mg/l vs 5.66 ± 2.91 mg/l). After nonsurgical periodontal therapy, a statistically significant reduction in the CRP level in the test group (2.06 mg/l) along with statistically significant improvement in periodontal status in both groups was observed. The mean birth weight for infants of both groups showed no statistically significant difference. Conclusions: Plasma CRP levels in pregnant women with diseased periodontium were statistically significantly re- duced after nonsurgical periodontal therapy. However, no association between CRP levels and adverse pregnancy outcome was observed. Key words: C-reactive protein, nonsurgical periodontal therapy, periodontal disease, pregnancy Oral Health Prev Dent 2018; 16: 281–289. Submitted for publication: 09.02.16; accepted for publication: 29.10.16 doi: 10.3290/j.ohpd.a40759 a Periodontist, Department of Restorative Dentistry, Faculty of Dentistry, Univer- sity of Malaya, Kuala Lumpur, Malaysia. Conceived the study, performed the statistical analysis, drafted the manuscript, read and approved the final manu- script. b Periodontist, Faculty of Dentistry, University of Babylon, Iraq. Helped draft the manuscript, proofread the manuscript, read and approved the final manuscript. c Professor, Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia. Supervised the study, helped draft the manuscript, read and approved the final manuscript. Correspondence: Dasan Swaminathan, Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia. Tel: +60-12-652-2675; e-mail: dasanswami@yahoo.com P eriodontal diseases are usually chronic infections that cause inflammation and destruction of periodontium, initiated by bacterial plaque accumulation on the tooth. 45 The severity of the destructive processes associated with these diseases is due to an excessive host response to the bacterial challenge, which is immune mediated. Therefore, periodontal disease is a multifactorial and complex dis- ease 2 with several risk factors that modify the host response towards bacterial assault, such as smoking, 7 diabetes mel- litus, 37 obesity, 41 genetic predisposition 14 and conditions that change estrogen levels, such as puberty, pregnancy and menopause. 13 In periodontal disease, bacteria and their virulence factors found in the periodontium directly stimulate various host cells residing in this area. 30 These cells release pro-inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interleukin-1β (IL-1β), IL-6, IL-12, chemo-attractants and prostaglandin (PGE2) in the connec- tive tissue, thus amplifying the inflammatory cascade. 30 Pro-inflammatory cytokines enter the circulation and reach the liver. There they activate hepatocytes, which leads to the synthesis of plasma proteins known as acute-phase proteins, including lipopolysaccharide (LPS), lipopolysaccha- ride-binding protein (LBP), CD14, complement protein and C-reactive protein (CRP). CRPs opsonise the bacteria, thereby facilitating recognition for phagocytosis. 42 Increased CRP levels indicate active systemic inflamma- tion in the body. Periodontal disease and the systemic bac- teraemia caused by periodontal pathogens are significant contributors to a systemic maternal inflammatory response during pregnancy. In turn, inflammation can serve as an in- dependent biochemical threat to the foetal-placental unit by inducing labour, rupture of membranes and early parturi- tion. Studies have shown that increased CRP levels have been associated with adverse pregnancy outcomes, includ- ing preterm birth (PTB), 33 preeclampsia 44 and intrauterine growth restriction. 46 Therefore, it is postulated that CRP may be a plausible mediator of the relationship between periodontal disease