Sociodemographic disparities and behavioral factors in clinical oral health status during pregnancy

Abstract

Although oral health (OH) problems are common during pregnancy, little is known about individual characteristics or behaviors relating to clinically assessed OH during pregnancy. This cross-sectional study describes the clinical OH status of a sample of pregnant women, examines relationships between sociodemographic factors and OH, behavioral factors and OH, and the influence of behavior on the relationships between sociodemographic clusters and OH. Baseline data were utilized from a pilot intervention study promoting OH during pregnancy. Participants (n=99), recruited from CenteringPregnancy(®) prenatal care groups completed questionnaires addressing race/ethnicity, income, education, dental insurance, oral hygiene practices, and dental care utilization; and clinical examinations for periodontal probing depths (PD), bleeding on probing (BOP), plaque assessment, and visual detection of untreated decay. Chi-squares and one-way anovas with Tukey's studentized range test of planned comparisons were conducted to examine bivariable relationships between both sociodemographic and behavioral characteristics to OH status. Multivariable logistic regression analyses tested whether the effects of sociodemographic variables on OH status might be mediated by behaviors, including self-reported oral hygiene and recent dental visits. Forty-five percent of the sample had untreated decay and the mean percentage of sites with BOP=18%. Bivariable analyses of sociodemographic factors indicated that compared with Whites, Hispanic women had greater % of sites with: BOP, PD ≥5mm plus BOP, and Plaque Index (PI) scores of ≥2, all P=0.05; and greater untreated decay (Chi-square 13.3, P<0.001). Lower income was related to greater untreated decay (Chi-square 7.6, P<0.01). Compared with the highest education level, the lowest level group had higher % BOP, P<0.05. Public dental insurance (versus private) was associated with greater % BOP, PD ≥5mm plus BOP, both P<0.05, and greater untreated decay (Chi-square 16.9, P<0.001). Regarding behaviors, lacking a past 6-month dental visit was related to greater: BOP, PD ≥5mm plus BOP, and PI ≥2 (F range 6.2-8.7, P<0.01-0.05); and greater untreated decay (Chi-square 12.0, P<0.001). Self-reported optimal oral hygiene was related to lower % BOP and PD ≥5mm plus BOP (F range 4.5-6.7, both P<0.05). Mediation analyses indicated that there were significant indirect effects of racial/ethnic differences on OH outcomes via having a recent dental visit (OR range 1.2-1.9). However, significant differences between the Hispanic and White groups remained. This study highlights sociodemographic disparities in clinical OH during pregnancy, the importance of dental care, and provides useful findings for tailoring interventions for expectant mothers and their infants.