Welcoming pregnant women as a strategy for adherence to dental prenatal care and health promotion in early childhood

Abstract

This research deals with implementing Dental Prenatal Care as a public policy in the Brazilian Unified Health System (SUS) to care for pregnant women and their future babies. The legal framework that assures pregnant women's rights of priority in accessing services is usually not enough to guarantee the health promotion coverage goals for this population group, who frequently have low adherence to dental care. Brazilian Unified Healthcare System (SUS) recommends monitoring pregnant women through eight mensal consultations during healthy pregnancy. Oral health is usually not monitored to the same extent, and many pregnant women still go through pregnancy without any dental consultation. This study was proposed to improve dental prenatal care and program adherence by mothers and children in the Basic Healthcare Unit Amaro José de Souza, in the municipality of Barueri, through the increased participation of the dental surgeon in the pregnant women welcoming team. A cross-sectional cohort study was designed to identify and meet the demands of low-risk pregnant women. For six months, all the women attending prenatal care at BHU Amaro José de Souza in Barueri were invited to participate and receive personal guidance from the multi-professional team. Information on dental health was investigated through questions targeting previous knowledge about the recommended moments for the first dental appointment of a child, the importance of exclusive nasal respiration, the identification of craniofacial asymmetries at birth, and general baby care. Attitudes and self-care were also investigated, including prenatal program adherence. Answers were collected in a Google Form platform and analyzed to characterize the group's literacy about prenatal care and breastfeeding and identify information needs about dental health care during pregnancy. At the same time, a welcoming expanded listening, educational, and preventive health action was developed: conversation and sharing experience groups were promoted monthly for pregnant women, breastfeeding mothers, and their families. 90 pregnant women out of the 104 attending the BHU in the six months of the research were invited, and 83 agreed to participate. All the participants declared at least one previous appointment with the healthcare team, 92.8 % of them, with a gynecologist. The nursing team was involved in 53.0 % of the appointments, but only 6.0 % were reported to have been conducted exclusively by a nurse. A dental surgeon appointment was mentioned by 30.1 % of the research participants. The dental health literacy investigation revealed that 57.8 % believed they should only take their babies to a dental appointment after teething, and 27.7 % were aware of the child's craniofacial asymmetries at birth. Only 28.9 % had previous knowledge about the importance of exclusive nasal respiration. Despite only 34.9 % having their first pregnancy, 78.3 % declared they would appreciate receiving information about pregnancy. After the guidance, 72.0 % of the pregnant women had undergone dental prenatal care. Workshops for pregnant women and breastfeeding mothers provided a convenient welcoming space, to listen and provide guidance to pregnant women and their families, in addition to demystifying the fear of dental care during pregnancy and breastfeeding. The intervention to guide pregnant women to perceive the BHU as an educational and health promotion space, not just a curative intervention, effectively increased adherence to dental prenatal care. The contact with the Specialist in Functional Jaw Orthopedics in this first phase of life facilitated dental health education and access to more complex cases. The prenatal program adherence, the pregnant woman’s self-care, and the care of the baby were favored by the welcoming, expanded listening, and personalized service.