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Published on: February 5, 2019
The association between oral risk assessment and obstetric and newborn outcomes
Carolina Martinez-King1, Charlie Rose1, Krystle M Perez2
1Division of Maternal-Fetal Medicine Department of Obstetrics and Gynecology University of Washington Seattle Washington USA.
Insights
A positive oral health screening during pregnancy is linked to increased risks of preterm birth, gestational hypertension, and gestational diabetes. Seeking dental care access surprisingly improved outcomes, highlighting the importance of each screening question.
Area of Science:
- Obstetrics and Gynecology
- Periodontology
- Public Health
Background:
- Periodontal disease in pregnancy poses risks for adverse obstetric and offspring outcomes, such as preeclampsia and preterm birth.
- The American College of Obstetricians and Gynecologists (ACOG) recommends a three-question oral risk assessment for pregnant individuals.
- No prior studies have linked positive oral risk assessment screens to adverse obstetric or newborn outcomes.
Purpose of the Study:
- To evaluate the association between a positive oral risk assessment and adverse pregnancy outcomes.
- Specific outcomes assessed include preterm birth, preeclampsia, gestational hypertension, gestational diabetes, and newborn birthweight.
Main Methods:
- A three-question oral risk assessment survey, recommended by ACOG, was administered to pregnant individuals at a university-based prenatal clinic.
- Unadjusted and adjusted linear and logistic regression models were used to analyze the associations between screening questions and pregnancy/offspring outcomes.
- 1242 pregnant patients were screened.
Main Results:
- Over half (50.3%) of the screened patients had an overall positive oral risk assessment.
- A positive overall screen was significantly associated with increased odds of preterm birth (aOR: 1.58), gestational hypertension (aOR: 1.71), and gestational diabetes (aOR: 1.79).
- Symptomatic oral disease increased preeclampsia risk (aOR: 1.77), while seeking dental care access was linked to reduced gestational hypertension and higher infant birthweight (+177.9 g).
Conclusions:
- Symptomatic oral disease identified via screening is associated with adverse pregnancy outcomes.
- Seeking assistance with dental care access unexpectedly correlated with improved pregnancy outcomes.
- These findings underscore the significance of each component of the oral risk assessment survey and suggest further research into underlying biological mechanisms.
Background:
Periodontal disease in pregnancy is a known risk factor for adverse obstetric and offspring outcomes, including preeclampsia and preterm birth. The American College of Obstetricians and Gynecologists (ACOG) recommends screening all pregnant patients on their first obstetric visit with a simple, self-administered, three-question oral risk assessment survey. Yet, no studies have evaluated whether a positive screen on this oral risk assessment is associated with adverse obstetric or newborn outcomes.
Objective:
We sought to assess the relationship between a positive overall oral risk assessment and preterm birth, preeclampsia, gestational hypertension, gestational diabetes, and newborn birthweight.
Study Design:
We screened pregnant individuals at a university-based prenatal clinic using the three-question ACOG-recommended oral risk assessment survey. We performed unadjusted and adjusted linear and logistic regression models to evaluate associations between screening questions and pregnancy/offspring outcomes.
Results:
Among 1242 screened pregnant patients, 50.3% (625 patients) had an overall positive screen with 21.7% (269), 43.1% (535), and 13.6% (169) screening positive on questions 1, 2, and 3, respectively. Patients who had an overall positive screen for heightened risk for oral disease had significantly increased odds of preterm birth (adjusted odds ratio [aOR]: 1.58, 95% confidence interval [CI]: 1.16, 2.16), gestational hypertension (aOR: 1.71, 95% CI: 1.10, 2.65), and gestational diabetes (aOR: 1.79, 95% CI 1.20, 2.67). Those with symptomatic oral disease (question 1) had a significantly increased odds of preeclampsia (aOR: 1.77, 95% CI 1.04, 2.99). Those who sought help finding a dentist (question 3) had significantly reduced odds of gestational hypertension (aOR: 0.43, 95% CI: 0.19, 0.97) and gave birth to infants with a significantly higher birthweight (+177.9 g; 95% CI: +40.3 g, +315.5 g).
Conclusions:
Symptomatic oral disease (question 1) is associated with adverse health outcomes. Surprisingly, seeking help in accessing dental care (affirmative response to question 3) is associated with improved outcomes. The differing associations highlight the importance of asking each question, and future research is needed to determine potential biological pathways linking the survey responses with adverse obstetric outcomes.
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