29th July 2011, Volume 124 Number 1338

Bianca M Claas, Lis Ellison-Loschmann, Mona Jeffreys

Women normally experience physiological, psychological and lifestyle changes during pregnancy and some of those changes can affect their dental health.1 The oral health of pregnant women has been receiving attention, both internationally and in New Zealand,2 with growing evidence that poor oral health can have detrimental effects, not only for the women (for example, increasing risk of pre-eclampsia)3 but also for the health of the fetus/baby.4–6

Periodontal disease combines a number of diseases of the periodontal tissue that can be broadly divided into gingivitis and periodontitis. Gingivitis is an inflammation of the soft tissue surrounding a tooth, which commonly manifests as bleeding gums. Periodontitis is characterised by inflammation of the supporting structures of teeth resulting in attachment and bone loss.7 Periodontal disease is relatively common among pregnant women due to hormonal and vascular changes which occur during pregnancy leading to the promotion of an accentuated response to plaque.4

There has been extensive discussion about the potential of periodontal disease to affect pregnancy outcomes. Some studies suggest that periodontitis is a risk factor for preterm and low birth weight infants, even after adjusting for other risk factors such as smoking, previous adverse pregnancies, race, age or socioeconomic status (SES).4–6 However, a recent study on the effect of maternal periodontal disease treatment on reducing the incidence of preterm birth failed to confirm this connection.8

Studies show that preventive measures, including adequate diet and plaque control, for expectant mothers, can have a positive impact on both the woman’s oral health and that of their child.9–11 In addition, because mothers are normally responsible for the introduction of dietary and hygiene habits to the infant, pregnancy is an ideal time in which to promote and reinforce healthy messages which will have long-term benefits for the woman as well as their family.12

There is some international evidence of inequalities in oral health status and access to dental care for pregnant women of different ethnic and socio-economic groups.13–16 In New Zealand, two national oral health surveys conducted in 1976 and 1988 showed a decrease in dental caries generally over this period, but this was not consistent across all population groups.17,18

Marked differences were reported in the levels of oral health of Māori compared to non-Māori, and also differences by SES with regard to access to oral health care services, according to the latest New Zealand Health survey conducted in 2006/2007.19 None of these surveys presented data on pregnant women.

A recent qualitative study of Māori women, found that current oral health services are not meeting Māori needs and participants reported a number of dental problems during their pregnancies.20Improving oral health and decreasing disparities in health are goals of the New Zealand government. The Ministry of Health has highlighted pregnant women as a priority group.21

Currently, there is a lack of information in New Zealand about the oral health care of pregnant women. The aims of this study were to gain an understanding of women’s oral health care practices, access to oral health information and use of dental care services both prior to and during pregnancy, and to investigate if these differed between sociodemographic groups.

Methods

Participants—Eligible participants were pregnant women, over 16 years of age, attending antenatal classes during a 6-month period (June-November 2008) in the Wellington region. There are approximately 3,500 babies born per year in the region and about 78% of first time mothers attend antenatal classes.22
Antenatal classes may be either government-funded programmes which are offered to women at no charge, or be taught by a range of private antenatal education providers at a cost of anything up to NZ$150 for a course of classes. Participants in the study were drawn from a range of available classes, both private and government funded. The private classes were run by Parents Centre, Wellington High School Adult Community Education Centre, Newlands and Onslow College Adult Community Education Centre and Tawa College Community Education.
The government funded classes were the breastfeeding classes at Wellington Hospital Women’s Health Service and the Wellington Maternity Project (MATPRO). The composition of the classes provided by MATPRO in 2003 were 20.5% Māori, 17.5% Pacific, 8% Asian, 7% other/not stated, and 47% of European New Zealand ethnicity.23 The women attending antenatal classes are typically in the last trimester of their pregnancy.
Data collection—The researcher arranged with the childbirth educator from each of the classes to attend one antenatal session in order to explain the study and leave women with an information sheet, questionnaires and self-addressed envelope for posting back the questionnaires which were self-completed by the women at home. Completed questionnaires could also be left at a ‘drop box’ at the antenatal class venue if the woman preferred.
Demographic information collected included, ethnic group, education level, and household income, based on definitions taken from the New Zealand Census 2001.24 Ethnicity was subsequently categorised as New Zealand European (which included New Zealand European and other European groups), and ‘Others’ group which, due to small numbers, included Māori and Pacific Islanders as well as Chinese and Indian ethnic groups.
Education was grouped as ‘high school’ level, ‘tertiary’, which includes any tertiary education program such as a certificate, diploma or incomplete degree and ’post-graduate’. Information on household income per year was collected in the follow categories: $1–5,000/$5,001–10,000/$10,001–15,000/$15,001–20,000/$20,001-$25,001/25,001–30,000/$30,001–40,000/$40,001–50,000/$50,001–70,000/$70,001–100,000 and $100,001+.
For the analyses, due to the majority of participants being in the highest income group, the income bands were reclassified into the following three groups: less than $70,000 (low income), $70,000 to 100,000 (medium income) and more than $100,000 (high income). The participants were asked their date of birth with the age bands created being based on the data: 16–25 years, 26–30 years, 31–35 years and 36+ years age group.
Questions relating to oral care practices, including use of floss and mouth care products, frequency of brushing and visits to a dentist (both prior to and during pregnancy), and the presence of dental problems during pregnancy were included, based on questions that had previously been validated in other international studies.13–16,25–28 Additional information was sought on changes to eating habits during pregnancy.
Questions on sources/content of dental health information were developed specifically for use in the current study. Women were asked if they had received any information on dental health during their pregnancy, what the information was about (care of gums and teeth, dietary advice, use of fluorides, oral diseases and early childhood oral health) and who provided the information, such as a dentist, dental healthcare worker, Lead Maternity Carer (LMC) (a health professional who may be a midwife, general practitioner (GP) or obstetrician and is responsible for providing or organising a woman’s maternity care including throughout the pregnancy, birth and the post-natal period), or other sources (media/internet/books).
The questionnaire was piloted and refined prior to the final version used for the survey. Ethical approval for this study was obtained from the Massey University Human Ethics Committee.
Analyses—All data was entered on Microsoft Access and analysed using STATA software package. Descriptive analysis, such as chi-squared tests and t-tests were used to investigate differences in knowledge/behaviour between the sociodemographic groups. Multivariable logistic regression was used to compare the prevalence of various risk factors between these groups, controlling for potential confounding variables, i.e. one or more of ethnicity, income, age and SES. To investigate the effect of confounding, the models were built adding in one variable at a time.

Results

Description of the sample—A total of 730 questionnaires were handed out to pregnant women at 69 antenatal classes and 405 questionnaires were completed, a response rate of 55.4%. New Zealand European made up 79.2% of the study population with the remaining 19.7% ‘Others’ ethnic group comprising 8.8% Māori, 1.9% Pacific and 8.6% Indian/ Chinese/other. Over half of the participants had a tertiary education (57.7%), and most of the sample studied had a high income (with NZ$100,001 or more annual income). The majority of women in the study were over 30 years of age (Table 1).

Dental visiting—About half of the women reported seeing their dentist at least once a year prior to pregnancy (Table 2). This was more common among New Zealand European, women with a higher education and income; and older women. A total of 23.2% of the women saw the dentist just when they had problems and this was more common among ‘Others’, lower education and income; and younger women. However, just 32.3% of women reported seeing a dentist during their current pregnancy. Women with higher income/education level, those who were older; and New Zealand European were all more likely to have visited a dentist during their pregnancy.

Table 1. Demographics of the 405 pregnant women who completed the survey
Variables
N (%)
Age
16–25
26–30
31–35
36+

46 (11.3)
111 (27.4)
140 (34.4)
108 (26.6)
Ethnicity
New Zealand European
Māori
Pacific
Others
Not stated

321 (79.2)
36 (8.8)
8 (1.9)
3.5 (8.6)
5 (1.2)
Education
High school
Tertiary
Postgraduate
Not stated

47 (11.6)
234 (57.7)
118 (29.1)
6 (1.4)
Household income ($NZ/year)
<70,000
70,001–100,000
100,001–or more
Not stated

52 (12.8)
94 (23.2)
214 (52.8)
45 (11.1)
Table 2. Dental visits pre and during pregnancy
Variables
Normally see a dentist once/year
N (%)
Normally see a dentist symptoms related
N (%)
Have seen a dentist during pregnancy
N (%)
Ethnicity
NZ European
Others

168 (52.2)
33 (41.7)

72 (22.4)
22 (27.8)

108 (33.6)
18 (22.7)
Education
Postgraduate
Tertiary
High School

67 (56.7)
112 (47.8)
22 (46.7)

21 (17.8)
57 (24.3)
16 (34)

39 (33)
72 (30.7)
15 (31.9)
Income ($NZ/year)
100,000 or more
70–100,000
Less than 70,000

121 (56.5)
44 (46.7)
16 (30.7)

39 (18.2)
26 (27.6)
21 (40.3)

18 (40)
31 (32.9)
11 (21.1)
Age (years)
16–25
26–30
31–35
36 +
All combined

15 (32.5)
59 (53.1)
70 (50)
62 (57.3)
206 (50.8)

21 (45.6)
32 (28.8)
23 (16.4)
18 (16.6)
94 (23.2)

12 (26)
33 (29.7)
39 (27.8)
47 (43.5)
131 (32.3)

Women were asked why they did not see a dentist (information not shown in table). The main reasons given were being unaware that they needed to see a dentist (37%), cost (18.7%) and believing it was not recommended to see a dentist when pregnant (14.5%). Nearly 5% of women expressed fear of dentists as being the primary reason for not seeing a dentist during pregnancy. Not seeing a dentist for economic reasons was more common among ‘Other’ women (27.8%), compared to New Zealand European women (16.5%); women with lower education (29.7%) compared to those with a higher education level (11.8%); those of lower income (42.3%) compared to a higher income level (11.2%); and younger (45.6%) compared to older (12%) women.

Oral health care—Table 3 presents information on the oral health care practices of women in the study. In general, women presented with good oral hygiene habits, with most brushing their teeth twice or more a day and approximately 20% flossing daily.

Forty-two percent of women reported increased sugar consumption during their pregnancy, which was more common among New Zealand European, young, medium income women; and those with up to high school education. Bleeding gums was the main problem reported during pregnancy (60%) by all women, followed by sensitive teeth (15%), toothaches (5.4%) and cavities (5.1%). There was no difference between sociodemographic groups for these outcomes.

Table 3. Oral health care practices and changes during pregnancy
Variables
Brush twice or more/day
N (%)
Floss once/day
N (%)
Use mouth rinse
N (%)
Eating more sugar
N (%)
Bleeding gums
N (%)
Ethnicity
NZ European
Others

264 (82.5)
64 (82)

48 (15)
17 (21.7)

95 (29.6)
21 (26.5)

139 (43.3)
33 (41.4)

197 (61.3)
48 (60.7)
Education
Postgraduate
Tertiary
High school

102 (86.4)
192 (82.7)
33 (70.2)

22 (18.6)
36 (15.5)
7 (14.8)

31 (26.2)
70 (29.9)
15 (31.9)

51 (43.2)
97 (41.1)
24 (51)

78 (66.1)
139 (59.4)
27 (57.4)
Income ($NZ/year)
100,000 or more
70–100,000
Less than 70,000

182 (85.4)
72 (77.4)
40 (76.9)

38 (17.8)
14 (15)
7 (13.4)

64 (29.9)
30 (31.9)
13 (25)

97 (45.3)
41 (43.6)
24 (46.1)

133 (62.1)
61 (64.8)
30 (57.6)
Age (years)
16–25
26–30
31–35
36+
All combined

37 (80.4)
87 (79.8)
115 (82.1)
94 (87)
333 (82.6)

9 (19.5)
11 (10)
24 (17.1)
22 (20.3)
66 (16.3)

14 (30.4)
25 (22.5)
46 (32.8)
34 (31.7)
119 (29.4)

15 (32.6)
47 (42.3)
61 (43.5)
51 (47.2)
174 (42.9)

26 (56.5)
63 (56.7)
93 (66.4)
65 (60.1)
247 (60.9)

Oral health information—The majority of women reported receiving no oral health information during their pregnancy (53.3%). For the women who did access some information, the most common source was ‘media’ (23.4%), being mainly pregnancy books, folders, pamphlets and the internet. New Zealand European women, older women and those with a higher education and medium-high income level were more likely to receive information from dental health workers about dental hygiene than other groups. Women belonging to the ‘Others’ ethnic group, younger women and those with lower education were more likely to report that they received information from their LMC about diet (Table 4).

Table 4. Source and content of oral health information received during pregnancy
Variables
Info about dental hygiene
N (%)
Info about diet

N (%)
Info from dental workers
N (%)
Info from LMCs(a)
N (%)
Info from media
N (%)
Ethnicity
NZ European
Others

68 (21.1)
14 (17.7)

44 (13.7)
15 (18.9)

49 (15.2)
8 (10.1)

36 (11.2)
15 (18.9)

85 (26.4)
9 (11.3)
Education
Postgraduate
Tertiary
High school

29 (24.5)
45 (19.2)
8 (17)

17 (14.4)
31 (13.2)
11 (23.4)

19 (16.1)
32 (13.6)
6 (12.7)

11 (9.3)
27 (11.5)
13 (27.6)

39 (33)
51 (21.7)
4 (8.5)
Income ($NZ/year)
100,000 or more
70–100,000
Less than 70,000

44 (20.5)
23 (24.4)
6 (11.5)

33 (15.4)
7 (7.4)
9 (17.3)

29 (13.5)
15 (15.9)
7 (13.4)

30 (14)
8 (8.5)
6 (11.5)

47 (21.9)
34 (36.1)
8 (15.3)
Age
16–25
26–30
31–35
36 +
All combined

9 (19.5)
22 (19.8)
21 (15)
30 (27.7)
82 (20.2)

9 (19.5)
16 (14.4)
17 (12.1)
17 (15.7)
59 (14.5)

5 (10.8)
15 (13.5)
14 (10)
23 (21.3)
57 (14)

6 (13)
14 (12.6)
15 (10.7)
16 (14.8)
51 (12.5)

7 (15.2)
21 (18.9)
44 (31.4)
23 (21.3)
95 (23.4)
(a) LMC: Lead Maternity Carer

Multivariable analysis—Table 5 shows the multivariable analysis (unadjusted and adjusted) for women who reported seeing a dentist or needing to see a dentist during pregnancy. Expectant mothers who reported visiting the dentist during pregnancy were more likely to be New Zealand European, older and have a higher education level and higher income, although few of these associations reached conventional levels of statistical significance.

The final model was adjusted for ethnicity, education, income and age. Each of the observed effects were marginally attenuated following adjustment, but in general, the effect of ethnicity was independent of other factors, and the effect of income was independent of education.

It is interesting to note that the older the woman, the more likely she was to have visited a dentist. Women belonging to ‘Others’ ethnicity group, with lower education and income were more likely to state that they needed to see a dentist than their peers. Income showed a stronger effect following adjustment with low income women being over two and a half times (OR 2.55, 95%CI 1.08-5.99) more likely to report the need to see a dentist than high income women.

Additionally, the age adjusted results were strongly affected by income with older women being more than twice as likely (OR 2.25, 95%CI 0.68-7.49) and women of the intermediary age groups: 31-35 years (OR 1.54, 95%CI 0.46-5.16) and 26-30 years (OR 1.46, 95%CI 0.43-4.87) to report the need to see a dentist than women in the youngest age group (Table 5).

The multivariable analyses for women who reported accessing oral health information during pregnancy are presented in table 6. For the unadjusted analyses, women belonging to ‘Others’ ethnicity group (OR 0.45, 95% CI 0.27-0.77), women from the low income group (OR 0.41, 95% CI 0.21-0.81), were less likely to have accessed oral health information during pregnancy compared to New Zealand European and women from the high income group respectively.

Women between 26-30 years old (OR 2.32, 95%CI 1.13-4.79), and over 36 years (OR 3.54, 95%CI 1.67-7.51) were significantly more likely to have accessed oral health information than younger women. Having recently visited the dentist was associated with having accessed oral health information during pregnancy (OR 2.16, 95% CI 1.35-3.45).

In the adjusted model, all the effects were attenuated except for those associations for ‘Others’ (OR 0.38, 95% CI 0.15-0.91) and low income groups (OR 0.27, 95% CI 0.10-0.76) which remained statistically significant. Both older women (over 36 years old) and those who had visited a dentist less than one year ago were more likely to have accessed oral health information but these associations were not statistically significant.

Table 6. Odds ratio (OR) and 95% CI for access to oral health information by ethnicity, education, income, age, hygiene practices, and visits to the dentist (adjusted for ethnicity, education, income and age)*.
Variables
N (%)
OR (95% CI)
OR (95%CI)*
Ethnicity
NZ European
Others

160 (50.3)
25 (31.6)

1
0.45 (0.27-0.77)

1
0.38 (0.15-0.91)
Education
Postgraduate
Tertiary
High school

62 (52.5)
102 (43.9)
21 (45.6)

1
0.7 (0.45-1.10)
0.75 (0.38-1.50)

1
0.99 (0.45-2.20)
1.16 (0.31-4.30)
Income ($NZ/year)
100,000 or more
70-100,000
less than 70,000

98 (46.8)
54 (57.4)
14 (26.9)

1
1.52 (0.93-2.49)
0.41 (0.21-0.81)

1
1.91 (0.77-4.75)
0.27 (0.10-0.76)
Age
16-25 years
26-30 years
31-35 years
36+ years

13 (28.2)
46 (41.8)
67 (47.8)
60 (58.2)

1
1.82 (0.86-3.84)
2.32 (1.13-4.79)
3.54 (1.67-7.51)

1
0.97 (0.19-4.88)
0.69 (0.14-3.42)
1.71 (0.31-9.20)
Brush teeth
Twice or more/day
Once a day

160 (48.7)
26 (38.8)

1
0.66 (0.38-1.13)

1
0.52 (0.20-1.34)
Floss teeth
No
Yes

35 (35)
151 (50.8)

1
1.92 (1.20-3.07)

1
1.32 (0.54-3.22)
Last visit to the dentist
2 years or more
1 year ago
Less than 1 year ago

42 (34.7)
38 (47.5)
106 (46.6)

1
1.70 (0.95-3.02)
2.16 (1.35-3.45)

1
2.06 (0.73-5.76)
2.27 (0.81-6.37)
Adjusted columns are flagged with*

Discussion

This study found that most of the women had good oral hygiene habits. However, a significant proportion of women had symptoms of periodontal disease, with over 60% reporting bleeding gums. A third of women had attended a dental appointment during pregnancy, and this was more frequent among New Zealand European women.

Women from lower income households were significantly more likely to report the need to see a dentist. About half of the women had not received any information about dental health during their pregnancy. Women who had access to oral health information were typically New Zealand European, older, with high income and education levels. However, given the response rate and the composition of the majority of the study population who were older, of higher income and education level and predominantly New Zealand European women, we are mindful that the study findings may not be representative of first-time mothers from the Wellington region.

Women’s oral hygiene practices did not change during pregnancy. About 50% of women reported visits to the dentist of once a year or less, when not pregnant, while the other half reported seeing a dentist only when they had a problem. This is consistent with previous New Zealand studies that have reported about half of the sample population as routine users of the dental health system, while the other half normally see the dentist or any other healthcare worker, only if there is a problem.29

One study found that minority ethnic groups including Pacific, Māori and Asian populations were significantly more likely to visit an oral health care worker only when they had toothache, and were more likely to have had a tooth removed.19

Only a third (32%) of women had seen a dentist or other dental health care worker during pregnancy. This finding is similar to other studies for example, 30% in Australia,16 a range of 25-50% in US studies,13,25,26,30 and 32% in an UK study.15

In our study, women who went to the dentist during pregnancy were mostly New Zealand European with high income and education levels. International studies have found that older, married, white women, with higher household incomes, higher education levels and insurance cover, were more likely to go to the dentist during pregnancy.25,26,30

International data also confirms that, women who visited the dentist in the previous year were more likely to have access to oral health information.13,30 Being aware of the possible connection between oral health and pregnancy outcomes were also associated with an increased frequency of dental visits during pregnancy.13

Several reasons for not seeing a dentist were given in the current study. The most frequent reason given was that it was not considered necessary, followed by the high cost of visiting a dentist and the perception that visiting a dentist while pregnant was not recommended. The economic reasons for not seeing the dentist are expected, because in New Zealand adults rely essentially on private dental care. There are some services and benefits relating to dental care assistance for low income people, but they are basically for emergency procedures only. There is a need for preventive oral services for the adult population, specifically for pregnant women and that should be considered in future strategies and policies. However, better knowledge and awareness about the importance and benefits of utilising dental services during pregnancy is necessary in a global context.

Even when dental care for pregnant women is funded by the government, such as in the UK, the number of women who see a dentist during pregnancy in the studies reviewed was still small.15

The main oral health problems reported by women during pregnancy were bleeding gums (60%). Similar findings were found in an Australian study where 59.5% of women stated that they had had gums which hurt and/or had bled at some stage during the previous 12 months.

The study concluded that women with less education and lower socio-economic status had an increased risk of poor periodontal health and were less knowledgeable about oral health and dental health than women from higher educational and socio-economic backgrounds.16 Bleeding gums is normally one of the first signs of gingivitis and can progress to periodontitis.

Both diseases are relatively common among pregnant women, but there is a need to increase awareness of gingival oral health as evidence shows that periodontal disease can be associated with birth outcomes such as low birth weight, preterm birth and pre-eclampsia.3 6-8

Overseas studies have reported that women from lower social classes, as well as women from ethnic minorities, have little or no exposure to information regarding the importance of preventive oral health practices during pregnancy and early childhood.27 In the current study, women who sought out oral health information were typically New Zealand European, with high income and education, as might be expected since this demographic group are in a better position to negotiate their way through the health care system and access information thus creating an advantage over those who do not have the resources or are less experienced in dealing successfully with the health care system.

Additionally, healthy literacy is an area that has gained more importance recently and should be further developed particularly for less privileged pregnant women in New Zealand.31

There is a lack of integration between dentistry and other health professionals, including those specifically involved in providing maternity services. The vast majority of women in New Zealand receive antenatal care from a midwife or obstetrician and will usually attend antenatal classes for at least a first time pregnancy. Thus, LMCs are in a strategic position to provide information to pregnant women regarding oral health.

Pregnant women are often receptive to information and very amendable to changing their lifestyle habits to benefit the baby. Women should be advised that it is safe to have routine dental treatment during pregnancy, and that frequent professional cleaning to remove plaque and irritants that contribute to dental problems is beneficial to potential both the women and foetus.

The main dietary advice in relation to oral health is to reduce sugar consumption and drink fluoridated water which can be easily incorporated and reinforced with other general diet recommendations provided to pregnant women. Diets rich in sugar also contribute to microorganism colonisation on the mother’s mouth which can potentially be transmitted to the foetus and increase the risk of future dental decay in the child.32 High levels of dental caries in childhood predict greater oral health disease levels in adulthood, even when other factors, such as hygiene and diet are taken into account.21

There are several limitations to the study. The study sample was limited to the number of women who participated in the selected antenatal classes in the Wellington region. The women were, in the majority, New Zealand European, around 30 years old, with high income and education.

Although this is not representative of the population of pregnant women in this region, these characteristics seem to be common among women that seek antenatal care/education during pregnancy. Studies show that privileged women are the group most likely to attend antenatal classes.33 In addition, the practices of different population groups have to be considered.34 For Pacific women, for example, their families attend to their antenatal care needs, and so may not necessarily attend formal antenatal classes. This could be reflected in the low number of Pacific people that took part in this research.

No data was collected from non-respondents, and the non-response could bias the reported study results. From the patterns identified in this study, it is likely that the need for oral health is greater than we report here. The non-response group (44.6%) would ideally require further investigation as these could differ in ethnicity and socio-economic distribution from the respondents. However, the non-response is unlikely to have affected the response associations between sociodemographic groups and oral health practices. Other New Zealand studies have shown that low adult SES has a significant effect on poor adult dental health and that there are oral health inequalities.35,36

Conclusions—Although more than half of the women who took part in the study reported bleeding gums, only a third of them had attended a dental appointment during pregnancy. The level of access to oral health information was higher among New Zealand European women from a high income household.

Women who visited the dentist during pregnancy were more likely to receive information on dental health. Women from low income households were significantly more likely to report the need to see a dentist. Improving access to oral health care and information during pregnancy can lead to better oral health for women and better oral health outcomes for children.

Recommendations—This study identifies that attention to pregnant women’s oral health in New Zealand is needed. There is a need to increase access to oral health services for pregnant women, especially for minority ethnic and low SES groups. Improving oral health could be achieved through public policies and strategies that integrate dental health workers and LMCs to assist women with their oral health during pregnancy, particularly through distribution of adequate information and encouragement of preventive measures.

Summary

The study was carried out in Wellington between June-November 2008 and involved a survey of 405 pregnant women. The research found that most pregnant women had good oral hygiene habits, but 60% reported bleeding gums during pregnancy. Only a third of women went to see the dentist when pregnant and less than half had received any oral health information during their pregnancy. New Zealand European women, with higher educational and socioeconomic levels were more likely to see a dentist and access oral health information during their pregnancy compared to women of other ethnicities with lower socioeconomic and education levels.

Abstract

Aim

The aims of this study were to gain an understanding of pregnant women’s oral health care practices, access to information, and dental care usage in New Zealand, and to investigate whether these differed between sociodemographic groups.

Method

One researcher visited 69 antenatal classes in the Wellington region to explain the study. Women self-completed the questionnaire and returned it by post.

Results

A total of 405 women (55% response rate) took part. 79.2% of participants identified as New Zealand European and most were of high income and education levels, 32% visited the dentist during pregnancy and more than 60% reported bleeding gums. Women with a household income under NZ$70,000 per year were significantly less likely to report access to oral health information (OR 0.27, 95%CI 0.10–0.76) and more likely to report the need to see a dentist (OR 2.55, 95%CI 1.08–5.99) compared to women with an income over NZ$100,000 per year.

Conclusion

Visits to the dentist and access to oral health information were more common among New Zealand European women with higher education achievements and higher socioeconomic backgrounds with only a third of women went seeing a dentist during pregnancy. Improving the oral health of pregnant women will have follow-on benefits of improved oral health outcomes for their children.

Author Information

Bianca M Claas, Research Fellow, Centre for Public Health Research, Massey University, Wellington, NZ; Lis Ellison-Loschmann, HRC Postdoctoral Research Fellow, Centre for Public Health Research, Massey University, Wellington, NZ; Mona Jeffreys, Senior Lecturer in Epidemiology, Department of Social Medicine, University of Bristol, Bristol, UK

Acknowledgements

The researchers thank the women who participate in this study and the childbirth educators for the facilitation of the data collection. Bianca Muriel Claas was funded by the Massey University Masterate Scholarship and the Centre for Public Health Research receives funding from the Health Research Council of New Zealand.

Correspondence

Bianca Muriel Claas, Centre for Public Health Research, Massey University, Wellington, NZ. PO Box 756, Wellington, New Zealand. Fax +64 (0)4 3800600

Correspondence Email

b.m.claas@massey.ac.nz

Competing Interests

None.

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