Investigation Of The Status And Demand For Oral Health Of Pregnant Women In Jiading District, Shanghai

Background:Oral diseases including caries, periodontal disease etc., can not only cause toothache, chewing difficulties, lisp and affect facial appearance, but also cause social interaction difficulties and psychological obstacles. Some microorganisms persisting in the oral cavity can cause or exacerbate systemic diseases including stomach problems, diabetes and cardiovascular diseases and other complications. Microorganisms in the oral cavity have become the important causes of systemic disease, and endanger the whole body health.Over the years, the main contents of maternal health care include regular physical check-up by obstetric staff, nutrition guidance, pregnancy monitoring, guidance and service for childbirth and breastfeeding, etc. However, oral health had been seriously neglected. Some studies have shown that pregnant women were more likely to have oral diseases, such as dental caries, gingivitis and periodontitis. Oral diseases during pregnancy can affect pregnant women on eating, sleeping and mental anxiety. Oral infections during pregnancy can cause or aggravate other systemic diseases. It had been reported that periodontal disease might lead to negative pregnancy outcomes, such as fetal growth and tooth development restriction, fetal deformity, prematurity, low birth weight newboms, pre-eclampsia and gestational diabetes, etc. By now, there were few studies on oral health status and clinical intervention study among pregnant women in China. Furthermore, there were few studies about the oral health knowledge, attitudes, health behavior and demands of pregnant women, especially through qualitative research. Therefore, we developed this study to know the status of oral health care during pregnancy in Jiading District, Shanghai, through the questionnaire investigation among pregnant women and individual interview with health providers.Aims:To understand the knowledge, attitude and behavior of pregnant women in Jiading District, Shanghai on oral health care, and to explore possible factors influencing their knowledge, attitude and behavior; To know the status, attitude and suggestion on oral health care from the both pregnant women and health providers. To provide evidence and advices for oral care interventions during pregnancy in the future for Jiading District, Shanghai.Methods:Questionnaire survey was conducted among the volunteers among pregnant women in the obstetric clinic of the Shanghai Jiading Maternal and Child Health Care Hospital from April to June in 2010. In combination of the quantitative and qualitative research methods,596 pregnant women were surveyed through the questionnaire investigation,8 pregnant women and 12 health providers were interviewed to get the status of pregnant women's knowledge, attitude and behavior of oral health.Results:1. Demographic characteristics of participants:The average age of participants was 25.5±4.0 years. The proportion of migrants among the participants was 75.3%. About 40% of participants were under education level of junior middle school, of which 97.5% were migrants. The average gestational age was 28 weeks. There were 3% of pregnant women had a complication of hypertension, diabetes and other diseases. And 79.4% of pregnant women were to be the first time mother.2. Knowledge of oral health during pregnancy:Nearly two thirds of subjects got scores lower than 60 (full scores-100) for oral health knowledge. More than half of them didn't know how to brush teeth correctly. Approximately 40% of them didn't know how long it should be when brushing teeth and the interval to replace the old toothbrush. Less than 40% of pregnant women knew brushing teeth had the preventive effect on periodontal disease and dental caries. Only 44.8% of them believed that periodontal diseases had the influence on pregnancy outcome and fetus. Whether or not a migrant and the education level were the related associated factors of the knowledge scores. The pregnant women without a Shanghai house property got lower scores than the pregnant women who hold a Shanghai house property. The pregnant women under junior middle school education got lower scores than women with higher education level.The oral health knowledge resources of pregnant women:40% of them learned the related knowledge from books and newspapers. One fourth got the knowledge from TV, family, friends and colleagues,15.4% from dentist, only 3.0% from the obstetricians.3. Awareness and attitudes of pregnant women on oral health care:42.8% of them had never seen dentists. Although nearly 80% of them recognized the importance of routine oral examination, only half of them could receive routine oral examination. 15% of them didn't think they need regular dental check. Among these women, about half of them believed that there was no problem on their teeth and no need to conduct the routine check. Qualitative study revealed that most of them were going to see dentist if only they suffered serious dental disease.4. Oral health behaviors of pregnant women:Most of pregnant women did not have the correct oral hygiene habits, and only 27.3% had the correct behaviors. The results of Multivariate Binary logistic analysis showed that the knowledge scores of oral health had the positive relationship with the correct behaviors of oral health. There were other factors associated with oral hygiene habits, such as pregnancy/morning reaction, changing lazy after pregnancy, holding house property, and living environment and sanitation restrictions, etc.5. The utilization status of pregnant women on oral health care:16.4% of them usually had bleeding gums, but only 7.5% go to hospital.15.9% perceived oral discomfort during pregnancy, but only one fifth of these pregnant women went to hospital for dental care. Among those who had oral problem, but did not seek for dental care, more than half of them were worrying about drugs affecting to the fetus during pregnancy.26.7% women thought it was not necessary and 10.7% women didn't go to seek for dental care because of the inconvenient traffic. There were only 16% of pregnant women having dental health insurance.50% of them were not clear whether the health insurance covered oral health care.6. Availability of oral health services during pregnancy:Qualitative survey showed that oral health care during pregnancy had not yet been carried out. The current maternal and child health care just provided passive dental treatment services. Usually, maternal and child health care hospitals didn't have department of stomatology. There was the lack of health education on oral health for pregnant women during pregnancy. Maternal health provider universally lacked of oral health knowledge and skills.7. Demand for oral health services during pregnancy:Nearly 80% of pregnant women lacked oral health knowledge. More than 70% of pregnant women thought they had the demand on oral health knowledge. More than three fifths of pregnant women preferred to obtain oral health knowledge from a professional medical staff, followed by books, newspapers and television. In addition,15% of pregnant women hoped obstetricians could provide some health oral knowledge. More than half of pregnant women were willing to carry out routine oral examination.Conclusion:1. Pregnant women in Jiading District, Shanghai universally lacked of knowledge of oral health during pregnancy, especially the migrants and low education pregnant women. The ways of accessing oral health knowledge were limited; few of them were from the professionals.2. Most of pregnant women lacked awareness on oral health and did not pay attention to oral health during pregnancy.3. The status of oral health behaviors and oral health of pregnant women were not optimistic. There was significant correlation between pregnant women's oral health knowledge and their proper oral hygiene behavior. Other factors including housing environment, sanitation conditions also affect oral health behaviors of pregnant women, and might have affect on their oral health.4. Oral health service was not widely used by pregnant women. Oral health insurance was not widely covered in this sample of pregnant women.5. The availability of oral health for pregnant women needed to be improved.6. Pregnant women had high demand for the health education and service provision of oral health during pregnancy. Pregnant women regarded health professionals as the reliable knowledge providers.Suggestion:1. More public advocacy is needed through the media, health care organizations and communities, to improve the awareness and knowledge of society, family and service providers as well as pregnant women regarding oral health during pregnancy.2. Health care organization should carry out a variety of health education and should pay attention to the time, content, and methods of education, to improve the oral health knowledge of pregnant women.3. It is recommended for pregnant women to study and be informed about oral health knowledge, to get timely treatment, to improve self-oral health care, correct bad oral hygiene habits and to improve oral health conditions during pregnancy.4. To develop training for obstetricians, gynecologists, and primary oral health personnel on oral health knowledge and skills. To improve the service ability and quality of health care institutions on oral health services for pregnant women. To improve accessibility of primary oral health services for pregnant women.5. Advocate the government and the health administration department, through pilot project, to emphasize on oral health care during pregnancy as key task of prenatal care and dental prevention. The government needs to provide the necessary financial support, explore the model of oral health services during pregnancy. Develop basic oral health intervention program during pregnancy, and conduct the systematic management.6 To improve service accessibility. Set up special oral care clinic for pregnant women in public institutions. Dentist and obstetricians need to develop professional cooperation to provide cheap and convenient oral health services, such as routine examination, teeth cleaning and fillings, and caries treatment.7. To put more concerns on migrants, low education and low-income pregnant women and improve their oral health status.