Effectiveness of community and primary-care-based maternal oral health interventions on pregnancy and infant outcomes: a systematic review.

OBJECTIVES

The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of community and primary care based maternal oral health interventions on maternal oral health outcomes, pregnancy outcomes, and infant oral health outcomes.

MATERIALS AND

METHODS

Electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, and Scopus, were searched for studies published between 2000 and 2025. Eligible studies included randomized controlled trials and non-randomized intervention studies evaluating maternal oral health interventions delivered in antenatal, primary care, or community settings. Primary outcomes were maternal oral health indicators, preterm birth, low birth weight, and early childhood caries at or before 24 months of age. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for randomized trials and the Risk of Bias in Non-randomized Studies of Interventions tool for non-randomized studies. Random-effects meta-analyses were conducted for selected outcomes.

RESULTS

Twelve studies met inclusion criteria. Meta-analysis of randomized trials showed a non-significant reduction in preterm birth (risk ratio 0.80, 95% confidence interval 0.60-1.05) and low birth weight (risk ratio 0.76, 95% confidence interval 0.51-1.13). Pooled analysis of non-randomized controlled studies demonstrated a significant reduction in early childhood caries prevalence (risk ratio 0.66, 95% confidence interval 0.59-0.74). Maternal oral health knowledge, behaviours, and clinical indicators consistently improved across studies.

CONCLUSIONS

Community and primary care maternal oral health interventions appear to improve maternal oral health knowledge, behaviours, service utilization, and some clinical oral-health indicators. Evidence for effects on pregnancy outcomes and early childhood caries remains less certain because most included studies were non-randomized and several were at serious or critical risk of bias. According to GRADE considerations, certainty of evidence for several key outcomes was low or very low. Further adequately powered randomized trials are required before firm conclusions can be drawn regarding birth and infant outcomes.

CLINICAL TRIAL NUMBER: not applicable.