The association between oral risk assessment and obstetric and newborn outcomes.

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.