Dental Visits during Pregnancy: Pregnancy Risk Assessment Monitoring System Analysis 2012–2015

Abstract

Objectives: This study aimed to update dental service utilization during pregnancy and to evaluate whether there are persistent disparities in dental care during pregnancy by race/ethnicity and Medicaid status. Methods: This retrospective secondary data analysis examined dental service utilization during and prior to pregnancy and met dental or oral health needs using the Pregnancy Risk Assessment Monitoring System (PRAMS) data sets on 75,876 women between 2012 and 2015. Results: Only about half of the women (51.7%) reported that they had at least 1 dental visit for cleaning during their most recent pregnancy. One of 5 women (19.7%) experienced dental problems during pregnancy, and 34.4% of these women did not visit dentists to address the problems. Non-Hispanic Black women had 14% lower odds of visiting dentists for cleaning during pregnancy compared to non-Hispanic White women (odds ratio [OR], 0.86; 95% CI confidence interval [CI], 0.80–0.92). There was no difference in dental visits prior to pregnancy between non-Hispanic Black and White women. Women enrolled in Medicaid showed significantly lower odds of visiting dentists for cleaning during pregnancy compared to women covered by private health insurance (OR, 0.55; 95% CI, 0.52–0.58). Conclusion for Practice: Oral health, as an integral part of primary care, needs to be included in the standard prenatal care through oral health education and timely dental care during pregnancy. With mounting evidence of persisting disparities in dental service utilization during pregnancy, both public and private prenatal programs and policies should address specific barriers in accessing and using dental care during pregnancy, especially for women from socially disadvantaged backgrounds. Knowledge Transfer Statement: The current study updated the previous findings with more recent multiyear PRAMS data (2012–2015) and found the Black-White disparity and disparity among Medicaid-enrolled women in visiting dentists during pregnancy persist. The results of this study can be used by policymakers and practitioners to integrate oral health into prenatal care for pregnant women from marginalized backgrounds to achieve oral health parity.

Maternal oral health framework: integration of oral health into perinatal care

“…It is, however, an overlooked element among public health interventions. Untreated dental caries in pregnant women can lead to higher risk for dental caries in young children through vertical transmission of cariogenic bacteria [ 5 , 6 ]. Severe early childhood caries can lead to extensive dental treatment under sedation, impairing everyday functions, such as speech and nutrition [ 5 ].…”

“…Untreated dental caries in pregnant women can lead to higher risk for dental caries in young children through vertical transmission of cariogenic bacteria [ 5 , 6 ]. Severe early childhood caries can lead to extensive dental treatment under sedation, impairing everyday functions, such as speech and nutrition [ 5 ]. Research has shown a positive association between periodontal disease during pregnancy and adverse birth outcomes, such as low birth weight and preterm birth [ 7 , 8 ], even though there are mixed results on the association of periodontal treatment and reduced adverse birth outcomes [ 9 ].…”

A Successful Dental Care Referral Program for Low-Income Pregnant Women in New York

“…During pregnancy, women are at increased risk of oral disease due to hormonal changes and behavioral changes [ 2 , 3 , 4 ]. Unfortunately, those women most vulnerable to oral disease (racial–ethnic minorities, low-income women) have the lowest rates of dental utilization during pregnancy [ 13 , 14 , 15 ]. Importantly, for these vulnerable women, pregnancy may be the only time when they have coverage for dental care via the Medicaid program, as is the case in New York State [ 13 ].…”

“…In 2006, the New York State Department of Health published a set of evidence-based guidelines that advocate for the provision of preventive dental care and timely treatment of dental disease during pregnancy [ 9 ]. Despite these and other guidelines [ 10 ], and the overwhelming evidence that dental care during pregnancy is safe and effective [ 11 , 12 ], utilization of dental services among pregnant women has remained low, especially among low-income women [ 13 , 14 , 15 , 16 ]. To date, there are few reports of successful evidence-based programs designed to improve dental care utilization among pregnant women.…”

Oral Health Care Access, Inequity, and Inequality

“…In this issue, readers will find 2 reports on oral health in pregnancy. Lee Het al (2022) analyzed data from >75,000 pregnant women from the 2012–2015 US Pregnancy Risk Assessment Monitoring System; they found that only slightly more than half had seen a dentist for a cleaning during their pregnancy, with non-Hispanic Black and Hispanic women significantly less likely than White women to have done so. When compared with those with private insurance, women enrolled in Medicaid were significantly less likely to have had a dental cleaning during their pregnancies.…”