Evaluation of a midwifery initiated oral health-dental service program to improve oral health and birth outcomes for pregnant women: A multi-centre randomised controlled trial |
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| Affiliation: | 1. Centre for Oral Health Outcomes, Research Translation and Evaluation (COHORTE), Western Sydney University, South Western Sydney Local Health District Oral Health Services, University of Sydney, Ingham Institute Applied Medical Research, Liverpool 1871, Australia;2. School of Nursing & Midwifery, Western Sydney University, Ingham Institute Applied Medical Research, Parramatta 2150, Australia;3. Faculty of Dentistry, University of Sydney, Sydney, 2006, Australia;4. Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney 2010, Australia;5. Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney 2010, Australia;6. Camden and Campbelltown Hospitals, South Western Sydney Local Health District, Campbelltown 2170, Australia;7. School of Nursing & Midwifery, University of Western Sydney, Liverpool, 1871, Australia;8. Western Sydney University, University of New South Wales, Ingham Institute Applied Medical Research, Liverpool 1871, Australia;9. Faculty of Health Sciences, Australian Catholic University, Sydney 2060, Australia;10. Ingham Institute Applied Medical Research, Liverpool 1871, Australia;11. Sydney Research, Sydney 2010, Australia |
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| Abstract: | BackgroundOral health care during pregnancy is important for the health of the mother and child. However, pregnant women have limited knowledge about maternal oral health and seldom seek dental care. Further, due to limited training antenatal care providers like midwives rarely discuss oral health with pregnant women. The Midwifery-Initiated Oral Health Dental Service program was developed to address current gaps in oral promotional interventions during pregnancy.ObjectivesTo assess the effectiveness of a Midwifery-Initiated Oral Health Dental Service program in improving uptake of dental services, oral health knowledge, quality of oral health, oral health status and birth outcomes of pregnant women.DesignMulti-centre randomised controlled trial.SettingThree large metropolitan public hospitals in Sydney, Australia.ParticipantsPregnant women attending their first antenatal appointment who were at least 18 years old and had a single low risk pregnancy between 12 and 20 weeks gestation.Methods638 pregnant women were allocated to three groups using block randomisation (n = 211) control group, intervention group 1 (n = 215), intervention group 2 (n = 212) and followed up till birth. Study investigators and data collectors were blinded to group allocation. Intervention group 1 received a midwifery intervention from trained midwives involving oral health education, screening and referrals to existing dental pathways. Intervention group 2 received the midwifery intervention and a dental intervention involving assessment/treatment from cost free local dental services. The control group received oral health information at recruitment. Primary outcome was uptake of dental services. Secondary outcomes included oral health knowledge, quality of oral health, oral health status and birth outcomes.ResultsSubstantial improvements in the use of dental services (20.2% Control Group; 28.3% Intervention group 1; 87.2% Intervention group 2; Odds Ratio Intervention group 2 vs Control Group = 29.72, 95% CI 15.02–58.53, p < 0.001), women’s oral health knowledge (p = 0.03); quality of oral health (p < 0.001) and oral health outcomes (sulcus bleeding, dental plaque, clinical attachment loss, decayed/filled teeth- p < 0.001) were found in Intervention group 2. No difference in the rate of preterm or low-birth weight was found.ConclusionsThe Midwifery-Initiated Oral Health Dental Service program (Intervention group 2) improved the uptake of dental services and oral health of pregnant women and is recommended during antenatal care. A cause and effect relationship between this intervention and improved birth outcomes was not supported. |
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| Keywords: | Midwives Oral health Pregnancy Prenatal care |
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