Pregnant Women’s Oral Health-Related Quality of Life and Lifestyle Factors

ABSTRACT

Introduction:

Pregnancy is often associated with a number of oral manifestations. There is a change in lifestyle factors and dental care during pregnancy.

Aim:

We conducted this cross-sectional study to determine how lifestyle factors affect oral health-related quality of life (OHRQOL) in pregnant women residing in Bero block, Jharkhand.

Methods:

The study included a total of 400 pregnant women aged 18–45. The assessment of lifestyle factors and OHRQOL was done using Health Practice Index (HPI) Index and Oral Health Impact Profile-14 (OHIP-14), respectively. Data was collected through face-to-face interviews.

Results:

Forty percent of the pregnant women showed low OHRQOL. The majority of them were not using mouthwash and were brushing their teeth using faulty techniques. The results of logistic regression analysis showed that women with poor lifestyle scores (Odds Ratio [OR] =3.8, P-value <0.0001*), and systemic diseases (OR = 2.6, P-value < 0.001*) were more likely to have poor OHRQOL.

Conclusion:

Pregnancy is associated with poor OHRQOL and poor lifestyle scores. Effective policies for oral health need to be drafted for this group.

INTRODUCTION

Expecting mothers usually find pregnancy to be a happy time in their lives.[1] Oral diseases in mothers become a significant problem and a public health issue during pregnancy.[2] Pregnant women undergo changes in hormonal balance during pregnancy. During pregnancy, the placenta produces a greater amount of estrogen and progesterone, which cause many tissues to undergo changes.[3] A woman who is pregnant also undergoes several lifestyle changes that may affect her oral health and well-being.[4] The lifestyle factors are determined by the living conditions, and individual patterns of behavior.[5] Changes in lifestyle factors may affect OHRQOL significantly during pregnancy.

The data regarding lifestyle factors and OHROQOL in pregnant women in India is limited. Therefore, this study was undertaken to evaluate the relationship between lifestyle factors and oral health-related quality of life in pregnant women from Bero block, Jharkhand. In light of these findings, policymakers will be able to draft effective policies for improving lifestyle factors in this population.

MATERIALS AND METHODS

The study was conducted between August 2022 and September 2022 on pregnant women in the Bero block of Ranchi, Jharkhand. This study was a part of a larger study for which ethical approval was taken. Informed consent was sought from the participants. We selected pregnant women between the ages of 18 and 45 using a convenient sampling technique. Those who consented to be a part of the study and who lived in Bero for at least 10 years were included in the study.

Using the formula recommended by World Health Organization for calculating sample size, 25 pregnant women were surveyed and the sample size was calculated to be 374 based on their results.[6] The investigators decided to round off the sample size to the nearest number and included 400 individuals to compensate for non-response.

Using a questionnaire, information was collected on sociodemographic characteristics, oral hygiene practices, dental visits, and systemic diseases. Oral Health Impact Profile-14 (OHIP-14) was used to assess the quality of life related to oral health. The higher the score, the worse the OHRQOL.[7] The assessment of lifestyle factors was done using the Health Practice Index, which was further classified into three categories as per the criteria given by Morimoto.[8]

The data collection was carried out by a trained investigator who is a dentist by profession and posted in CHC, Bero. He was trained in the recording of the various items of the questionnaire. The investigator conducted a face-to-face interview to collect the requisite information and any doubts he encountered while filling out the proforma were clarified by him.

All statistical analysis was performed by SPSS v 20. Appropriate descriptive tests were conducted. An OHRQOL score above its median signifies a poorer health-related quality of life. Logistic regression analysis was conducted. All statistical significance was calculated at P-value < 0.05.

RESULTS

Sixty percentof the participating women reported good oral health-related quality of life [Table 1].

Table 1.

Distribution as per OHRQOL

Categories	Number (%)
Poor	160 (40%)
Good	240 (60%)

Most study participants (94.0%) had never visited a dentist and did not use mouthwash for dental hygiene maintenance (98.0%). In addition, 52.0% of pregnant women had poor lifestyle scores. Based on bivariate analysis, pregnant women who had unresolved systemic diseases had never visited a dentist before and had poor lifestyle scores were significantly less likely to enjoy good oral health [Table 2].

Table 2.

Bivariate analysis for analyzing factors associated with poor OHRQOL

Factor	Categories	Number (%)	Unadjusted Odds Ratio	95% CI	P
Age	≤30 years	216 (54.00%)	1.1	0.72-1.32	0.723
	>30 years	184 (48.00%)	1.00
Oral Hygiene aid	Toothbrush	296 (74.00%)	1.09	0.81-1.30	0.738
	Finger	64 (16.00%)	1.21	0.92-1.30	0.480
	Others	40 (10.00%)	1.00
Material used	Toothpaste	344 (86.00%)	1.13	0.40-1.29	0.886
	Toothpowder	40 (10.00%)	1.20	0.35-1.30	0.820
	Others	16 (4.00%)	1.00
Frequency of brushing	≤once daily	368 (92.00%)	1.3	1.1-2.8	0.523
	Twice or more daily	32 (8.00%)	1.00
Technique of brushing	Vertical	48 (12.00%)	1.04	0.48-1.8	0.903
	Horizontal	72 (18.00%)	0.90	0.45-0.96	0.904
	Combination	24 0 (60.00%)	0.86	0.33-0.99	0.924
	Others	40 (10.00%)
Mouthwash use	Yes	8 (2.00%)	0.5	0.20-1.23	0.103
	No	392 (98.00%)	1.00
Systemic diseases	Yes	112 (28.00%)	2.3	1.63-2.8	0.013*
	No	288 (72.00%)	1.00
Trimester of pregnancy	Third	160 (40.00%)	1.1	0.6-1.3	0.839
	Second	128 (32.00%)	1.1	0.6-1.3	0.839
	First	112 (28.00%)	1.0
Lifestyle factors	Poor	208 (52.00%)	3.6	1.6-4.3	<0.0001**
	Fair	152 (38.00%)	2.7	1.1-3.9	<0.001*
	Good	40 (10.00%)	1.0

Significant (P value < 0.05), *Highly significant (P value < 0.001), **Very highly significant (P value < 0.0001)

Based on logistic regression analysis, pregnant women with poor lifestyle scores (OR = 3.8, P-value 0.0001) and systemic diseases (OR = 2.6, P-value 0.001) reported significantly worse OHRQOL [Table 3].

Table 3.

Logistic regression (enter method)

Factor	Categories	Adjusted ODDS Ratio	95% CI	P
Lifestyle factors	Poor	3.8	1.1-4.3	<0.0001**
	Fair	2.6	1.1-2.9
	Good	1.0
Systemic disease	Yes	2.6	0.72-3.6	<0.001*
	No	1.0

Significant (P value < 0.05), *Highly significant (P value < 0.001), **Very highly significant (P value < 0.0001)

DISCUSSION

It was found that 40% of pregnant ladies reported poor OHRQOL. The findings are higher than those reported by Kumar S et al[4] (2018) in their study done in urban areas of India. Considering that this study was conducted in a rural and low socioeconomic area of Jharkhand where residents are not aware of oral health and lack access to oral care, the above findings are likely to be observed.

More than half of the pregnant women reported poor lifestyle scores. The period of pregnancy is often associated with a lack of sleep, depression, stress, dietary alterations, and change in physical activities.[9,10] These alterations in the body have a negative impact on lifestyle scores.

The majority of the pregnant women were brushing their teeth with a frequency less than or equal to once daily and were using improper brushing techniques. This is suggestive of the fact that the pregnant women were having poor oral hygiene awareness. The use of the correct brushing techniques needs to be demonstrated to pregnant women. Improper brushing of teeth during pregnancy can cause serious periodontal problems leading to depleted oral health in the study population.

Also, the majority of them reported not using mouthwashes for oral hygiene maintenance. The use of chemical mouth rinses in conjunction with mechanical plaque control has been recommended by a number of studies.[11,12] The authors recommend the use of chemical mouthwashes along with mechanical cleansing aids for oral hygiene maintenance during pregnancy.

It was found that individuals who had poor lifestyle scores were more likely to have a poor OHRQOL, which is similar to Kumar S et al.[4] (2018) and Santiago et al.[13] (2013). A healthy lifestyle leads to a better oral health-related quality of life.

The quality of life associated with oral health was worse in pregnant women who suffered from systemic diseases. A number of systemic diseases have been linked with poor oral health status.[14,15] The authors are of the opinion that hormonal changes during pregnancy along with the occurrence of systemic diseases have a synergistic effect leading to this.

The study was carried out in only one low socioeconomic area of Jharkhand. The study should include more number of similar areas before the results can be generalized. This study may have missed some other factors associated with poor OHRQOL. The results cannot be generalized without a larger longitudinal study on a larger sample size including larger sites.

CONCLUSION

More than half of the pregnant women reported poor OHRQOL, and poor lifestyle scores. The majority of the pregnant ladies were not using mouthwashes as an aid for oral hygiene maintenance. Also, the majority of them were not using the correct brushing techniques. The pregnant ladies have poor oral hygiene awareness and have seldom visited a dentist for dental treatment. Those with systemic diseases and poor lifestyle scores were more likely to have poor OHRQOL.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.