Pregnancy is often a time marked by increased oral health (OH) concerns, yet dental care utilization rates, especially among underserved women;indicate that most low-income pregnant women do not receive dental care. Improving the oral health of pregnant women: 1) safeguards their own oral health;2) has the potential to improve their overall health and decrease early childhood caries in their children;and 3) may reduce adverse birth outcomes. Although several national organizations recommend that women receive dental care and anticipatory guidance for infant oral health care during pregnancy, it is unlikely that many women, particularly those in underserved areas, are receiving these important preventive health services. The purpose of this project is to develop and pilot test an interactive educational and behavioral oral health promotion (OHP) intervention to improve maternal and infant OH status, knowledge, attitudes, and behaviors for low-income women attending a group prenatal care program, CenteringPregnancy (CP(R)), in the San Francisco Bay Area. With a growing number of groups, currently more than 200 nationally, CP(R) is an innovative group care model designed to provide comprehensive prenatal care and to advance women's sense of health awareness through assessment, education, and support. The OHP development will be guided by the Social Cognitive Theory, will use the PRECEDE PROCEED model for planning, and adhere to the essential care components of CP(R): assessment, education, and support. The study includes two phases: Phase 1: DEVELOPMENT &TRAINING and Phase 2: PILOT TEST &EVALUATION. Phase I aims are to: 1) develop, with CP(R) staff and participants, an OHP curriculum that will address predisposing (knowledge, attitudes), enabling (skills building, environmental), and reinforcing (feedback) OH factors;2) consult with CP(R) community to develop acceptable research procedures to evaluate the OHP intervention;and 3) train 8 CP(R) staff to conduct the OHP pilot intervention. Phase II aims are: 4) pilot test the OHP intervention in 2 CP(R) sites (n= 50 CP(R) participants) and examine pre-post changes in OH status and OH-related outcomes;and 5) evaluate changes in same OH factors in 2 CP(R) sites (n= 50 CP(R) participants) without the OHP intervention to assess changes due to pregnancy, the CP(R) program without OHP, and other secular factors. We will assess OH status through on-site study dental exams and self- reports. We will assess OH knowledge, attitudes, and behaviors about maternal and infant OH through questionnaires. If successful, these results will be used to develop a full-scale clinical research study (RO1), which would formally test the efficacy of the OHP intervention in improving the oral health of pregnant women and their children.

Public Health Relevance

Many women receive inadequate oral health care during pregnancy, especially those in low-income and underserved groups. As proposed in this R21 application, the development of an oral health promotion intervention for women receiving their prenatal care within a well-established, innovative, group model of prenatal care, CenteringPregnancy (CP(R)) may provide the opportunity to advance women's oral health and the oral health of their children, as well as improve their general health across the life span. The results of the proposed application will hopefully provide the preliminary data needed to submit an R01 application to formally test the efficacy of the oral health promotion intervention, which if successful, could be implemented widely in CP(R) programs nationally and internationally, as well as other prenatal care groups.

National Institute of Health (NIH)
National Institute of Dental & Craniofacial Research (NIDCR)
Exploratory/Developmental Grants (R21)
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Community-Level Health Promotion Study Section (CLHP)
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Nowjack-Raymer, Ruth
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University of California San Francisco
Schools of Medicine
San Francisco
United States
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Adams, Sally H; Gregorich, Steven E; Rising, Sharon S et al. (2017) Integrating a Nurse-Midwife-Led Oral Health Intervention Into CenteringPregnancy Prenatal Care: Results of a Pilot Study. J Midwifery Womens Health 62:463-469
Chung, Lisa H; Gregorich, Steven E; Armitage, Gary C et al. (2014) Sociodemographic disparities and behavioral factors in clinical oral health status during pregnancy. Community Dent Oral Epidemiol 42:151-9