The Association Between Maternal Oral Health Experiences and Risk of Preterm Birth in 10 States, Pregnancy Risk Assessment Monitoring System, 2004–2006

Sunah S. Hwang; Vincent C. Smith; Marie C. McCormick; Wanda D. Barfield


Matern Child Health J. 2012;16(8):1688-1695. 

In This Article

Abstract and Introduction


The aim of this study is to investigate the association between oral health experiences of women in the peripartum period and the risk of preterm delivery (<37 weeks). We analyzed 2004–2006 data from the CDC Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based surveillance system that collects data on pregnancy and postpartum experiences of mothers who have recently delivered a live infant. Ten states included in the analysis had a ≥70% weighted response rate and three standard questions pertaining to oral health. White non-Hispanic (WNH), Black non-Hispanic (BNH), and Hispanic women were selected for analysis. Chi-squared analysis was performed for our bivariate analysis and multivariate logistic regression models were created to calculate adjusted odds ratios, controlling for socio-demographic characteristics and peripartum morbidities. Weighted percentages and standard errors were used for all analyses. Among the 35,267 women studied, in the multivariate analysis, mothers who did not receive dental care during pregnancy and did not have a teeth cleaning during pregnancy were at higher risk for delivering a preterm infant (OR 1.15, CI 1.02–1.30; OR 1.23, CI 1.08–1.41). In this population-based study, women who did not receive dental care or have a teeth cleaning during pregnancy were at slightly higher risk for preterm delivery after adjustment for pertinent confounders.


Improving the oral health of the US population has become a major public health issue. Recent studies have demonstrated that overall health cannot be achieved without oral health. For instance, periodontal disease has been implicated in the increased risk for coronary artery disease and stroke.[1–3] For pregnant women, achieving and maintaining periodontal health also has additional implications for pregnancy outcome. Periodontal disease has been shown in some studies to contribute to a higher risk of preterm birth. The Oral Conditions and Pregnancy (OCAP) Study, a prospective observational study, has shown that maternal periodontal disease and disease progression during pregnancy conferred a significant increased risk for preterm delivery.[4,5] The proposed mechanism involves the up-regulation of inflammatory markers in the mother as well as the fetus secondary to oral infection.[6] Infection and inflammation have been shown to be important risk factors in causing preterm birth.[7] However, significant controversy still exists; the most recent clinical trials which treated pregnant women with periodontal disease during their second trimester has shown no difference in rates of preterm birth when compared to untreated mothers.[8–10] In these clinical trials, treatment took place in the second trimester, perhaps too late to reverse the lifelong exposure of poor oral health experienced by some pregnant women, thus offering some explanation for the discrepancy in results from longitudinal cohort studies and randomized clinical trials. Instead of treating active oral infection during pregnancy to prevent preterm birth, the maintenance of oral health to prevent disease before and during pregnancy may yield more significant results. This argument receives support from a recently published population-based study by Albert et al.[11] in which, women who received preventive dental care during the study's period of observation, which included the time period prior to delivery, were less likely to deliver preterm or low birth weight infants. This study, however, included only privately insured women of mid to high socioeconomic status. Given that privately insured individuals are more likely to receive preventive dental services,[12] the positive effect of dental care during pregnancy in potentially improving birth outcomes may have been biased toward the null given that these women may already have had optimal dental health.

In this report, we assess the association of maternal oral health experiences and the risk of preterm delivery in a population-based multi-state cohort of mothers of varying insurance and socioeconomic status.