734 - Pregnant Patients With Positive Oral Health Screens Have an Increased Risk of Adverse Pregnancy and Offspring Outcomes

Publication Number: 734.6189

L. Carolina Martinez-King, University of Washington School of Medicine, Seattle, WA, United States; Sherrill “Charlie” Rose, University of Washington School of Medicine, Seattle, WA, United States; Krystle M.. Perez, University of Washington, Seattle, WA, United States; Olivia C. Brandon, University of Washington: Magnuson Health Sciences Center – RR 544A, Seattle, WA, United States; Kanika Z. Nallaseth, University of Washington, Redmond, WA, United States; Tommy J. Yang, University of Washington School of Medicine, Sammamish, WA, United States; Abdul Muhsin Hameed, University of Washington School of Medicine, Bellevue, WA, United States; Kathryn J. Gray, University of Washington School of Medicine, Seattle, WA, United States; Thomas R. Wood, University of Washington School of Medicine, Seattle, WA, United States; Gregory C.. Valentine, University of Washington School of Medicine, Tacoma, WA, United States

Background: Periodontal disease in pregnancy is a known risk factor for adverse pregnancy and offspring outcomes including preeclampsia and preterm birth. The American College of Obstetricians and Gynecologists (ACOG) recommends screening all pregnant patients on their first obstetric visit with a 3-question survey to assess their risk of oral disease (Table 1). Yet, no studies have evaluated whether a positive screen is associated with adverse pregnancy or offspring outcomes.

Objective: We sought to assess the relationship between a positive overall screen (defined as a positive response to any of the three questions) and preterm birth, preeclampsia, gestational hypertension, gestational diabetes, and offspring birthweight.

Design/Methods: We screened pregnant individuals at a university-based prenatal clinic using the 3-question ACOG screening tool. We performed unadjusted and adjusted (including covariates significantly different at baseline, Table 2) linear and logistic regression models to evaluate associations between screening questions and pregnancy/offspring outcomes.

Results: Among 886 screened pregnant patients, 51.7% (458 patients) had an overall positive screen with 23.5% (208), 44.0% (390), and 14.6% (129) screening positive on questions 1, 2, and 3, respectively. Patients who had an overall positive screen had significantly increased odds of preterm birth (aOR 1.44, 95% CI: 1.03, 2.03), gestational hypertension (aOR 1.75, 95% CI: 1.08, 2.84), and gestational diabetes (aOR 1.71, 95% CI 1.08, 2.71), see Table 3. Those with symptomatic oral disease (question 1), had a significantly increased odds of preeclampsia (aOR 2.26, 95% CI 1.30, 3.94) and gave birth to infants with significantly lower birthweight (-193g; 95% CI -341.0, -44.4; Table 3). Those who sought help finding a dentist had significantly reduced odds of pre-eclampsia and gestational hypertension and gave birth to infants with a significantly higher birthweight (+244g; 95% CI +45.5, +442.4; Table 3).

Conclusion(s): A positive ACOG oral disease screen is associated with significantly increased risks of adverse pregnancy and offspring outcomes. Symptomatic oral disease is associated with adverse health outcomes, while seeking help in accessing dental care is associated with improved outcomes. Further studies are needed to determine: (a) whether each screening question directly relates to degree of oral disease, and (b) whether actual receipt of dental care after referral versus simply the act of patients self-advocating for assistance in receiving dental care in pregnancy leads to similar preventive benefit.

ACOG Recommended Oral Health Screening Questions
Three oral health screening questions are provided in the ACOG Committee Opinion "Oral Health Care During Pregnancy and Through the Lifespan" that was first published in 2013 and reaffirmed in 2022. ACOG recommends that these three questions be asked of all pregnant patients at their first obstetric visit, yet there is no literature on how these questions relate to pregnancy and offspring outcomes.

Table 2: Antenatal Characteristics of Pregnant Patients with a Positive ACOG Screen Compared to Those with a Negative Overall Screen
#p-value calculated using Fisher’s Exact Test. ^p-value calculated using Mann-Whitney U test. Of note, this table depicts the data after imputing missing data. Missing or unknown data was imputed assuming the condition was not present except for the variables of age, race, ethnicity, or type of medical insurance.

Table 3: Adjusted Logistic Regression Models Evaluating Neonatal and Pregnancy Outcomes Based on Positive Overall Screen and Per Question
Adjustments include the statistically significant variables in Table 1: type of medical insurance, chronic hypertension, autoimmune conditions in pregnancy, maternal age, self-described ethnicity, and self-described race. *Gestational hypertension does not include adjustment for chronic hypertension as diagnoses are mutually exclusive. #Data presented as n/N (%) for categorical variables and median (IQR) for continuous variables (e.g. birthweight).