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
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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DOI：
10.1016/j.ijnurstu.2018.03.006
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发表时间：
2018-06-01
影响因子：
8.1
通讯作者：
Johnson, Maree
中科院分区：
文献类型：
--
作者：
George, Ajesh;Dahlen, Hannah G.;Johnson, Maree
背景：孕期口腔保健对母婴健康十分重要。然而，孕妇对产妇口腔健康的了解有限，很少寻求牙科护理。此外，由于培训有限，助产士等产前护理提供者很少与孕妇讨论口腔健康问题。助产士发起的口腔健康牙科服务计划是为了解决目前孕期口腔宣传干预方面的空白而开发的。目的：评估助产士发起的口腔健康牙科服务计划在改善孕妇对牙科服务的吸收、口腔健康知识、口腔健康质量、口腔健康状况和分娩结果方面的有效性。设计：多中心随机对照试验。地点：悉尼的三家大型大都市公立医院，参与者：参加第一次产前检查的孕妇，年龄至少18岁，在怀孕12-20周之间有一次低风险妊娠。方法：638名孕妇按随机区组分为三组：对照组(n=211)、干预1组(n=215)、干预2组(n=212)，并随访至分娩。研究调查人员和数据收集者对分组分配视而不见。干预1组接受了训练有素的助产士的助产干预，包括口腔健康教育、筛查和转诊到现有的牙科路径。干预组2接受当地免费牙科服务机构的助产干预和牙科干预，包括评估/治疗。对照组在招募时接受口腔健康信息。主要结果是接受牙科服务。结果：口腔卫生服务使用情况有显著改善(对照组20.2%；干预组1 28.3%；干预组2 87.2%；比数比=29.72，95%可信区间15.02-58.53，p<；0.001)，妇女口腔健康知识(p=0.03)；0.001)和口腔健康状况(沟出血、牙菌斑、临床附着丧失、龋齿/充填牙-p<；0.001)。未发现早产或低出生体重率的差异。结论：助产士发起的口腔健康牙科服务项目(干预组2)提高了孕妇对口腔服务的接受程度和口腔健康水平，建议在产前保健中使用。这种干预和改善生育结果之间的因果关系没有得到支持。
Background: Oral 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.Objectives: To 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.Design: Multi-centre randomised controlled trial.Setting: Three large metropolitan public hospitals in Sydney, Australia.Participants: Pregnant 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.Methods: 638 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.Results: Substantial 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.Conclusions: The 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.