Factors related to orientation of search for dental care in high risk pregnancy

quantitative approach study with cross-sectional design carried out with high-risk pregnant women, from January to May 2018. Statistical analysis was performed using Pearson's chi-square association test and Fisher's exact test, followed by logistic regression analysis and odds ratio calculation.

Results:

the final sample was composed of 190 pregnant women and the guidance for seeking dental care was significantly related to issues related to Prenatal Dental Care, regarding safety (p = 0.025), effective search (p < 0.0001) and the Unit Basic Health Care as a place of assistance (p = 0.0018). Pregnant women who did not receive search guidance are 19.6 more likely to not seek this service (p <0.001), when they seek it without guidance, they have 6.3 more chances to seek private services (p = 0.014) and when they do not receive guidance, they are 4.5 more likely to not feel secure in relation to this assistance (p = 0.005).

Conclusion:

the guidance and encouragement provided by the health team is paramount in pregnant woman's decision to seek assistance, especially in the context of Primary Health Care, and is characterized as a strategic tool in reducing insecurities related to dental treatment during pregnancy.

Key words:
Prenatal care; Oral health; Pregnant women; Pregnancy; High risk

Preexisting conditions
Hypertension under treatment	Autoimmune diseases
Addiction to illicit drugs	Previous uterus/vaginal surgery (outside of pregnancy)
Cardiac diseases under treatment and/or under follow-up	Hypothyroidism (changed T4L or patient undergoing treatment)
Pneumoties under treatment	Neoplasms
Nephropathies under treatment and/or in follow-up	Morbid obesity
Diabetes	Psychosis and severe depression
Hemopathies (except mild and moderate anemia, physiological of pregnancy)	Bariatric Surgery (less than 2 years after surgery)
Uterus/vaginal malformation	Hyperthyroidism
Infectious diseases (consider the local epidemiological situation, periodontal diseases and their impact on pregnancy)	Addiction to legal drugs (smoking/alcoholism) with clinical complications or other maternal/fetal risk factor.
Epilepsy
Clinical complications
Hypertensive syndrome in current pregnancy	Previous placent
Twin pregnancy	Uterine bleeding
Rh isoimmunization	Fetal malformation
Gestational diabetes mellitus	Abrupt change in BMI curve
Intrauterine growth retardation (estimated fetal weight below the 10^th percentile)	Premature labor
Infectious-contagious diseases experienced during the current pregnancy (recurrent urinary tract infection, respiratory tract diseases, rubella, HIV, toxoplasmosis, syphilis, Zika virus infection, influenza influenza, viral hepatitis, other arboviruses with fetal repercussions)	Premature amniorrhexis (below 37 weeks of gestation)

Variables	Received orientation to seek a dental surgeon during the current pregnancy
	Yes (n=169)		No (n=21)		Total		p
	n	%	n	%	n	%	p
Age (years)							0.11
18 - 25	71	42.0	12	57.1	83	43.7
26 - 35	72	42.6	4	19.1	76	40.0
> 35	26	15.4	5	23.8	31	16.3
Scholarity							0.61
Elementary or middle school complete	106	62.7	12	57.1	118	62.1
High school or superior complete	63	37.3	9	42.9	72	37.9
Family income (minimum wage)							0.66
Until 1	72	42.6	10	47.6	82	43.1
1 - 2	97	57.4	11	53.4	108	56.9
Marital status							0.42
Single/other	73	43.2	11	52.4	84	44.2
Married/stable union	96	56.8	10	47.6	106	55.8
Occupation							0.26
General Services	31	18.3	7	33.3	38	20.0
Housewife	105	62.1	11	52.4	116	61.0
Other	33	19.6	3	14.3	36	19.0

Variables	Received orientation to seek a dental surgeon during the current pregnancy
	Yes (n=169)		No (n=21)		Total		p
	n	%	n	%	n	%	p
Systemic and gestational health
Preexisting clinical condition or clinical complications							0.34
Present	100	59.2	15	71.4	115	60.5
Absent	69	40.8	6	28.6	75	39.5
First pregnancy							0.87
Yes	51	30.2	6	28.6	57	30.0
No	118	69.8	15	71.4	133	70.0
Miscarriage history *							0.53
Yes	29	24.6	5	33.3	34	25.6
No	89	75.4	10	66.7	99	74.4
Premature birth history *							0.07
Yes	17	14.4	5	33.3	22	16.6
No	101	85.6	10	66.7	111	83.4
Low birth weight child history *							0.24
Yes	16	13.6	4	26.7	20	15.0
No	102	86.4	11	73.3	113	85.0
Oral Health
Habit of dental appointments in the pre-pregnancy period							0.15
Yes	122	72.2	12	57.1	134	70.5
No	47	27.8	9	42.9	56	29.5
Change in oral hygiene habits							0.56
Yes	33	19.5	3	14.3	36	19.0
No	136	80.5	18	85.7	154	81.0
Self-perception of change in the oral cavity							0.77
Yes	67	39.6	9	42.9	76	40.0
No	102	60.4	12	57.1	114	60.0
Toothache in the last 6 months							0.58
Yes	50	29.6	5	21.8	55	29.0
No	119	70.4	16	76.2	135	71.0
Oral Health Evaluation							0.13
Positive	116	68.6	11	52.4	132	69.5
Negative	53	31.4	10	47.6	63	30.5
Prenatal Dental Care
Knowledge about the term PDC							0.20
Yes	61	36.1	5	23.8	66	34.7
No	108	63.9	16	76.2	124	65.3
Security regarding dental care							0.025
Yes	155	91.7	16	76.2	171	90.0
No	14	8.3	5	23.8	19	10.0
Effective search for dental care							<0.001
Yes	160	94.7	10	46.6	170	89.5
No	9	5.3	11	52.4	20	10.5
BHU as a search location for dental care **							0.002
Yes	146	91.2	6	60.0	152	80.0
No	14	8.8	4	40.0	54	20.0

Variable	OR (CI95%)	p
Effective search for dental care
Yes	1,00	<0.001
No	19.6(6.6-58.1)
BHU as search location for dental care
Yes	1.00	0.014
No	6.3(1.5-27.5)
Security regarding dental care
Yes	1.00	0.005
No	4.54 (3.06-6.72)

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E-mail: revista@imip.org.br

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[1] Authors’ contribution

Galvan J: literature review; conceptualization; elaboration of the data collection instrument; data collect; formal analysis; investigation; manuscript writing. Bordin D: methodology design; validation; formal analysis; manuscript writing; final review. Fadel CB: conceptualization; methodology design; discussion of the article; manuscript writing; final review. Alves FBT: methodology design; study supervision; writing guidance; project design; final review. All authors have approved the final version of the article.