Oral health-related quality of life and its association with oral health literacy and dental caries experience among a group of pregnant women: a cross-sectional study

Oral health-related quality of life and its association with oral health literacy and dental caries experience among a group of pregnant women: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Oral health-related quality of life and its association with oral health literacy and dental caries experience among a group of pregnant women: a cross-sectional study Mojdeh Shahpari, Hajar Shekarchizadeh, Mahsa Sadat Mousavi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1924110/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Oral health plays an important role in general health of the pregnant women and their newborns. The aim of this study was to assess oral health-related quality of life and its association with oral health literacy and dental caries experience among a group of Iranian pregnant women. Methods : Applying a convenient sampling method, a cross-sectional study was conducted on 200 pregnant women attending a governmental hospital in Isfahan, Iran, in 2019. Self-administrated questionnaires requested information about women’s demographics, their oral health-related quality of life utilizing Oral Health Impact Profile-14 (OHIP-14), and their oral health literacy utilizing Oral Health Literacy-Adult Questionnaire. A senior dental student conducted clinical examination under the artificial light of a headlamp based on the WHO (World Health Organization) criteria to record dental caries experience with Decayed, Missing and Filled Teeth (DMFT) index. Mann-whitney U test, Kruskal–Wallis test, spearman correlation coefficient, and a linear regression model served for statistical analysis (p<0.05). Results : The mean age of the pregnant women was 28.8 ± 5.5. About half of the women (49.5%) had a high school diploma, and 84% were homemaker. The mean score of OHIP-14 was 13.2 ± 9.0 (range 0-38). The mean score of oral health literacy was 9.7 ± 3.2 (range 1-16). The mean DMFT was 9.8 ± 5.2. In multivariate analysis, higher score of OHIP-14 was associated with higher caries experience (p<0.05). Conclusions : Higher caries experience was associated with more effects of oral problems on pregnant women’s quality of life. Thus, it is recommended to increase their oral health-related quality of life via preventive measures to control the dental caries experience. Pregnancy Oral health Health literacy Quality of life Dental caries Background Higher risk of oral complications exists during pregnancy. Pregnancy hormones, by changing the inflammatory mediators and the immune response, predispose the oral cavity to problems such as gingivitis and periodontitis. Periodontal diseases might lead to gingival bleeding, pain, halitosis, tooth loss and even individuals’ poor quality of life [1, 2]. Furthermore, pregnant women are in greater risk of developing dental caries due to increased acidity of the oral cavity, higher tendency to eat sweet foods, and ignoring the oral hygiene during pregnancy [1]. Oral health during pregnancy plays an important role in general health of both the pregnant women and their newborns. Low birth weight, preeclampsia, and gestational diabetes mellitus have been reported to be associated with periodontitis during pregnancy [1, 3]. Most oral complications are not fetal but might affect the patients’ quality of life through their effects on individuals’ physical, social, and psychological health [4]. Oral health-related quality of life indicates the patients’ comfort while eating, sleeping, participating in social interaction, and their satisfaction with their oral health [5]. Pregnancy-related changes in the oral cavity play an important role in women’s quality of life [6]. According to the results of a systematic review, dental and gingival health during pregnancy affect the oral health-related quality of life of pregnant women [7]. Health literacy affects the women’s ability to understand and use health information during pregnancy [8]. Oral health literacy is defined as the individuals’ ability to receive, analyze and understand basic oral health information and necessary services to make appropriate decisions regarding their oral health [9]. Based on the report of Divaris et al, pregnant women with low level of oral health literacy reported more effects of oral problems on their quality of life [10]. However, according to the results of a systematic review by Firmino et al, the association of oral health literacy with oral health perception and behaviors, and dental treatment outcomes is inconclusive [11]. several studies have indicated the association between parents’ oral health literacy and their child’s dental health status [12-15]. In a systematic review, an association revealed between parents’ or caregivers’ low level of oral health literacy and high prevalence of dental caries in children’s deciduous dentition [12]. Other studies have also reported the relationship between parents’ inadequate oral health literacy and their children’s tooth decay [13-15]. In a study among pregnant women, those with highest level of health literacy showed higher knowledge regarding their infant’s nutritional habits and oral health [16]. Due to the importance of oral health literacy as a new determinant of oral health [17], and since the pregnant women are at greater risk of oral complications and poor quality of life, the present study aimed to evaluate oral health-related quality of life and its association with oral health literacy and dental caries experience among a group of pregnant women. Methods Utilizing a convenient sampling method, we conducted a cross-sectional study on 200 pregnant women attending a governmental hospital in Isfahan, Iran, in 2019. The minimum sample size of 194 was estimated to calculate the simple correlation coefficient of oral health-related quality of life with oral health literacy and dental caries experience considering the precision of 0.05, power of 80% (β = 0.2), a minimum correlation coefficient of 0.2 (medium effect size) for the significant association in a hypothesis test of ρ = 0 compared to ρ ≠ 0. The data were collected with self-administered questionnaire and clinical examination. Three questionnaires requested information regarding participants’ oral health-related quality of life as the dependent variable, and women’s demographic characteristics (age, education, occupation, number of family members) and their oral health literacy as independent variables. Completing the questionnaires took around 30 minutes with each participant. To assess mothers’ oral health-related quality of life, we used the Persian version of Oral Health Impact Profile-14 (OHIP-14) [18]. This instrument comprises 14 items in 7 domains: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. Responses to the questions are rated based on a 5-point Likert scale (0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, and 4 = very often). The total score ranges from 0 to 56. higher score of OHIP-14 indicates poor oral health-related quality of life [18]. Oral Health Literacy-Adult Questionnaire (OHL-AQ) comprises 17 questions in four sections: I) reading comprehension, II) numeracy, III) listening, and IV) decision making. Assigning a score of 1 to each correct answer, a total score for the questionnaire ranges between 0 and 17. OHL-AQ is a standard questionnaire in Persian language which was developed and pilot tested in a sample of Iranian population by Naghibi et al [19]. A senior dental student who was trained and calibrated by a specialist in community oral health (Kapa coefficient of intra-examiner reliability=0.82), conducted the clinical examination based on the WHO (World Health Organization) criteria [20] to record the Decayed, Missing and Filled Teeth (DMFT) index and its components: Decayed Teeth, Filled Teeth, and Missing Teeth under the light of a headlamp using a disposable mirror. Following the examination, treatment suggestions were given to each participant. Statistical analysis We applied the Statistical Package for Social Science (SPSS 20.0/PC; SPSS, Chicago, IL, USA). To test the normal distribution of the continuous variables, we used the Kolmogorov-Smirnov test. Since these variables were not normally distributed, Mann-whitney U test, Kruskal–Wallis test, and spearman correlation coefficient served for statistical analysis (p < 0.05). A linear regression model was fitted to the data to analyze the factors associated with participants’ oral health-related quality of life. Ethical considerations The study was approved by the secretory of the Medical Ethics Committee in the research committee of Islamic Azad University of Isfahan (Research Code: 23810201961006). Participation in the study was voluntarily. All participants filled in anonymous questionnaires, and provided the written informed consent. Results In total, 200 pregnant women participated in our study (Response rate = 85%). The mean age of the women was 28.8 ± 5.5 (range 18-41 years), and 62% were between 25-34 years of age. Most participants were homemaker (84%), and had high school diploma (49.5%). The mean number of their family members was 2.9 ± 0.9, range: 2-6 (Table 1). Table 1- Demographic characteristics of pregnant women attending a governmental hospital in Isfahan, Iran, in 2019 (n=200) Variable N (%) Age <25 40 (20) 25-34 124 (62) 35≤ 36 (18) Mean (SD) = 28.8 (5.5) Education Less than diploma 31 (15.5) Diploma 99 (49.5) University education 70 (35) Job status Employed 15 (7.5) Student 17 (8.5) Homemaker 168 (84) Number of family members Two 74 (37) Three 85 (42.5) Four 30 (15) Five or more 11 (5.5) Mean (SD) = 2.9 (0.9) Dental caries experience The mean DMFT of pregnant women was 9.8 ± 5.2, range 0-28. Filled Teeth comprised the main part of the index (5.5 ± 4.1, range 0-16), followed by Decayed Teeth (2.4 ± 2.5, range 0-14) and Missing Teeth (2.0 ± 3.7, range 0-28). Oral heath literacy The mean score of oral health literacy among pregnant women was 9.7 ± 3.2, range 1-16. The mean score of its subscales includes comprehension: 3.2 ± 1.5, calculation: 3.2 ± 1.0, listening: 0.7 ± 0.6, and decision making: 2.5 ± 1.4. A direct week correlation revealed between oral health literacy and the participants’ age (p = 0.001, r = 0.23) and their education (p < 0.001, r = 0.32). However, oral health literacy showed no significant association with pregnant women’s occupation (p = 0.618), and their number of family members (p = 0.672). Although no significant correlation existed between participants’ oral health literacy and their DMFT index (p = 0.071), subscale of reading comprehension (p = 0.021, r = 0.16) revealed a direct week correlation with dental caries experience. Oral health-related quality of life The mean score of OHIP-14 among pregnant women was 13.2 ± 9.0, range 0-38. Table 2 presents the mean score of each OHIP-14 subscale. Physical pain and psychological discomfort were the domains with most impact on quality of life fallowed by psychological disability. Oral health-related quality of life showed no significant correlation with participants’ age (p = 0.702), their education (p = 0.091), and the number of family members (p = 0.363). No significant association existed between pregnant women’s oral health-related quality of life and their occupation (p = 0.658) as well. Table 2- The mean score of OHIP-14 subscales among pregnant women attending a governmental hospital in Isfahan, Iran, in (n=200) Subscales of OHIP-14 Mean ± SD minimum maximum Functional limitation 1.1 0 6 Physical pain 2.8 0 7 Psychological discomfort 2.7 0 7 Physical disability 1.7 0 6 Psychological disability 2.1 0 7 Social disability 1.5 0 6 Handicap 1.3 0 6 A direct week correlation revealed between OHIP-14 and the DMFT index (p = 0.003, r = 0.21). Table 3 shows the correlation between subscales of OHIP-14 and the DMFT. All subscales of OHIP-14 showed significant correlation with DMFT except for functional limitation (p > 0.05). No significant correlation existed between OHIP-14 and oral health literacy (p = 0.347). Table 3- Correlation between subscales of OHIP-14 and DMFT index among pregnant women attending a governmental hospital in Isfahan, Iran, in 2019 (n=200) Subscales of OHIP-14 r p Functional limitation 0.05 0.512 Physical pain 0.16 0.027 Psychological discomfort 0.18 0.013 Physical disability 0.16 0.028 Psychological disability 0.25 0.001< Social disability 0.17 0.018 Handicap 0.16 0.025 In multivariate analysis, only participants with higher caries experience revealed higher score of OHIP-14 (Table 4). Table 4- Factors associated with OHIP-14 among pregnant women attending a governmental hospital in Isfahan, Iran, based on a linear regression model Variables B Standard Error Beta P 95% Confidence Interval for B Age -0.058 0.129 -0.035 0.654 -0.313 - 0.197 Education 1.294 0.694 0.142 0.064 -0.075 - 2.663 Number of family members 0.708 0.808 0.067 0.382 -0.885 - 2.301 Job status (Homemaker) a Student 0.737 2.442 0.022 0.763 -4.079 - 5.553 Employed -1.454 2.275 -0.045 0.523 -5.941 - 3.032 DMFT b 0.308 0.128 0.178 0.017 0.056 - 0.560 Oral health literacy -0.060 0.215 -0.021 0.780 -0.484 - 0.364 a Reference group b Decayed, Missing and Filled Teeth R 2 =0.06 Discussion In the present study of oral health-related quality of life among pregnant women, and its association with oral health literacy and dental caries experience, we found no significant association between oral health literacy and oral health-related quality of life. However, participants with higher score of DMFT reported more effects of oral problems on their quality of life. Oral health-related quality of life among pregnant women in our study was 13.2. Considering the possible range of OHIP-14 total score (0–56), the impact of oral problems on their quality of life was low. This score was almost similar to that of Brazilian pregnant women (12.1) [ 6 ], but worse than that of a group of low-income female caregivers in North Carolina (10.6) [ 10 ], and that of a sample of pregnant women in China (7.92) [ 21 ]. Different methodology of the studies or different study target groups might justify such difference in the results. Physical pain and psychological discomfort were the domains with most impact on quality of life fallowed by psychological disability. Similarly, based on the results of a systematic review, the most affected domains of quality of life among pregnant women were mental and psychological discomfort, followed by physical and functional problems [ 7 ]. We found no association between oral health-related quality of life and participants’ educational level. This is in line with the study by Ikebe et al. who reported no association between education and OHIP-14 among elderly Japanese [ 22 ]. However, based on available evidence among other target groups, those with higher education reported less effects of oral problems on their quality of life [ 23 , 24 ]. Among pregnant women, higher score of DMFT was associated with more effects of oral problems on quality of life. This finding is supported by the result of a meta-analysis among pregnant women indicating a positive association between DMFT and poor oral health-related quality of life [ 25 ]. Similar findings have been reported in studies among other target groups [26–28]. As explained by Gift and Redford, oral and dental complications have significant effects on individual’s physical, mental and social wellbeing, and can affect a person's quality of life through impaired interpersonal relationships [29]. No association revealed between oral health literacy and OHIP-14 in our study. In contrast, based on other reports, higher level of oral health literacy was associated with less effect of oral problems on quality of life [10, 30, 31]. As suggested by Divaris et al, the relationship between oral health literacy and oral health-related quality of life seems to be different among different ethnic groups [ 10 ]. The mean score of oral health literacy among pregnant women in our study (9.7) was lower than that of their counterparts in general population (OHL-AQ mean score: 10.9) [ 17 ] which might be due to different socioeconomic characteristics of the participants. Considering the stratified multistage random sampling method, Naghibi et al. studied oral health literacy of citizens from all socioeconomic regions of Tehran (capital city of Iran) [ 17 ]. However, we studied only the pregnant women attending one governmental hospital in Isfahan. Similarly, oral health literacy of pregnant women from a low-income group in North Carolina was lower than that of other target groups [ 8 ]. This finding is important due to its possible effect on child’s oral health status, as several studies have indicated the association between parents’ oral health literacy and their child’s dental health status [ 12 – 15 ]. Oral health literacy was higher among more educated women in our study. Several reports have also emphasized the direct association between oral health literacy and educational level [8, 10, 16, 19, 32–36]. Women’s ability to understand and use health information during pregnancy is affected by Health literacy [ 8 ]. Thus, as suggested by Vilella et al, health professionals should consider their clients’ level of education in order to improve their communication with patients and to provide effective health information and recommendations [ 16 ]. No significant association revealed between oral health literacy and DMFT index. It seems that other more important factors might affect dental caries experience among our participants than do oral health literacy; factors including oral health behaviors, access to preventive care, nutritional habits, and socioeconomic status. Similar result was reported among a group of Iranian pregnant women attending a health governmental institute [33], and among dental patients in a university dental clinic in America [35]. In contrast, lower level of oral health literacy was associated with higher score of DMFT in patients attending a university dental center in India [37], and was associated with more untreated dental caries among Brazilian adult patients [30]. Among adult dental patients in Belarus, those with adequate oral health literacy had fewer missing teeth and more filled teeth [36]. The association of oral health literacy with oral health perception, oral health behaviors, and oral health-related treatment outcomes was inconclusive based on a systematic review by Firmino et al. [ 11 ]. To the best of our knowledge, this is the first study to report oral health literacy, dental caries experience, and oral health-related quality of life simultaneously among pregnant women. In addition, clinical examinations utilizing standard questionnaires and a high response rate are other strengths of this study. However, the cross-sectional nature of the study makes it impossible to interfere a causal relationship. In addition, we selected the participants from one governmental hospital thus, the results could not be generalized to all pregnant women including those from other medical centers or even private practices. Furthermore, we should consider the social desirability due to the use of questionnaires. However, we tried to overcome this limitation by anonymous data collection. Conclusions The impact of oral problems on Iranian pregnant women’s quality of life was low. No association revealed between oral health literacy and oral health-related quality of life. However, higher caries experience was associated with more effects of oral problems on pregnant women’s quality of life. Thus, it is recommended to design and implement preventive oral health programs for pregnant women in order to control their dental caries experience, and to increase their oral health-related quality of life. Abbreviations OHL-AQ: Oral Health Literacy-Adult Questionnaire OHIP-14: Oral Health Impact Profile-14 DMFT: Decayed, Missing, Filled Teeth Declarations Ethics approval and consent to participate: The study was approved by the secretory of the Medical Ethics Committee in the research committee of Islamic Azad University of Isfahan (Research Code: 23810201961006). All methods were performed in accordance with the relevant guidelines in Declaration of Helsinki. Participation in the study was voluntarily. All participants filled in anonymous questionnaires, and provided written informed consent. Consent for publication: Not applicable. Availability of data and materials: The dataset used and/or analyzed during the current study is available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: Not applicable. Authors' contributions: All authors contributed to design and conception of the study. 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Oral Health Literacy and Oral Health Knowledge among 2,263 First-time Pregnant Urban Women: A Cross-sectional Questionnaire Study. J Contemp Dent Pract. 2019;20(9):1029-1032. Baskaradoss JK. Relationship between oral health literacy and oral health status. BMC oral health. 2018;18(1):172. Blizniuk A, Ueno M, Zaitsu T, Kawaguchi Y. Association of oral health literacy with oral health behaviour and oral health status in Belarus. Community Dent Health. 2015;32(3):148-52. Haridas R, Supreetha S, Ajagannanavar SL, Tikare S, Maliyil MJ, Kalappa AA. Oral health literacy and oral health status among adults attending dental college hospital in India. J Int Oral Health. 2014;6(6):61-6. Additional Declarations No competing interests reported. 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Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1924110","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":127942956,"identity":"a518e293-83df-44a3-9cc8-c0a8396442ee","order_by":0,"name":"Mojdeh Shahpari","email":"","orcid":"","institution":"Islamic Azad University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mojdeh","middleName":"","lastName":"Shahpari","suffix":""},{"id":127942957,"identity":"97298331-3195-4af4-99fd-720fc16d8b6c","order_by":1,"name":"Hajar Shekarchizadeh","email":"data:image/png;base64,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","orcid":"","institution":"Islamic Azad University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Hajar","middleName":"","lastName":"Shekarchizadeh","suffix":""},{"id":127942958,"identity":"32408208-9479-4af4-a739-e4a64246175d","order_by":2,"name":"Mahsa Sadat Mousavi","email":"","orcid":"","institution":"Islamic Azad University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mahsa","middleName":"Sadat","lastName":"Mousavi","suffix":""}],"badges":[],"createdAt":"2022-08-03 05:59:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1924110/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1924110/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":29710051,"identity":"26f8ea91-fdcf-4782-b49a-3042cd0f8b93","added_by":"auto","created_at":"2022-11-30 09:44:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":288272,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1924110/v1/bf32fd69-259a-453c-b09b-e342bafe1493.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Oral health-related quality of life and its association with oral health literacy and dental caries experience among a group of pregnant women: a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eHigher risk of oral complications exists during pregnancy. Pregnancy hormones, by changing the inflammatory mediators and the immune response, predispose the oral cavity to problems such as gingivitis and periodontitis. Periodontal diseases might lead to gingival bleeding, pain, halitosis, tooth loss and even individuals\u0026rsquo; poor quality of life [1,\u0026nbsp;2]. Furthermore, pregnant women are in greater risk of developing dental caries due to increased acidity of the oral cavity, higher tendency to eat sweet foods, and ignoring the oral hygiene during pregnancy [1].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOral health during pregnancy plays an important role in general health of both the pregnant women and their newborns. Low birth weight, preeclampsia, and gestational diabetes mellitus have been reported to be associated with periodontitis during pregnancy [1,\u0026nbsp;3].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMost oral complications are not fetal but might affect the patients\u0026rsquo; quality of life through their effects on individuals\u0026rsquo; physical, social, and psychological health [4]. Oral health-related quality of life indicates the patients\u0026rsquo; comfort while eating, sleeping, participating in social interaction, and their satisfaction with their oral health [5]. Pregnancy-related changes in the oral cavity play an important role in women\u0026rsquo;s quality of life [6]. According to the results of a systematic review, dental and gingival health during pregnancy affect the oral health-related quality of life of pregnant women [7].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHealth literacy affects the women\u0026rsquo;s ability to understand and use health information during pregnancy [8]. Oral health literacy is defined as the individuals\u0026rsquo; ability to receive, analyze and understand basic oral health information and necessary services to make appropriate decisions regarding their oral health [9]. Based on the report of Divaris et al, pregnant women with low level of oral health literacy reported more effects of oral problems on their quality of life [10]. However, according to the results of a systematic review by Firmino et al, the association of oral health literacy with oral health perception and behaviors, and dental treatment outcomes is inconclusive [11].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eseveral studies have indicated the association between parents\u0026rsquo; oral health literacy and their child\u0026rsquo;s dental health status [12-15]. In a systematic review, an association revealed between parents\u0026rsquo; or caregivers\u0026rsquo; low level of oral health literacy and high prevalence of dental caries in children\u0026rsquo;s deciduous dentition [12]. Other studies have also reported the relationship between parents\u0026rsquo; inadequate oral health literacy and their children\u0026rsquo;s tooth decay [13-15]. In a study among pregnant women, those with highest level of health literacy showed higher knowledge regarding their infant\u0026rsquo;s nutritional habits and oral health [16].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDue to the importance of oral health literacy as a new determinant of oral health [17], and since the pregnant women are at greater risk of oral complications and poor quality of life, the present study aimed to evaluate oral health-related quality of life and its association with oral health literacy and dental caries experience among a group of pregnant women.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eUtilizing a convenient sampling method, we conducted a cross-sectional study on 200 pregnant women attending a governmental hospital in Isfahan, Iran, in 2019. The minimum sample size of 194 was estimated to calculate the simple correlation coefficient of oral health-related quality of life with oral health literacy and dental caries experience considering the precision of 0.05, power of 80% (\u0026beta; = 0.2), a minimum correlation coefficient of 0.2 (medium effect size) for the significant association in a hypothesis test of \u0026rho; = 0 compared to \u0026rho; \u0026ne; 0.\u0026nbsp;The data were collected with self-administered questionnaire and clinical examination. Three questionnaires requested information regarding participants\u0026rsquo; oral health-related quality of life as the dependent variable, and women\u0026rsquo;s demographic characteristics (age, education, occupation, number of family members) and their oral health literacy as independent variables. Completing the questionnaires took around 30 minutes with each participant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo assess mothers\u0026rsquo; oral health-related quality of life, we used the Persian version of Oral Health Impact Profile-14 (OHIP-14) [18]. This instrument comprises 14 items in 7 domains: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. Responses to the questions are rated based on a 5-point Likert scale (0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, and 4 = very often). The total score ranges from 0 to 56. higher score of OHIP-14 indicates poor oral health-related quality of life [18].\u003c/p\u003e\n\u003cp\u003eOral Health Literacy-Adult Questionnaire (OHL-AQ) comprises 17 questions in four sections: I) reading comprehension, II) numeracy, III) listening, and IV) decision making. Assigning a score of 1 to each correct answer, a total score for the questionnaire ranges between 0 and 17. \u0026nbsp;OHL-AQ is a standard questionnaire in Persian language which was developed and pilot tested in a sample of Iranian population by Naghibi et al [19].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA senior dental student who was trained and calibrated by a specialist in community oral health (Kapa coefficient of intra-examiner reliability=0.82), conducted the clinical examination based on the WHO (World Health Organization) criteria [20] to record the Decayed, Missing and Filled Teeth (DMFT) index and its components: Decayed Teeth, Filled Teeth, and Missing Teeth under the light of a headlamp using a disposable mirror. Following the examination, treatment suggestions were given to each participant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe applied the Statistical Package for Social Science (SPSS 20.0/PC; SPSS, Chicago, IL, USA). To test the normal distribution of the continuous variables, we used the Kolmogorov-Smirnov\u003c/p\u003e\n\u003cp\u003etest. Since these variables were not normally distributed, Mann-whitney U test, Kruskal\u0026ndash;Wallis test, and spearman correlation coefficient served for statistical analysis (p \u0026lt; 0.05). A linear regression model was fitted to the data to analyze the factors associated with participants\u0026rsquo; oral health-related quality of life.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the secretory of the Medical Ethics Committee in the research committee of Islamic Azad University of Isfahan (Research Code: 23810201961006). Participation in the study was voluntarily. All participants filled in anonymous questionnaires, and provided the written informed consent.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn total, 200 pregnant women participated in our study (Response rate = 85%). The mean age of the women was 28.8 \u0026plusmn; 5.5 (range 18-41 years), and 62% were between 25-34 years of age. Most participants were homemaker (84%), and had high school diploma (49.5%). The mean number of their family members was 2.9 \u0026plusmn; 0.9, range: 2-6 (Table 1).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 1- Demographic characteristics of pregnant women attending a governmental hospital in Isfahan, Iran, in 2019 (n=200)\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e124 (62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35\u0026le;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eMean (SD) = 28.8 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eEducation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLess than diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31 (15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e99 (49.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUniversity education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70 (35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eJob status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStudent\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17 (8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHomemaker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e168 (84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eNumber of family members\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTwo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74 (37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eThree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e85 (42.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFour\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFive or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eMean (SD) = 2.9 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eDental caries experience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean DMFT of pregnant women was 9.8 \u0026plusmn; 5.2, range 0-28. Filled Teeth comprised the main part of the index (5.5 \u0026plusmn; 4.1, range 0-16), followed by Decayed Teeth (2.4 \u0026plusmn; 2.5, range 0-14) and Missing Teeth (2.0 \u0026plusmn; 3.7, range 0-28).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOral heath literacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean score of oral health literacy among pregnant women was 9.7 \u0026plusmn; 3.2, range 1-16. The mean score of its subscales includes comprehension: 3.2 \u0026plusmn; 1.5, calculation: 3.2 \u0026plusmn; 1.0, listening: 0.7 \u0026plusmn; 0.6, and decision making: 2.5 \u0026plusmn; 1.4. A direct week correlation revealed between oral health literacy and the participants\u0026rsquo; age (p = 0.001, r = 0.23) and their education (p \u0026lt; 0.001, r = 0.32). However, oral health literacy showed no significant association with pregnant women\u0026rsquo;s occupation (p = 0.618), and their number of family members (p = 0.672).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough no significant correlation existed between participants\u0026rsquo; oral health literacy and their DMFT index (p = 0.071), subscale of reading comprehension (p = 0.021, r = 0.16) revealed a direct week correlation with dental caries experience.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOral health-related quality of life\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean score of OHIP-14 among pregnant women was 13.2 \u0026plusmn; 9.0, range 0-38. Table 2 presents the mean score of each OHIP-14 subscale. Physical pain and psychological discomfort were the domains with most impact on quality of life fallowed by psychological disability. Oral health-related quality of life showed no significant correlation with participants\u0026rsquo; age (p = 0.702), their education (p = 0.091), and the number of family members (p = 0.363). No significant association existed between pregnant women\u0026rsquo;s oral health-related quality of life and their occupation (p = 0.658) as well.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 2- The mean score of OHIP-14 subscales among pregnant women attending a governmental hospital in Isfahan, Iran, in (n=200)\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.243589743589745%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubscales of OHIP-14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.67948717948718%\"\u003e\n \u003cp\u003e\u003cstrong\u003eminimum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.115384615384617%\"\u003e\n \u003cp\u003e\u003cstrong\u003emaximum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.243589743589745%\"\u003e\n \u003cp\u003eFunctional limitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.67948717948718%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.115384615384617%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.243589743589745%\"\u003e\n \u003cp\u003ePhysical pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.67948717948718%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.115384615384617%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.243589743589745%\"\u003e\n \u003cp\u003ePsychological discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.67948717948718%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.115384615384617%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.243589743589745%\"\u003e\n \u003cp\u003ePhysical disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.67948717948718%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.115384615384617%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.243589743589745%\"\u003e\n \u003cp\u003ePsychological disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.67948717948718%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.115384615384617%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.243589743589745%\"\u003e\n \u003cp\u003eSocial disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.67948717948718%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.115384615384617%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.243589743589745%\"\u003e\n \u003cp\u003eHandicap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.67948717948718%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.115384615384617%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eA direct week correlation revealed between OHIP-14 and the DMFT index (p = 0.003, r = 0.21). Table 3 shows the correlation between subscales of OHIP-14 and the DMFT. All subscales of OHIP-14 showed significant correlation with DMFT except for functional limitation (p \u0026gt; 0.05). \u0026nbsp;No significant correlation existed between OHIP-14 and oral health literacy (p = 0.347).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3- Correlation between subscales of OHIP-14 and DMFT index among pregnant women attending a governmental hospital in Isfahan, Iran, in 2019 (n=200)\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubscales of OHIP-14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.333333333333336%\"\u003e\n \u003cp\u003eFunctional limitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.333333333333336%\"\u003e\n \u003cp\u003ePhysical pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.333333333333336%\"\u003e\n \u003cp\u003ePsychological discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.333333333333336%\"\u003e\n \u003cp\u003ePhysical disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.333333333333336%\"\u003e\n \u003cp\u003ePsychological disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.001\u0026lt;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.333333333333336%\"\u003e\n \u003cp\u003eSocial disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.333333333333336%\"\u003e\n \u003cp\u003eHandicap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn multivariate analysis, only participants with higher caries experience revealed higher score of OHIP-14 (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4- Factors associated with OHIP-14 among pregnant women attending a governmental hospital in Isfahan, Iran, based on a linear regression model\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStandard Error\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBeta\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e95% Confidence Interval for B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.654\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.313 - 0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEducation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.075 - 2.663\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNumber of family members\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.708\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.885 - 2.301\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\n \u003cp\u003eJob status\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(Homemaker)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.737\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.763\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-4.079 - 5.553\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-1.454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-5.941 - 3.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDMFT\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.056 - 0.560\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOral health literacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.484 - 0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Reference group\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Decayed, Missing and Filled Teeth\u003c/p\u003e\n\u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e=0.06\u003c/p\u003e\n"},{"header":"Discussion","content":"\u003cp\u003e In the present study of oral health-related quality of life among pregnant women, and its association with oral health literacy and dental caries experience, we found no significant association between oral health literacy and oral health-related quality of life. However, participants with higher score of DMFT reported more effects of oral problems on their quality of life.\u003c/p\u003e \u003cp\u003eOral health-related quality of life among pregnant women in our study was 13.2. Considering the possible range of OHIP-14 total score (0\u0026ndash;56), the impact of oral problems on their quality of life was low. This score was almost similar to that of Brazilian pregnant women (12.1) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], but worse than that of a group of low-income female caregivers in North Carolina (10.6) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and that of a sample of pregnant women in China (7.92) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Different methodology of the studies or different study target groups might justify such difference in the results. Physical pain and psychological discomfort were the domains with most impact on quality of life fallowed by psychological disability. Similarly, based on the results of a systematic review, the most affected domains of quality of life among pregnant women were mental and psychological discomfort, followed by physical and functional problems [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e We found no association between oral health-related quality of life and participants\u0026rsquo; educational level. This is in line with the study by Ikebe et al. who reported no association between education and OHIP-14 among elderly Japanese [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, based on available evidence among other target groups, those with higher education reported less effects of oral problems on their quality of life [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong pregnant women, higher score of DMFT was associated with more effects of oral problems on quality of life. This finding is supported by the result of a meta-analysis among pregnant women indicating a positive association between DMFT and poor oral health-related quality of life [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Similar findings have been reported in studies among other target groups [26\u0026ndash;28]. As explained by Gift and Redford, oral and dental complications have significant effects on individual\u0026rsquo;s physical, mental and social wellbeing, and can affect a person's quality of life through impaired interpersonal relationships [29].\u003c/p\u003e \u003cp\u003e No association revealed between oral health literacy and OHIP-14 in our study. In contrast, based on other reports, higher level of oral health literacy was associated with less effect of oral problems on quality of life [10, 30, 31]. As suggested by Divaris et al, the relationship between oral health literacy and oral health-related quality of life seems to be different among different ethnic groups [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe mean score of oral health literacy among pregnant women in our study (9.7) was lower than that of their counterparts in general population (OHL-AQ mean score: 10.9) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] which might be due to different socioeconomic characteristics of the participants. Considering the stratified multistage random sampling method, Naghibi et al. studied oral health literacy of citizens from all socioeconomic regions of Tehran (capital city of Iran) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, we studied only the pregnant women attending one governmental hospital in Isfahan. Similarly, oral health literacy of pregnant women from a low-income group in North Carolina was lower than that of other target groups [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This finding is important due to its possible effect on child\u0026rsquo;s oral health status, as several studies have indicated the association between parents\u0026rsquo; oral health literacy and their child\u0026rsquo;s dental health status [\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOral health literacy was higher among more educated women in our study. Several reports have also emphasized the direct association between oral health literacy and educational level [8, 10, 16, 19, 32\u0026ndash;36]. Women\u0026rsquo;s ability to understand and use health information during pregnancy is affected by Health literacy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Thus, as suggested by Vilella et al, health professionals should consider their clients\u0026rsquo; level of education in order to improve their communication with patients and to provide effective health information and recommendations [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNo significant association revealed between oral health literacy and DMFT index. It seems that other more important factors might affect dental caries experience among our participants than do oral health literacy; factors including oral health behaviors, access to preventive care, nutritional habits, and socioeconomic status. Similar result was reported among a group of Iranian pregnant women attending a health governmental institute [33], and among dental patients in a university dental clinic in America [35]. In contrast, lower level of oral health literacy was associated with higher score of DMFT in patients attending a university dental center in India [37], and was associated with more untreated dental caries among Brazilian adult patients [30]. Among adult dental patients in Belarus, those with adequate oral health literacy had fewer missing teeth and more filled teeth [36]. The association of oral health literacy with oral health perception, oral health behaviors, and oral health-related treatment outcomes was inconclusive based on a systematic review by Firmino et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, this is the first study to report oral health literacy, dental caries experience, and oral health-related quality of life simultaneously among pregnant women. In addition, clinical examinations utilizing standard questionnaires and a high response rate are other strengths of this study. However, the cross-sectional nature of the study makes it impossible to interfere a causal relationship. In addition, we selected the participants from one governmental hospital thus, the results could not be generalized to all pregnant women including those from other medical centers or even private practices. Furthermore, we should consider the social desirability due to the use of questionnaires. However, we tried to overcome this limitation by anonymous data collection.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe impact of oral problems on Iranian pregnant women\u0026rsquo;s quality of life was low. No association revealed between oral health literacy and oral health-related quality of life. However, higher caries experience was associated with more effects of oral problems on pregnant women\u0026rsquo;s quality of life. Thus, it is recommended to design and implement preventive oral health programs for pregnant women in order to control their dental caries experience, and to increase their oral health-related quality of life.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOHL-AQ: Oral Health Literacy-Adult Questionnaire\u003c/p\u003e\n\u003cp\u003eOHIP-14: Oral Health Impact Profile-14\u003c/p\u003e\n\u003cp\u003eDMFT: Decayed, Missing, Filled Teeth\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate:\u0026nbsp;The study was approved by the secretory of the Medical Ethics Committee in the research committee of Islamic Azad University of Isfahan (Research Code: 23810201961006).\u0026nbsp;All methods were performed in accordance with the relevant guidelines in Declaration of Helsinki.\u0026nbsp;Participation in the study was voluntarily. All participants filled in anonymous questionnaires, and provided written informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The dataset used and/or analyzed during the current study is available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding: Not applicable.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: All authors contributed to design and conception of the study. M.Sh. collected the data. M.S.M. and H.Sh. interpreted the data. All authors participated in either drafting or critical revising the manuscript. All authors approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eHartnett E, Haber J, Krainovich-Miller B, Bella A, Vasilyeva A, Lange Kessler J. Oral Health in Pregnancy. J Obstet Gynecol Neonatal Nurs. 2016;45(4):565-73.\u003c/li\u003e\n \u003cli\u003eIbrahim HM, Mudawi AM, Ghandour IA. Oral health status, knowledge and practice among pregnant women attending Omdurman maternity hospital, Sudan. East Mediterr Health J. 2016;22(11):802-9.\u003c/li\u003e\n \u003cli\u003eAmerican Academy of Pediatric Dentistry. Guideline on perinatal and infant oral health care. Pediatr Dent. 2016;38(6):150-3.\u003c/li\u003e\n \u003cli\u003eVaziri F, Haerian A, Morowati Sharifabadi M A, Amirian E. Relationship Between Oral Health Related Quality of Life and Dental Condition in Patients Referring to Yazd Dental University and Yazd Khatamolanbia Clinic. 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J Am Dent Assoc. 2012;143(9):972-80.\u003c/li\u003e\n \u003cli\u003eNational Institute of Dental and Craniofacial Research, National Institute of Health, US Public Health Service, Department of Health and Human Services. The invisible barrier: literacy and its relationship with oral health. A report of a workgroup sponsored by the National Institute of Dental and Craniofacial Research, National Institute of Health, US Public Health Service, Department of Health and Human Services. J Public Health Dent. 2005;65(3):174-82.\u003c/li\u003e\n \u003cli\u003eDivaris K, Lee JY, Baker AD, Vann WF. The relationship of oral health literacy with oral health-related quality of life in a multi-racial sample of low-income female caregivers. Health Qual Life Outcomes. 2011;9(1):108.\u003c/li\u003e\n \u003cli\u003eFirmino RT, Martins CC, Faria LDS, Martins Paiva S, Granville-Garcia AF, Fraiz FC, Ferreira FM. Association of oral health literacy with oral health behaviors, perception, knowledge, and dental treatment related outcomes: a systematic review and meta-analysis. J Public Health Dent. 2018;78(3):231-245.\u003c/li\u003e\n \u003cli\u003eFirmino RT, Ferreira FM, Paiva SM, Granville-Garcia AF, Fraiz FC, Martins CC. Oral health literacy and associated oral conditions: A systematic review. American Dental Association (JADA). 2017;148(8):604-13.\u003c/li\u003e\n \u003cli\u003eTyagi U, Menon I, Tomar D, Singh A, Goyal J. Association between maternal oral health literacy and their preschoolers\u0026rsquo; oral health outcomes in Muradnagar\u0026mdash;A cross-sectional study. J Dent Specialities. 2017;5(2):98-101.\u003c/li\u003e\n \u003cli\u003eKhodadadi E, Niknahad A, Sistani MM, Motallebnejad M. Parents\u0026rsquo; oral health literacy and its impact on their children\u0026rsquo;s dental health status. Electron Physician. 2016;8(12):3421.\u003c/li\u003e\n \u003cli\u003eVichayanrat T, Sittipasoppon T, Rujiraphan T, Meeprasert N, Kaveepansakol P, Atamasirik Y. Oral health literacy among mothers of pre-school children. M Dent J. 2014;34(3):243-52.\u003c/li\u003e\n \u003cli\u003eVilella KD, Alves SG, de Souza JF, Fraiz FC, da Silva Assun\u0026ccedil;ao LR. The association of oral health literacy and oral health knowledge with social determinants in pregnant brazilian women. J Community Health. 2016;41(5):1027-32.\u003c/li\u003e\n \u003cli\u003eNaghibi Sistani MM, Yazdani R, Virtanen J, Pakdaman A, Murtomaa H. Determinants of oral health: does oral health literacy matter?. ISRN Dent. 2013; 2013.\u003c/li\u003e\n \u003cli\u003eRavaghi V, Farrahi-Avval N, Locker D, Underwood M. Validation of the Persian short version of the Oral Health Impact Profile (OHIP-14). Oral Health Prev Dent. 2010;8(3):229-35.\u003c/li\u003e\n \u003cli\u003eNaghibi Sistani MM, Montazeri A, Yazdani R, Murtomaa H. New oral health literacy instrument for public health: development and pilot testing. J Investig Clin Dent. 2014;5(4):313-21.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. Oral health surveys: basic\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003emethods. 5th ed. Geneva: World Health Organization; 2013.\u003c/li\u003e\n \u003cli\u003eLu HX, Xu W, Wong MC, Wei TY, Feng XP. Impact of periodontal conditions on the quality of life of pregnant women: a cross-sectional study. Health Qual Life Outcomes. 2015;13(1):67.\u003c/li\u003e\n \u003cli\u003eIkebe K, Hazeyama T, Enoki K, Murai S, Okada T, Kagawa R, Matsuda KI, Maeda Y. Comparison of GOHAI and OHIP‐14 measures in relation to objective values of oral function in elderly J apanese. Community Dent Oral Epidemiol. 2012;40(5):406-14.\u003c/li\u003e\n \u003cli\u003ePapaioannou W, Oulis CJ, Yfantopoulos J. The oral health related quality of life in different groups of senior citizens as measured by the OHIP-14 questionnaire. Oral Biol Dent. 2015;3(1):1.\u003c/li\u003e\n \u003cli\u003eTsakos G, Sheiham A, Iliffe S et al. The impact of educational level on oral health-related quality of life in older people in London. Eur J Oral Sci 2009;117:286\u0026ndash;92.\u003c/li\u003e\n \u003cli\u003eGharehghani MAM, Bayani A, Bayat AH, Hemmat M, Karimy M, Ahounbar E, Armoon B, Fakhri Y, Schroth RJ. Poor oral health-related quality of life among pregnant women: A systematic review and meta-analysis. Int J Dent Hyg. 2021;19(1):39-49.\u003c/li\u003e\n \u003cli\u003eAmiri S, Shekarchizadeh H. Oral health-related quality of life among a group of patients with substance use disorders in rehabilitation treatment: a cross-sectional study. BMC Oral Health. 2021;21(1):409.\u003c/li\u003e\n \u003cli\u003eHirani S, Tariq A. OHRQoL with DMFT of undergraduates and graduates of Dow university of health sciences. J Pak Dent Assoc 2018;27(4):186-89.\u003c/li\u003e\n \u003cli\u003eBakhtiar M, Mohammadi TM, Hajizamani A, Vossoughi M. Association of oral health indicators with quality-of-life related to oral health in Iranian adolescent. J Int Oral Health 2014;6(6):5-9.\u003c/li\u003e\n \u003cli\u003eGift HC, Redford M. Oral health and the quality of life. Clin Geriatr Med. 1992;8(3):673-83.\u003c/li\u003e\n \u003cli\u003eBatista MJ, Lawrence HP, de Sousa MD. Oral health literacy and oral health outcomes in an adult population in Brazil. BMC public health. 2018;18(1):60.\u003c/li\u003e\n \u003cli\u003eJu HJ, Oh HW, Lee HS. Impact of oral health literacy on oral health-related quality of life among adults. J Korean Acad Oral Health. 2014;38(4):220-6.\u003c/li\u003e\n \u003cli\u003eNiazi S, Eusufzai SZ, Saddki N. Predictors of oral health literacy in pregnant women. Health Care Women Int. 2022 Mar 18:1-15. Epub ahead of print\u003c/li\u003e\n \u003cli\u003eAfshar MK, Torabi M, Bahremand M, Afshar MK, Najmi F, Mohammadzadeh I. Oral health literacy and related factors among pregnant women referring to Health Government Institute in Kerman, Iran. Pesqui Bras Odontopediatria Cl\u0026iacute;n Integr. 2020; 20:e5337.\u003c/li\u003e\n \u003cli\u003eMuralidharan S, Mallaiah P, Garale S, Acharya A. Oral Health Literacy and Oral Health Knowledge among 2,263 First-time Pregnant Urban Women: A Cross-sectional Questionnaire Study. J Contemp Dent Pract. 2019;20(9):1029-1032.\u003c/li\u003e\n \u003cli\u003eBaskaradoss JK. Relationship between oral health literacy and oral health status. BMC oral health. 2018;18(1):172.\u003c/li\u003e\n \u003cli\u003eBlizniuk A, Ueno M, Zaitsu T, Kawaguchi Y. Association of oral health literacy with oral health behaviour and oral health status in Belarus. Community Dent Health. 2015;32(3):148-52.\u003c/li\u003e\n \u003cli\u003eHaridas R, Supreetha S, Ajagannanavar SL, Tikare S, Maliyil MJ, Kalappa AA. Oral health literacy and oral health status among adults attending dental college hospital in India. J Int Oral Health. 2014;6(6):61-6.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pregnancy, Oral health, Health literacy, Quality of life, Dental caries","lastPublishedDoi":"10.21203/rs.3.rs-1924110/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1924110/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Oral health plays an important role in general health of the pregnant women and their newborns. The aim of this study was to assess oral health-related quality of life and its association with oral health literacy and dental caries experience among a group of Iranian pregnant women.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Applying a convenient sampling method, a cross-sectional study was conducted on 200 pregnant women attending a governmental hospital in Isfahan, Iran, in 2019. Self-administrated questionnaires requested information about women’s demographics, their oral health-related quality of life utilizing Oral Health Impact Profile-14 (OHIP-14), and their oral health literacy utilizing Oral Health Literacy-Adult Questionnaire. A senior dental student conducted clinical examination under the artificial light of a headlamp based on the WHO (World Health Organization) criteria to record dental caries experience with Decayed, Missing and Filled Teeth (DMFT) index. Mann-whitney U test, Kruskal–Wallis test, spearman correlation coefficient, and a linear regression model served for statistical analysis (p\u0026lt;0.05). \u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The mean age of the pregnant women was 28.8 ± 5.5. About half of the women (49.5%) had a high school diploma, and 84% were homemaker. The mean score of OHIP-14 was 13.2 ± 9.0 (range 0-38). The mean score of oral health literacy was 9.7 ± 3.2 (range 1-16). The mean DMFT was 9.8 ± 5.2. In multivariate analysis, higher score of OHIP-14 was associated with higher caries experience (p\u0026lt;0.05).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Higher caries experience was associated with more effects of oral problems on pregnant women’s quality of life. Thus, it is recommended to increase their oral health-related quality of life via preventive measures to control the dental caries experience.\u003c/p\u003e","manuscriptTitle":"Oral health-related quality of life and its association with oral health literacy and dental caries experience among a group of pregnant women: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-08-12 21:21:34","doi":"10.21203/rs.3.rs-1924110/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"acdffbfa-8c14-40f4-bce6-8deb5e54d8f6","owner":[],"postedDate":"August 12th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-11-30T09:44:16+00:00","versionOfRecord":[],"versionCreatedAt":"2022-08-12 21:21:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1924110","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1924110","identity":"rs-1924110","version":["v1"]},"buildId":"pf3fE39SIOqb-0xH_OWvX","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}