Amidst all 647 registered women, 454 (intervention, n=239 and control, n=215) participated the examination session. The flowchart of sampling is provided in Figure 1. During the follow-up, totally, 18 pregnant women (intervention, n=3 and control, n=15) discontinued this study.
The mean (SD) age of the women in the intervention and control group was 27.05 (5.43) and 27.98 (5.76) respectively. About half of the mothers participated in the study were educated for a period of less than 12 years. Majority of mothers in both intervention and control group were located in low- and middle-income groups (Table 1).
Table 1
Participants distribution according to demographic, socioeconomic, dental care behaviors, and mother’s dental caries variables in intervention and control groups (n=436).
Characteristics
|
|
Intervention
(n=236)
|
|
|
Control
(n = 200)
|
|
Comprehensive
(n = 74)
|
Group discussion
(n = 58)
|
Face to face by PHCPs
(n = 52)
|
Social network
(n = 52)
|
Control
(n = 200)
|
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
Demographic variables
|
|
|
|
|
Maternal age group
|
|
|
|
|
15-25
|
22 (29.70)
|
21 (36.20)
|
16 (30.80)
|
19 (36.50)
|
58 (29.00)
|
25-35
|
45 (60.80)
|
29 (50.00)
|
31 (59.60)
|
27 (51.90)
|
112 (56.00)
|
35-44
|
7 (9.50)
|
8 (13.80)
|
5 (9.60)
|
6 (11.50)
|
30 (15.00)
|
Socioeconomic variables
|
|
|
|
|
Maternal level of education
|
|
|
|
|
Less than 12 years
|
42 (56.80)
|
28 (48.30)
|
31 (59.60)
|
28 (53.80)
|
116 (58.00)
|
12 years
|
27 (36.50)
|
28 (48.30)
|
18 (34.60)
|
18 (34.60)
|
71 (35.50)
|
More than 12 years
|
5 (6.80)
|
2 (3.40)
|
3 (5.80)
|
6 (11.50 )
|
13 (6.50)
|
Family income
|
|
|
|
|
|
Low
|
33 (44.60)
|
15 (25.90)
|
20 (38.50)
|
15 (28.80)
|
70 (35.00)
|
Middle
|
26 (35.10)
|
27 (46.60)
|
22 (42.30)
|
19 (36.50)
|
95 (47.50)
|
High
|
15 (20.30)
|
16 (27.60)
|
10 (19.20)
|
18 (34.60)
|
35 (17.50)
|
Family size
|
|
|
|
|
|
3-4
|
50 (67.60)
|
40 (69)
|
36 (69.20)
|
40 (76.90)
|
132 (66.00)
|
5-6
|
24 (32.40)
|
18 (31)
|
16 (30.80)
|
12 (23.10)
|
68 (34.00)
|
Total
|
74 (100%)
|
58 (100%)
|
52 (100%)
|
52 (100%)
|
200 (100%)
|
At the last follow-up (24 months after delivery), participants in low-income group had more D compared to middle and high-income group. Also, more filled teeth were observed in participants who had educated for more than 12 years or visited a dentist in 6 months ago compared to others. Moreover, women in higher age group had more D, M, and F (P <0.05, P <0.001). More missing teeth also were explored in mothers with higher family size (P <0.001) (Table 2).
Table 2
Demographic, socioeconomic and oral health of women at 24 months’ follow-up (n=436).
|
Variables
|
|
N (%)
|
D
Mean
(SD)
|
M
Mean
(SD)
|
F
Mean
(SD)
|
Demographic variables
|
Age group
|
15-25
|
169 (38.8)
|
6.64 (4.23)
|
1.51 (1.92)
|
1.17 (1.79)
|
25-35
|
221(50.7)
|
6.40 (3.97)
|
2.57 (2.61)
|
1.80 (2.44)
|
35-44
|
46 (10.6)
|
4.96 (2.89)
|
4.46(3.51)
|
2.85 (2.89)
|
P-value
|
|
0.05 a
|
<0.001 a
|
<0.001 a
|
Place
|
Intervention
|
236 (54.1)
|
6.72 (4.02)
|
2.53 (2.8)
|
1.78 (2.18)
|
Control
|
200 (45.9)
|
5.89 (3.93)
|
2.16 (2.41)
|
1.54 (2.46)
|
P-value
|
|
0.01 b
|
0.16 b
|
0.03 b
|
Indicators of socioeconomic status
|
Income
|
Low
|
152 (34.9)
|
7.98 (4.18)
|
2.38 (2.55)
|
1.55 (2.05)
|
Middle
|
189 (43.3)
|
6.0 (3.17)
|
2.53 (2.54)
|
1.61 (2.06)
|
High
|
95 (21.8)
|
4.4 (4.16)
|
1.99 (2.91)
|
1.98 (3.07)
|
P-value
|
|
<0.001 a
|
0.02 a
|
0.85 a
|
Education (years of schooling)
|
Less than 12 years
|
187 (42.9)
|
6.68(4.21)
|
3.36 (4.33)
|
1.96 (2.49)
|
12 years
|
224 (51.4)
|
6.76 (4.22)
|
2.21 (2.35)
|
1.20 (1.84)
|
More than12 years
|
25 (5.7)
|
5.79 (3.63)
|
2.40 (2.64)
|
2.19 (2.67)
|
P-value
|
|
0.09 a
|
0.69 a
|
<0.001 a
|
Family size
|
3-4
|
298(68.3)
|
6.23(3.98)
|
2.03(2.49)
|
1.68(2.39)
|
5-6
|
138(31.7)
|
6.58(4.03)
|
3.06(2.79)
|
1.64(2.16)
|
P-value
|
0.74 b
|
0.46b
|
<0.001 b
|
0.843 b
|
Dental care behaviors
|
Brushing Habit(6month)
|
Once a day or more
|
325 (74.50)
|
6.42 (4.03)
|
2.39 (2.47)
|
1.69 (2.22)
|
Less than once a day
|
111 (25.50)
|
6.09 (3.91)
|
2.28 (3.07)
|
1.59 (2.58)
|
P-value
|
|
0.40b
|
0.13 b
|
0.23 b
|
Flossing Habit
(6month)
|
once a day or more
|
98 (22.5)
|
6.51(3.84)
|
2.02 (2.23)
|
1.61 (2.33)
|
Less than once a day
|
338 (77.5)
|
6.29 (4.04)
|
2.46 (2.73)
|
1.69 (2.32)
|
P-value
|
|
0.43 b
|
0.11 b
|
0.56 b
|
Dental Visit
(6month)
|
Yes
|
118 (27.1)
|
7.16 (4.02)
|
3.20 (2.84)
|
2.29 (1.97)
|
No
|
318 (72.9)
|
6.04 (3.95)
|
2.05 (2.48)
|
1.44 (2.39)
|
P-value
|
|
0.01b
|
<0.001 b
|
<0.001 b
|
Sweet Consumption
|
once a day
|
301 (69)
|
6.12 (3.89)
|
2.31 (2.57)
|
1.86 (2.57)
|
more than once a day
|
135 (31)
|
6.84 (4.19)
|
2.47 (2.77)
|
1.24 (1.52)
|
P-value
|
|
0.17 b
|
0.55 b
|
0.21b
|
Total
|
|
436(100%)
|
6.34 (3.99)
|
2.36 (2.63)
|
1.67 (2.32)
|
Bold numbers: relationship significant at 5% level. |
aKrusal–Wallis test |
bMann-Whitney U-test |
The frequency of daily brushing among women in intervention group increased from 64% at baseline to 85.6% at the last follow-up, while no change was observed in the control group. At baseline, one third of women in intervention group consumed sweet stuff more than once a day which decreased to 17% at the last follow-up. Also, having a dental visit in the previous year decreased from 58% to 1.5% in the control group whereas it increased from 43% to nearly 50% in the intervention group during the study period.
Women in intervention group especially those who underwent comprehensive intervention had more daily tooth brushing, flossing and less sweet consumption habits and also, having a dental visit has increased among them in the last 12 months at the last follow-up compared to the base line. Detailed information regarding brushing, and flossing, sweet consumption and dental visit were indicated in Figure 2. Most and least dental caries changes were in comprehensive intervention group and social network intervention group compared to other intervention groups respectively. The mean D in intervention group significantly decreased from 7.60 at baseline to 6.72 at follow-up in 24 months after delivery (P <0.05). Also, while the mean F in control group was more than intervention group at baseline, this amount surpassed in intervention group at the last follow-up.
The results of the last follow-up showed that the intervention group had 10% less decayed teeth compared to the control group after controlling for place, age, and SES (models 1 to 3). But in model 4 when oral health behavioral factors were controlled, no significant difference was detected. The number of missing teeth were not statistically different in intervention group, neither in adjusted models nor in unadjusted ones (Table 3).
Table 3
Association between demographic and dental care behaviors with number of missing teeth at 24 month follow up (n=436).
M-24 month
|
|
Model1
P-value&CR(95% CI)
|
Model2
P-value&CR(95% CI)
|
Model3
P-value&CR(95% CI)
|
Model4
P-value&CR(95% CI)
|
Baseline M at pregnancy
|
|
<0.001*
|
<0.001*
|
<0.001*
|
<0.001*
|
Place
|
intervention
|
0.76 & 1.01(0.89,1.15)
|
0.50 & 1.04(0.92,1.18)
|
0.56 & 1.03(0.91,1.18)
|
0.82 & 0.98(0.85,1.12)
|
age
|
|
|
<0.001*
|
0.52
|
0.35
|
Family size
|
|
|
|
0.004*
|
0.01*
|
Education
|
|
|
|
0.03*
|
0.09
|
income
|
Low
|
|
|
<0.001* &
1.39(1.16,1.18)
|
<0.001* &
1.35(1.12,1.63)
|
Middle
|
|
|
<0.001* &
1.36(1.14,1.61)
|
0.002* &
1.32(1.10,1.57)
|
Daily brush (at 6m)
|
less than once
|
|
|
|
0.23 & 0.91(0.78,1.06)
|
Daily floss(at6m)
|
less than once
|
|
|
|
0.56 & 1.04(0.89,1.23)
|
Having Visited a dentist in the past 12 month (at 6m)
|
Yes
|
|
|
|
0.002* &
1.24(1.08,1.42)
|
GLM model with Poisson link.function
Bold numbers: relationship significant at 5% level.
Model 1: adjusted for baseline M and place.
Model 2: adjusted for baseline M and place, and age.
Model 3: adjusted for baseline M, place, age, education, and income.
Model 4: adjusted for baseline M, place, age, education, income, and oral health behaviors.
Women in intervention group had 48% [CR = 1.48 (95% CI 1.27;1.73)] more filled teeth compared to women in control group. In adjusted models, people with low or middle SES had more D, M, and F compared to control group (P<0.05) (Tables 4).
Table 4
Association between demographic and dental care behaviors with number of filled teeth at 24 month follow up (n=436).
F-24 month
|
|
Model1
P-value&CR
(95% CI)
|
Model2
P-value&CR
(95% CI)
|
Model3
P-value&CR
(95% CI)
|
Model4
P-value&CR
(95% CI)
|
Baseline F at pregnancy
|
|
<0.001*
|
<0.001*
|
<0.001*
|
<0.001*
|
Place
|
intervention
|
<0.001* &
1.48(1.26,1.73)
|
<0.001* &
1.49(1.27,1.73)
|
<0.001* &
1.51(1.29,1.76)
|
0.03* &
1.19(1.01,1.41)
|
age
|
|
|
0.04*
|
0.78
|
0.60
|
Family size
|
|
|
|
0.20
|
0.41
|
Education
|
|
|
|
0.79 &
1.00(0.98,1.02)
|
0.78 &
0.99(0.97,1.01)
|
income
|
Low
|
|
|
<0.001*
|
0.009*
|
Middle
|
|
|
0.009* &
1.30(1.06,1.59)
|
0.03* &
1.24(1.01,1.52)
|
Daily brush (at 6m)
|
less than once
|
|
|
|
0.10 & 0.85(0.70,1.03)
|
Daily floss(at6m)
|
less than once
|
|
|
|
0.93 & 0.99(0.82,1.18)
|
Having Visited a dentist in the past 12 month (at 6m)
|
Yes
|
|
|
|
<0.001* &
2.14(1.81,2.53)
|
GLM model with Poisson link.function
Bold numbers: relationship significant at 5% level.
Model 1: adjusted for baseline F and place.
Model 2: adjusted for baseline F and place, and age.
Model 3: adjusted for baseline F, place, age, education, and income.
Model 4: adjusted for baseline F, place, age, education, income, and oral health behaviors.