Maternal Knowledge of Oral Health During Pregnancy and Early Childhood: A Systematic Review.

Background: Pregnant women's knowledge about the changes that occur in the oral cavity during pregnancy, as well as their impact on the course of pregnancy, is insufficient. Likewise, there is limited awareness of early childhood caries and of preventive oral-health measures. Objectives: The aim of this study is to assess the level of knowledge, attitudes, and practices related to oral health among pregnant women, and to identify the main knowledge gaps concerning their own oral health and that of their future children. Data sources: Scopus, Web of Science, Embase, and PubMed electronic databases were searched. Eligibility criteria: Observational and cross-sectional studies published in different languages were included. Studies assessing adult pregnant women's knowledge, attitudes, and practices regarding their own oral health and that of their children were selected. Studies were excluded if they were qualitative in nature or focused solely on beliefs and opinions; included fewer than 50 participants; addressed topics unrelated to the review objectives; or were conducted after an informational intervention. Studies focusing exclusively on children, or on women who were neither primiparous nor recently delivered, were also excluded. In addition, studies were excluded if the questionnaire or its individual items were not reported, or if a questionnaire was used without a quantitative assessment of knowledge. Material and Methods: Given the heterogeneity of the questionnaires and scoring systems, a quantitative synthesis was not feasible; therefore, a narrative synthesis approach was adopted. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS) for longitudinal studies, and modified Newcastle-Ottawa Scale (NOS) for cross-sectional studies. Results: A total of 26 studies met the inclusion criteria. Studies reporting scoring systems showed knowledge levels ranging from 0.13-8.39 (out of a maximum of 12 points) or 40-82.8% correct answers, depending on the assessment format. Overall, most pregnant women demonstrated insufficient knowledge regarding pregnancy-related oral changes, periodontal disease, and their potential adverse effects on gestation, as well as the risk of transmitting cariogenic bacteria to the newborn. Persistent misconceptions were identified including the belief that "a tooth is lost with every pregnancy," and incorrect perceptions regarding the safety of dental treatments during pregnancy. Furthermore, a substantial proportion of women were unaware of when to initiate infant oral hygiene or schedule their child´s first dental visit. Oral hygiene practices were often irregular, and information was obtained from dentists, gynecologists, magazines, and the internet; however, access to structured professional counseling remains limited. Limitations: The review was restricted to studies published in English, French, Italian, and Spanish, which may have limited representation from non Western or low resource settings. Grey literature and non indexed sources were not included, potentially leading to exclusion of locally relevant evidence. Considerable variability in study populations and methodologies affected comparability across studies. In addition, many investigations relied on non validated questionnaires (42%), which likely contributed to the observed heterogeneity in quality scores (40-82.8%). Conclusions: These findings highlight the need to strengthen oral health education during pregnancy through integrated strategies and the active involvement of dentists within prenatal care programs.