Socioeconomic, access-related, and periodontal factors associated with oral health-related quality of life among pregnant women in primary health care: a cross-sectional study

Periodontal disease affects not only clinical status but also oral-health–related quality of life (OHRQoL). Socioeconomic context, pregnancy-related systemic changes, hygiene habits, service access/use, and unmet periodontal needs may shape OHRQoL in pregnancy. This cross-sectional study aimed to identify factors associated with worse OHRQoL among pregnant women receiving care in the Brazilian Unified Health System (SUS). OHRQoL was assessed using the OHIP-14 questionnaire by standardized interview, and participants were categorized into: moderate/high impact (G1 = 56; OHIP-14 > 9) and no impact (G2 = 48; OHIP-14 = 0) on OHRQoL. Sociodemographic variables, systemic conditions, oral hygiene behaviors, access to prenatal dental care, and periodontal indicators were collected. Student’s t-test, Mann–Whitney, chi-square, and Poisson regression with robust variance were adopted (p < 0.05). G1 demonstrated lower educational attainment (p = 0.036) and frequency of daily toothbrushing (p = 0.024), with higher probing pocket depth (p = 0.003) and clinical attachment level (p < 0.001). Although 75% of the sample had a record of prenatal dental care, the absence of consultations was more prevalent in G1 (33.9%). The prevalence of periodontitis was also higher in this group (71.4% vs. 25.0%). In the multivariable analysis, three factors remained independently associated with worse OHRQoL: educational level, in which each additional year of schooling was associated with a lower prevalence of moderate/high OHRQoL impairment (PR = 0.96; 95% CI 0.92–0.99; p = 0.025), absence of prenatal dental care (PR = 1.49; 95% CI 1.11–1.99; p = 0.008), and greater severity of periodontitis in a dose–response gradient, with stage III showing the highest prevalence (PR = 2.93; 95% CI: 1.91–4.48; p < 0.001). Social, access-related, and clinical vulnerabilities were associated with worse OHRQoL among pregnant women in primary health care. These findings reinforce the most recent Brazilian epidemiological data in dentistry (SB Brasil 2023) and support the need for integrated strategies in primary health care to expand effective prenatal dental care and prioritize periodontal disease prevention during pregnancy.