Growing evidence suggests that periodontal disease during pregnancy may be associated with serious complications, including preterm birth, low birth weight, preeclampsia, and gestational diabetes. Yet oral health remains one of the most overlooked components of prenatal care.
With funding from Colgate, researchers in the School of Dentistry and the School of Medicine at the University of California, San Francisco (UCSF), in partnership with investigators at the Rory Meyers College of Nursing and the Grossman School of Medicine at New York University (NYU), have launched the CHEER study (Closing Health Equity through Empowering Oral Health for Maternal Wellness). The study is being conducted in collaboration with the International Healthy Outcomes of Pregnancy for Everyone (HOPE) Research Consortium and the UCSF California Preterm Birth Initiative/Center for Birth Justice to advance efforts to reduce preventable preterm birth and improve maternal health equity.
CHEER is a randomized control clinical study enrolling pregnant individuals in early pregnancy who have gum disease and are receiving prenatal care through participating clinics. The study focuses on communities that often face barriers to accessing dental care, including individuals covered by public insurance or similar programs.
Participants will be randomly assigned to receive either enhanced oral health education alone or enhanced education plus additional support. Those in the intervention group will receive a home oral care kit, personalized oral hygiene guidance, and supportive text messages throughout pregnancy to encourage healthy daily habits. The goal is to determine whether providing practical tools and ongoing reinforcement can meaningfully improve oral health during pregnancy.
Participants will be followed from early pregnancy through several months after delivery. Throughout the study, researchers will conduct dental assessments, gather survey information, and collect oral samples. These samples will support future research examining whether the intervention leads to changes in the oral microbiome—the community of bacteria in the mouth that may influence inflammation and overall health.
In addition to measuring improvements in gum health, the research team will explore whether the intervention may be associated with differences in pregnancy outcomes, including preterm birth, low birth weight, hypertensive disorders such as preeclampsia, and gestational diabetes.
“Pregnancy is a critical window for both prevention and equity,” said Effie Ioannidou, DDS, MDS, Professor and Chair of the Department of Orofacial Sciences at UCSF and one of the Principal Investigators of CHEER. “For too long, oral health has been separated from prenatal care. With CHEER, we are testing whether simple, practical tools—delivered in ways that fit into people’s lives—can improve maternal health and give babies a healthier start.”
Laura Jelliffe-Pawlowski, MS, PhD, Professor and Senior Associate Dean of Research in the Rory Meyers College of Nursing and Professor of Medicine in the Grossman School of Medicine at NYU and Emeritus Professor of Epidemiology & Biostatistics in the School of Medicine at UCSF, the other Principal Investigator of CHEER, emphasized the broader public health implications. “Preterm birth remains one of the most pressing challenges in maternal health,” she said. “If improving oral health can help reduce risk—even modestly—it could have meaningful impact for families and communities, particularly those who experience the greatest disparities.”
Larry Rand, MD, study collaborator and Professor of Obstetrics, Gynecology, and Reproductive Sciences at UCSF and Principal Investigator of the UCSF California Preterm Birth Initiative/Center for Birth Justice, underscored the importance of integration. “We cannot continue to treat oral health and prenatal care as separate systems,” he said. “Addressing preventable sources of inflammation during pregnancy is an important step toward reducing preterm birth and advancing birth justice.”
By prioritizing communities disproportionately affected by both periodontal disease and adverse pregnancy outcomes, CHEER seeks to generate evidence that can inform scalable strategies integrating dental and prenatal care and advance maternal health equity.