"Thinking healthy" in pregnancy: a comment on Christian et al.

Increasing work shows that self-rated health correlates with actual health status, although the mechanisms through which this occurs remain unclear [1]. Christian et al.[2] explored this relationship in pregnant women by examining how perceived health status is associated with a number of objective health and demographic variables with an eye toward future work aimed at understanding how these relationships might affect birth outcome and infant health. The findings are consistent with existing literature in many ways, but importantly, there are components of the work which are of special relevance to understanding the mechanism(s) that may connect self-rated health to objective measures of health. An especially interesting inclusion is considering periodontal disease in pregnant women as a potential factor in perceived health status. One reason for exploring this connection is other work associating periodontal inflammation with low birth weight [3] and preterm birth [4]. Moreover, although data connecting periodontal disease to increases in circulating inflammatory cytokines is equivocal [5, 6], recent work has connected elevated serum inflammatory markers to shortened gestational age at birth [7], suggesting that examining the relationship between periodontal disease, circulating inflammatory markers, and birth outcome would be a worthwhile pursuit. To my knowledge, the Christian et al. study is the first to attempt to examine these factors together, although, regrettably, the frequency of preterm birth in the sample (9 out of 101) was too small for the analysis of these connections. Nevertheless, this approach is an important one, which should be pursued further. The oral health component of the study did yield an interesting finding that, along with others in the project, contributes to a better understanding of the factors which contribute to how a pregnant woman assesses her own health. Although periodontal disease was not associated with poorer self-rated health, women reporting bleeding gums assessed their own health status less positively than women who did not have bleeding gums, suggesting that environmental cues may play a role in self-assessment of health status. Consistent with this, the authors also found that higher BMI was associated with lower self-rated health. Of special interest is the finding that African-American women rated their health as excellent more often than Caucasian women, which, the authors suggest, might be due to relatively higher frequency of significant illness in the African-American community overall. This, again, suggests that external reference points may play a role in self-rated health for pregnant women and could provide targets for education or intervention. In conclusion, I echo the authors' assertion that understanding relationships between self-rated and actual health during pregnancy is important because prenatal visits are an ideal time to encourage positive health behaviors. Not only are pregnant women a “captive audience” as a result of being in the clinic with some frequency, but they also have raised awareness of how their behavior affects their unborn infant. This intriguing study underscores the need for more work in this area, especially given the increasing evidence that early experiences have lasting effects on development and across the lifespan[8].