Oral health integration in antenatal care: knowledge, attitudes and practices of practicing gynecologists and obstetricians in Khyber Pakhtunkhwa, Pakistan – a multicenter cross-sectional study

Oral health during pregnancy plays an important role in maternal and fetal well-being, yet its integration into routine antenatal care remains limited. As primary providers of antenatal care, gynecologists and obstetricians are well positioned to promote oral health through patient education, screening, and timely referral. This study assessed the knowledge, attitudes, and practices (KAP) of gynecologists/obstetricians and postgraduate residents regarding oral health during pregnancy and identified factors associated with clinical practice in Khyber Pakhtunkhwa, Pakistan. This multicenter cross-sectional study included 230 participants recruited from public and private healthcare facilities across four districts. Data were collected using a pretested, structured questionnaire adapted from previously published KAP studies. Knowledge, attitude, and practice scores were converted to percentage scores and categorized using Bloom’s cut-offs. Internal consistency, group comparisons, correlations, and predictors of practice were assessed using appropriate nonparametric tests, Spearman’s correlation, robust linear regression and exploratory logistic regression. Participants demonstrated limited knowledge (mean score 36.2 ± 23.3%) and poor clinical practice (39.4 ± 19.2%), despite relatively favorable attitudes (65.9 ± 22.3%). Routine oral examination was reported by 8.3%, and formal dental referral by 7.8%, and recommendation of routine dental check-ups was infrequent (4.3%). Referral reasons were predominantly symptom-driven, with toothache/dental pain reported most frequently (51.3%), followed by bleeding gums/gingivitis (30.4%). Knowledge was positively correlated with attitude ( ρ = 0.158, p = 0.016) and practice ( ρ = 0.293, p < 0.001). In adjusted analyses, higher knowledge independently predicted better practice (β = 0.29, 95% CI 0.17–0.41, p < 0.001). Gynecologists/obstetricians demonstrated favorable attitudes toward integrating oral health into antenatal care but had substantial deficiencies in knowledge and routine clinical practice. Strengthening maternal oral health education, preventive oral assessment, continuing professional development, interdisciplinary collaboration, and effective national antenatal care guidelines may improve oral health integration into prenatal care.