Abstract

Introduction: Oral and dental health is an integral part of general body health and gains more importance during pregnancy. Pregnant women are exposed to a wide range of oral and dental diseases that can have significant consequences for their health and their babies' health. Tobacco consumption, especially among women and in low-income communities, is increasing and negatively affects the health of mothers and their children during pregnancy and lactation. The aim of this study is to investigate the impact of tobacco on the oral and dental health of pregnant and lactating women in Zahedan in 2025 to take steps towards increasing awareness and reducing risks.

Materials and methods: This qualitative study was conducted to assess the status and problems related to tobacco use with oral and dental health of pregnant and breastfeeding mothers. The study population included pregnant and lactating mothers referring to comprehensive health centers, health bases, and health homes in Zahedan city, first and second-level healthcare providers (health caregivers/ behvarzes and dentists), and oral health officials and specialists at the ministry and university levels. Sampling for participent was convenient sampling until data saturation. Data collection was conducted through semi-structured interviews with pregnant and lactating mothers, focus group discussions with health caregivers/ behvarzes and dentists, and the Nominal Group Technique with oral health specialists and officials. Data analysis employed content analysis and thematic analysis.

Results: A total of 74 participants (31 pregnant mothers and 43 lactating mothers) were included in this study. Their mean age was 37.24 (SD 4.6) years, and most had a diploma. Qualitative analysis identified three main themes: environmental, educational, and organizational factors, along with 21 sub-themes related to existing challenges. Environmental factors included the lack of suitable physical space for smoking, unsuitable waiting rooms, inadequate equipment, and inappropriate infrastructure in comprehensive health centers. Educational factors encompassed insufficient knowledge and perception among pregnant and lactating mothers about oral health and the effects of tobacco use, inadequate knowledge among health caregivers/behvarzes regarding tobacco effects, incomplete dental student curricula and unclear guidelines for dentists, and dentists' fear of legal consequences when treating smoking mothers. Organizational factors involved insufficient inter-professional collaboration, inadequate human resources and high workload in centers, insufficient time for preventive and educational services, and a salary-based payment system lacking financial incentives for health caregivers.

Discussion and conclusion: Given the suboptimal care performance and prevalent misconceptions, effective preventive and educational interventions are essential. Furthermore, overcoming financial and organizational barriers, providing necessary incentives for service providers, and utilizing mass media for public awareness are advised. Overall, the oral and dental health of pregnant and lactating mothers in Iran requires more serious attention and comprehensive interventions at environmental, educational, and organizational levels to improve the quality of life for mothers and the health of future generations.