{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T18:10:50Z","timestamp":1774980650129,"version":"3.50.1"},"reference-count":48,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"unspecified","delay-in-days":89,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,3,12]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pregnancy is associated with complex physical and physiological changes that may adversely affect the oral cavity. Dental diseases such as dental caries, gingivitis and periodontitis are common occurrences in pregnancy, whereby psychological factors such as anxiety and depression may be associated with poorer oral health in pregnant women. Such poorer oral health has been associated with adverse maternal and fetal outcomes. Despite this, limited studies from Pakistan have explored the association of anxiety and depression with oral health in this vulnerable population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>In this analytical, cross-sectional study, we will recruit 224 pregnant women in any trimester attending the antenatal care clinics at Aga Khan University, Karachi, Pakistan. Participants meeting the eligibility criteria will be assessed for demographics, pregnancy-related history, dental care seeking behaviours, anxiety and depression using Aga Khan University Anxiety and Depression Scale, and oral health assessment using decayed, missing, filled teeth index, gingival index and community periodontal index. The association between anxiety and depression with oral health status will be assessed using logistic and ordinal regression techniques, adjusting for confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study\u2019s protocol has been approved by the Ethical Review Committee of Aga Khan University (ERC # 2025-11293-35157). Written informed consent will be taken from all participants eligible, ensuring voluntary participation. The findings of this study will be published in peer-reviewed journals, presented at conferences and shared with stakeholders and policymakers, emphasising the importance of oral health during pregnancy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-003524","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T17:35:43Z","timestamp":1774978543000},"page":"e003524","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association of anxiety and depression with oral health status of pregnant women attending antenatal care clinics at a tertiary care hospital, Karachi: a study protocol"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0018-7069","authenticated-orcid":false,"given":"Abhishek","family":"Lal","sequence":"first","affiliation":[{"name":"Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shafquat","family":"Rozi","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3509-5260","authenticated-orcid":false,"given":"Wafa Zehra","family":"Jamal","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Novera","family":"Chughtai","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, The Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3817-5941","authenticated-orcid":false,"given":"Fahad","family":"Umer","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"2026033110353160000_4.1.e003524.1","doi-asserted-by":"publisher","DOI":"10.1007\/s10928-020-09677-1"},{"key":"2026033110353160000_4.1.e003524.2","doi-asserted-by":"crossref","DOI":"10.1155\/2016\/4897890","article-title":"Sex Hormones Enhance Gingival Inflammation without Affecting IL-1\u03b2 and TNF-\u03b1 in Periodontally Healthy Women during Pregnancy","volume":"2016","author":"Wu","year":"2016","journal-title":"Mediators Inflamm"},{"key":"2026033110353160000_4.1.e003524.3","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph191710681","article-title":"Oral Healthcare during Pregnancy: Its Importance and Challenges in Lower-Middle-Income Countries (LMICs)","volume":"19","author":"Jahan","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2026033110353160000_4.1.e003524.4","unstructured":"Oral health. 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