|Year : 2017 | Volume
| Issue : 2 | Page : 57-61
Pregnant women's knowledge and attitude toward role of stem cells in dentistry: A cross-sectional study
D Vignesh, N Vanishree, N Naveen, M Anushri, Rosa R Narayan, M. P. Neethi Raveendran
Department of Public Health Dentistry, Bangalore Institute of Dental Sciences, Bengaluru, Karnataka, India
|Date of Web Publication||25-Jan-2018|
Dr. D Vignesh
Department of Public Health Dentistry, Bangalore Institute of Dental Sciences, 5/3, Hosur Main Road, Bengaluru - 560 029, Karnataka
Source of Support: None, Conflict of Interest: None
Aim: The aim of this study is to assess pregnant women knowledge and attitudes toward stem cells in dentistry in Bengaluru city. Settings and Design: A cross-sectional study was conducted among 300 pregnant women in Bengaluru city for 3 months. Materials and Methods: Sampling technique used in this study was convenience sampling. A structured questionnaire consisting of sociodemographic details, 20 questions about knowledge and 7 questions about the attitude toward stem cells and its banking were included in the questionnaire. Data were collected by interviewing the participants. Statistical Analysis Used: Data obtained were analyzed using descriptive statistics Chi-square test, t-test, and regression analysis using SPSS version 19. Results: Among 300 pregnant women, 68 (22.7%) attended private maternity hospitals and 232 (77.3%) attended public maternity hospitals. Pregnant women attending both public and private maternity hospitals 230 (76.7%) had no knowledge and 70 (23.3%) had knowledge about stem cells. Conclusion: The majority of the participants had inadequate knowledge about stem cells and its banking and wanted to be informed. The majority of the pregnant women wanted to have their stem cells stored and preferred public cord blood banking. The data obtained in this study can also provide a basis for future studies.
Keywords: Banking, pregnant women, stem cells
|How to cite this article:|
Vignesh D, Vanishree N, Naveen N, Anushri M, Narayan RR, Raveendran MP. Pregnant women's knowledge and attitude toward role of stem cells in dentistry: A cross-sectional study. Indian J Oral Health Res 2017;3:57-61
|How to cite this URL:|
Vignesh D, Vanishree N, Naveen N, Anushri M, Narayan RR, Raveendran MP. Pregnant women's knowledge and attitude toward role of stem cells in dentistry: A cross-sectional study. Indian J Oral Health Res [serial online] 2017 [cited 2018 Feb 25];3:57-61. Available from: http://www.ijohr.org/text.asp?2017/3/2/57/223924
| Introduction|| |
The human body is made up of three basic categories of cells: germ cells, somatic cells, and stem cells. Somatic cells include the bulk of the cells that make up the human adult and each of these cells in its differentiated state. Germ cells are cells that give rise to gametes, i.e., eggs and sperm, whereas stem cells are cells that have the ability to self-replicate and give rise to specialized cells.
In mammals, there are two broad types of stem cells: embryonic stem cells that are isolated from the inner cell mass of blastocysts, and adult stem cells that are found in various tissues. In adult organisms, stem cells and progenitor cells act as a repair system for the body, replenished in adult tissues. In a developing embryo, stem cells can differentiate into all the specialized cells and also maintain the normal turnover of regenerative organs such as blood, skin, or intestinal tissues. Stem cells are found in blood, bone marrow, dental tissues, muscles, skin, and organs such as the brain and liver. Stem cell therapy involves manipulation of the cells in vitro and using for therapeutic purposes.
Stem cells are cells that are capable of self-replication and differentiation into at least two different cell types. The self-renewal characteristics of stem cells enable them to go through numerous cycles of cell division while maintaining the undifferentiated state and also the ability to proliferate and differentiate into multiple mature cell types.
The discovery of stem cell in deciduous teeth sheds light on the intriguing possibility of using dental pulp stem cells for tissue engineering. Stem cells prove to be a better option as stem cell therapy could potentially lead to the regeneration of tooth roots, with periodontal ligament (PDL) that can remodel with host bone, which would be functionally superior to titanium dental implants. Banking teeth and dental stem cells offer patients a viable alternative to other sources of stem cells, and harvesting can be done during routine procedures in adults and from the deciduous teeth of children. Dental professionals have the opportunity to make their patients aware of these new sources of stem cells that can be conveniently recovered and remotely stored for future use as new therapies are developed for a range of diseases and injuries.
Stem cells from cord blood are much easier to get because these cells are readily obtained from the cord and the placenta at the time of delivery. Similar to cord blood, connective tissue from a section of the umbilical cord can also be collected, preserved, and stored for use in clinical research, donated to a public cord blood bank, or kept in a private cord blood bank for future medical need.
There has been a significant increase in stem cell research in recent years, but very little is known. The objectives of the study were to assess the knowledge of pregnant women's toward stem cells and to assess the attitude toward stem cell banking. Hence, the present study was conducted to assess pregnant women's knowledge and attitude toward stem cells in dentistry in Bengaluru.
| Materials and Methods|| |
A cross-sectional study was conducted to assess pregnant women knowledge and attitude towards stem cells in dentistry in Bengaluru. The study proposal was submitted for approval and clearance was obtained from the ethical review board. Before the study, permission was obtained from the Head/General Manager of Apollo Cradle, Sagar hospitals (maternity) and H. Siddaiah referral and maternity hospital to conduct the study. A self-structured pretested and validated questionnaire was used in the study.
The questionnaire was divided into three sections: Section 1: Demographic details were included. Section 2: Q1-Q20 - to assess knowledge. Section 3: Q21-Q27 - to assess the attitude. Data were collected from pregnant women who came for routine prenatal visits to Apollo Cradle, Sagar Hospitals, and H. Siddaiah referral and maternity hospital, Bengaluru, from March 10, 2015, to June 10, 2015, for the duration of 3 months. Pregnant women who came for routine prenatal visits and who volunteered to participate in the study were included. Pregnant women who did not give consent and did not wish to participate in the study were excluded from the study.
Kannada translation of English version of the self-structured questionnaire was undertaken to have a clear and easy to read and express questionnaires in local language. Care was taken to keep it conceptually equivalent to the original questionnaire. Translations were produced by a forward–backward procedure, involving two forward and two backward translators. Two independent bilingual translators who were native speakers of Kannada with experience in translating health-related questionnaires translated the English version of questionnaires to Kannada language. The translation choices and quality of two translations were reviewed in the consensus meeting consisting of the investigator, translators and two experts in the subject (Translation report). Attention was given to the meaning of the words in the different languages to obtain similar effects. An effort was made to identify possible difficulties in understanding the questionnaire. The resulting intermediate version of questionnaire was pilot tested on a convenience sample of ten participants. Modifications were made according to the suggestion of patients to facilitate comprehension. The final version of Kannada translated questionnaire was back-translated to English by two independent bilingual translators who were fluent in English and Kannada. This was done to verify the semantic equivalence between versions. Two experts fluent in both language and with no prior knowledge of the study compared the back-translated English version with the original English version. The two English versions proved nearly identical. The content validity was assessed by a panel of subject experts.
The purpose was to depict those items with a high degree of agreement among experts. The panel of experts recommended modifying the wording of the questions and addition of options in others. The kappa value of reliability was 0.80. Verbal informed consent was obtained from the patients by disclosing that the data collected was for research purpose. Patients' who agreed to participate in the survey were assured of confidentiality.
A pilot study was conducted on thirty participants who were selected randomly, to pretest the data collection methods and to check the validity and reliability of the questions. The pilot study participants were not included in the main study. Convenience sampling technique was used. Data were collected by interviewing the illiterate participants. The questionnaires were distributed to patients who were willing to participate in the study. Age group of the patients' was between 15 years and 40 years. The patients were explained about the questionnaire before they answered the questions. The study participants were given 15 min to fill the questionnaire. Filled questionnaires were collected back immediately on the day of data collection. A total of 300 questionnaires were distributed among pregnant women. Data analysis was done using statistical software SPSS version 19. Chi-square test, unpaired t-test, and Pearson's correlation were carried out to check any relation between the parameters. Any values ≤0.05 was considered to be statistically significant.
| Results|| |
There has been a significant increase in stem cell research in recent years. In the present study, among 300 pregnant women, 68 (22. 7%) attended private maternity hospitals and 232 (77.3%) attended public maternity hospitals. Out of which 200 (66.7%) were Hindu, 98 (32.7%) were Muslims, and 2 (0.7%) were Christians. Among pregnant women attending both private maternity hospitals and public maternity hospitals, 37 (12.3%) were in their 1st trimester, 98 (32.7%) were in their 2nd trimester, and 165 (55%) were in their 3rd trimester. Totally, 146 (48.7%) were in 1st pregnancy, 125 (41.7%) were 2nd pregnancy, 25 (8.3%) were at 3rd pregnancy and 4 (1.3%) were pregnant more than 3 times. In total, 238 (79.3%) were educated and 261 (87%) were employed [Table 1].
Among 300 pregnant women, 146 (48.7%) were in 1st pregnancy, 125 (41.7%) were in 2nd pregnancy, 25 (8.3%) were in 3rd pregnancy, and 4 (1.3%) were pregnant more than three times [Table 2].
|Table 2: Distribution of pregnant women based on their number of pregnancies|
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The majority of pregnant women attended public maternity hospitals, 232 (77.3%) compared to private maternity hospitals 68 (22.7%) [Table 3].
|Table 3: Distribution of pregnant women attending public and private maternity hospitals|
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When age was correlated with knowledge and attitude, it was found that the correlation between age and knowledge was negative (r = –0.236) and statistically significant (P< 0.05), whereas the correlation between age and attitude was positive (r = 0.089) and not statistically significant (P > 0.05). When education was correlated with knowledge and attitude, it was found that the correlation between education and knowledge was negative (r = –0.601) and statistically significant (P< 0.05), whereas the correlation between education and attitude was positive (r = 0.063) and not statistically significant (P > 0.05). When income was correlated with knowledge and attitude, it was found that the correlation between income and knowledge was negative (r = –0.633) and was statistically significant (P< 0.05), whereas the correlation between income and attitude was positive (r = 0.108) and was not statistically significant (P > 0.05) [Table 4].
|Table 4: Correlation among age, education, income, attitude, and knowledge|
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Overall knowledge of pregnant women toward stem cells shows that among 300 pregnant women, 230 (76.7%) had no knowledge and 70 (23.3%) had knowledge about stem cells [Figure 1].
|Figure 1: Assessment of overall knowledge of pregnant women toward stem cells|
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Distribution of pregnant women willing to donate stem cells in public and private stem cell banks, attending both public and private maternity hospitals, among which pregnant women willing to donate in public stem cell banks were 241 (80.3%) and pregnant women willing to donate in private stem cell banks were 59 (19.7%) [Figure 2].
|Figure 2: Distribution of pregnant women willing to donate stem cells in public and private stem cell banks, attending both public and private maternity hospital|
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| Discussion|| |
Stem cells are recent advances in cellular and molecular biology. Stem cells are used to treat various diseases such as Parkinson's disease, cancer, spinal injuries, heart diseases, liver diseases, muscle damage, diabetes, less risk of complications when used in transplants, blood-cell formation, missing teeth, dental tissues regeneration, dental implants, PDL regeneration, deafness, blindness and vision impairment, wound healing, infertility, HIV/AIDS, and many other diseases. Stem cell banks are progressively more seen as a fundamental resource of biological materials for both basic and translational research.
In this study, 230 (76.7%) had no knowledge and 70 (23.3%) had knowledge about stem cells, 4 (5.7%) had knowledge and 54 (23.5%) had no knowledge about stem cells below 20 years age group, and 176 (94.3%) had knowledge and 66 (76.5%) had no knowledge about stem cells among 21–40 years age group, due to lack of education and low socioeconomic status. However, in a study conducted by Fernandez et al., about 70% of pregnant women had a little or very little knowledge level. Similar results were seen with the study conducted by Vijayalakshmi  in which pregnant women had poor knowledge score (95%) regarding collection and storage of stem cell and its banking. These findings were supported by Suen et al. The results of this study revealed poor and inadequate knowledge on stem cell banking and its applications among most of the pregnant women.
In this study, almost all of the pregnant women around 80.3% had positive attitudes toward banking stem cells in public maternity hospitals, due to less cost as compared to private maternity hospitals. A study conducted by Fernandez et al. in Canada, where public cord blood banking is legal and widespread, 86% of the women preferred to use public banks for storage, which is similar to the present study. In the present study, as age increased knowledge toward stem cells and its banking decreased and it was statistically significant (P< 0.05). Whereas as age increased attitude toward stem cells and its banking increased, and it was statistically significant (P< 0.05). As the number of pregnancies increased knowledge and attitude increased toward stem cells and its banking (P< 0.05).
Storing cord blood in private banks was impossible for the majority of population who could not afford the cost of private stem cell banks. In parallel with this study, women did not know about the cost of collecting and storing stem cells and its banking. For this reason, stem cell banks need to be founded and financed by the government. The majority of the participants who wanted to be informed about stem cells collection and storage wanted this information to be given to them by their obstetrician.
Limitations of this study were pregnant women attending both public and private maternity hospitals were not very comfortable in answering male investigator. Generalizability of results is not possible. A bigger sample could have been taken but could not be done due to time constraint.
The following recommendations can be implemented in future studies:
- Professionals, private and public institutions should make an effort to provide unbiased information and education about both donation and preservation 
- Obstetricians should provide detailed information especially to pregnant women and to future parents about stem cells and its banking 
- Dentists should create awareness about stem cells and its utilization in dentistry. Patients who arrive to them should be told about the benefits of stem cell banking and motivate them to bank their own and their children stem cells 
- Stem cell funding should be encouraged by government and international agencies by providing funds for storage of stem cells 
- Majority of pregnant women wanted the details about stem cells and its banking in form of handouts
- The study can be replicated on a larger sample for generalizing the findings.
| Conclusion|| |
The majority of the participants had inadequate knowledge about stem cells and its banking and wanted to be informed. Pregnant women preferred to receive this information from their obstetrician. The majority of the pregnant women wanted to have their stem cells stored and preferred public cord blood banking.
Stem cell therapy is emerging as a revolutionary treatment modality to treat diseases and injury, with wide-ranging medical benefits. The available opportunities to bank stem cells will have the greatest future impact if seized while patients are young and healthy. The data obtained in this study can also provide a basis for future studies.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sede MA, Audu O, Azodo CC. Stem cells in dentistry: Knowledge and attitude of Nigerian dentists. BMC Oral Health 2013;13:27.
Alok A, Singh ID, Singh S, Kishore M. Stem cells: A review. Int J Dent Med Res 2014;1:92-7.
Dinc H, Sahin NH. Pregnant women's knowledge and attitudes about stem cells and cord blood banking. Int Nurs Rev 2009;56:250-6.
Masthan KM, Aravindha Babu N, Leena Sankari S, Gopala Krisnan T, Elumalai M. Life saving is cost effective – Dental pulp stem cells. Int J Pharm Bio Sci 2013;4:361-5.
Honda MJ, Imaizumi M, Tsuchiya S, Morsczeck C. Dental follicle stem cells and tissue engineering. J Oral Sci 2010;52:541-52.
Hend S, Hend AM, Sayed EL. Knowledge and attitude of maternity nurses regarding cord blood collection and stem cells: An educational intervention. J Nurs Edu Pract 2015;5:58-69.
Fernandez CV, Gordon K, Van den Hof M, Taweel S, Baylis F. Knowledge and attitudes of pregnant women with regard to collection, testing and banking of cord blood stem cells. CMAJ 2003;168:695-8.
Vijayalakshmi S. Knowledge on collection and storage of cord blood banking. Sinhgad E J Nurs 2013;3:14-7.
Suen SS, Lao TT, Chan OK, Kou TK, Chan SC, Kim JH, et al.
Maternal understanding of commercial cord blood storage for their offspring – A survey among pregnant women in Hong Kong. Acta Obstet Gynecol Scand 2011;90:1005-9.
Didilescu AC, Rusu MC, Nini G. Dental pulp as a stem cell reservoir. Rom J Morphol Embryol 2013;54:473-8.
Perlow JH. Patients' knowledge of umbilical cord blood banking. J Reprod Med 2006;51:642-8.
Braat DD, Mummery CL, Schattenberg AV, Borst-Eilers E. Freezing umbilical-cord blood and bone marrow for one's own use: Present-day quackery? Ned Tijdschr Geneeskd 2006;150:2410-4.
Katz G, Mills A, Garcia J, Hooper K, McGuckin C, Platz A, et al.
Banking cord blood stem cells: Attitude and knowledge of pregnant women in five European countries. Transfusion 2011;51:578-86.
Shin S, Yoon JH, Lee HR, Kim BJ, Roh EY. Perspectives of potential donors on cord blood and cord blood cryopreservation: A survey of highly educated, pregnant Korean women receiving active prenatal care. Transfusion 2011;51:277-83.
Screnci M, Murgi E, Pirrè G, Valente E, Gesuiti P, Corona F, et al.
Donating umbilical cord blood to a public bank or storing it in a private bank: Knowledge and preference of blood donors and of pregnant women. Blood Transfus 2012;10:331-7.
Hatzistilli H, Zissimopoulou O, Galanis P, Siskou O, Prezerakos P, Zissimopoulos A, et al.
Health professionals' knowledge and attitude towards the umbilical cord blood donation in Greece. Hippokratia 2014;18:110-5.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]