Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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Population The target population for this investigation was expectant women residing in Winnipeg, Canada located at latitude 49º 53’ North. The majority being <strong>of</strong> self-declared Aboriginal heritage. Many Aboriginal people live at or below the poverty level. 16,17 It is well known that poverty influences food security and that limited food choice can affect the nutritional status <strong>of</strong> individuals. There are also other factors besides poverty alone that affect women’s food purchasing practices. 18 Therefore, it was important to study this population group to determine the outcomes that nutritional deficiencies in utero could have on the infant. Women were excluded if they had any significant medical conditions that would potentially affect their vitamin D status. Many Aboriginal expectant mothers in remote northern communities have difficulties in sustaining adequate levels <strong>of</strong> vitamin D during pregnancy with the prevalence <strong>of</strong> vitamin D deficiency exceeding 80% in some communities. 6,19 One purpose <strong>of</strong> this study was to determine whether analogous levels <strong>of</strong> vitamin D deficiency exist in an urban dwelling Aboriginal population <strong>of</strong> expectant women. This has not been previously evaluated. Another reason for targeting the Aboriginal community was the high prevalence <strong>of</strong> ECC witnessed in this population 17,20-23 , even those residing in urban centres. Enamel hypoplasia, a risk factor for ECC, is also known to be more prevalent in lower socioeconomic (SES) populations. 24-27 Sample & Calculation <strong>of</strong> Sample Size Determining appropriate sample size is important for study results to have statistical significance upon analysis. Sample size for this study was reviewed by a senior 2-7
iostatistician to ensure that the method was best suited for the nature <strong>of</strong> this research and was further validated using PASS 6.0 (Power Analysis & Sample Size) statistical s<strong>of</strong>tware. The difficulty with this method <strong>of</strong> estimation is that very little information exists regarding vitamin D concentrations among Canadian urban populations, more specifically expectant urban women, most <strong>of</strong> whom are Aboriginals. As the known prevalence <strong>of</strong> vitamin D deficiency in some northern communities in Manitoba was over 80% 6 , a reasonable estimate <strong>of</strong> prevalence in an urban population was 50%. The limitation <strong>of</strong> this method <strong>of</strong> sample size calculation is that it is not appropriate for hypothesis testing. Initial sample size calculation: Using established estimation methods, the percent <strong>of</strong> Aboriginal women in an urban center with vitamin D deficiency was calculated to within ± 10 % confidence intervals with 95% confidence. Using the formula n = [1.96 2 p (1 - p)] / interval 2 n = [1.96 2 0.5 (1 – 0.5)] / 0.01 = 96 The sample size calculation was verified using PASS 6.0 s<strong>of</strong>tware: Numeric Results from PASS 6.0 S<strong>of</strong>tware C.C. N P0 Confidence Sample Baseline Precision Coefficient Size Proportion 0.10000 0.95105 96 0.50000 Population size = 10000 Taking into consideration the likelihood <strong>of</strong> significant dropouts, withdrawals, and losses to follow-up <strong>of</strong> study participants in this population, the estimated sample size for participant recruitment was doubled to 200 women. Enrolling this number <strong>of</strong> women 2-8
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Influence
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Abstract Influence
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Acknowledgements This longitudinal
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Table of Contents
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Status and Non-<st
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Table 1.1-1 - Recent studies report
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Table 1.1-2 - Previous used terms f
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The Link Between Enamel Hypoplasia
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If enamel hypoplasia results from n
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malocclusions. 145 Additional human
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Daily intakes of v
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13. Milnes AR, Rubin CW, Karpa M, T
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40. Definition of
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71. Watt RG. From victim blaming to
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97. Fearne JM, Bryan EM, Elliman AM
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124. Burt BA, Pai S. Does low birth
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151. Tinanoff N, D
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Section 2 - Risk Factors for Enamel
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correspond to the timing of
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een published. 3,4,17,19 The intent
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Table 1.2-2 - Risk factors for DDE
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Opacity 51 Implicated Risk Developm
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Implicated Risk Factor Factors asso
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o Metabolic Abnormalities and Healt
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12 months of life.
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Other Factors Some uncommon risk fa
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devastating problem of</str
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13. An epidemiological index <stron
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54. Seow WK, Perham S. Enamel hypop
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82. Berdal A, Papagerakis P, Hotton
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Vitamin D may be d
Page 64 and 65: have been used to prof</str
Page 66 and 67: health’. In addition, articles we
Page 68 and 69: 36 month trial had ended. 45 The nu
Page 70 and 71: Recently, a cross-sectional study <
Page 72 and 73: andomized, placebo-controlled study
Page 74 and 75: Further, amelogenin and enamelin, p
Page 76 and 77: A study of Austral
Page 78 and 79: Both dietary interventions and supp
Page 80 and 81: incidence of carie
Page 82 and 83: important nutrient. However, many <
Page 84 and 85: caries, and more hardening
Page 86 and 87: controls. 106 Interestingly, childr
Page 88 and 89: A few years later, additional resea
Page 90 and 91: Delayed Tooth Eruption Vita
Page 92 and 93: Description of Pop
Page 94 and 95: Influence
Page 96 and 97: D has an effect on the dentition, p
Page 98 and 99: 14. Utiger RD. The need for more vi
Page 100 and 101: 42. Spiller WF, Jr. A clinical eval
Page 102 and 103: 67. Itota T, Tashiro Y, Torii Y, Ni
Page 104 and 105: 95. Bruszt P. Kariesuntersuchungen
Page 106 and 107: 121. Seow WK, Needleman HL, Holm IA
Page 108 and 109: Chapter 2 - Methods for a Prospecti
Page 110 and 111: Each participant also completed an
Page 112 and 113: Table 2.2 - Recognized case definit
Page 116 and 117: allowed the project to suffer some
Page 118 and 119: women of limited m
Page 120 and 121: involving the surface of</s
Page 122 and 123: and training cup. In addition, each
Page 124 and 125: The questionnaire was administered
Page 126 and 127: statistics including frequencies an
Page 128 and 129: elationship between the two. Poisso
Page 130 and 131: References 1. Combs GF. Vit
Page 132 and 133: 27. Seow WK, Amaratunge A, Bennett
Page 134 and 135: Table 3.2 - Self-declared heritage
Page 136 and 137: Question Number Valid % Do you take
Page 138 and 139: Maternal Awareness
Page 140 and 141: time of recruitmen
Page 142 and 143: Table 3.6- Prenatal</strong
Page 144 and 145: A total of 77 care
Page 146 and 147: indicated that they were receiving
Page 148 and 149: and 11 hypoplasia). DDEs were also
Page 150 and 151: Caries rates for children in this p
Page 152 and 153: Table 3.12 - Frequency of</
Page 154 and 155: Chapter 4 - Results: Associations <
Page 156 and 157: II. Relationship Between 25(OH)D Le
Page 158 and 159: Pregnancy & Health Prof</st
Page 160 and 161: The frequency of v
Page 162 and 163: did not (42.9 ± 21.2 nmol/L vs. 49
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Early Childhood Caries (ECC) Pr<str
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likely to have vitamin D levels at
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did not statistically differ from v
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Figure 4.4 - Predicted number <stro
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Table 4.7 - Relationship between ds
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frequently, and less likely to have
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health as average or poor, and more
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tail (p=.034) suggesting that early
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The next series of
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Results from the second model appea
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Table 5.6 - Multiple regression sta
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vitamin D. However, it did suggest
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significant at the bivariate level
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Table 5.12(a) - Logistic regression
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III. Multivariate Regression Analys
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Table 5.14 - Logistic regression fo
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Table 5.19(b) - Backwards logistic
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Table 5.20(a) - Logistic regression
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Table 5.21 - Poisson regression for
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If enamel hypoplasia is present and
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Since maternal calcium levels were
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vitamin D deficiency, and rickets)
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to obtain it. Health literacy may b
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vitamin D from the diet as dietary
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home environment can be determinant
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hormone, calcium absorption and bon
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important nutrient. For many, this
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this potential relationship with ac
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genetic conditions, childhood medic
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vitamin D status including milk int
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y cariogenic oral flora. 49 Since e
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(49.8 ± 26.3 nmol/L vs. 45.1 ± 20
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pregnancy, which may have influence
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observed and it allowed multiple ou
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scientific evidence linking prenata
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cognizant that children who undergo
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preventive program would need to be
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makers in the formative stages. As
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Surprisingly, the final regression
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13. First Nations IaMHCCPS. <strong
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38. Hollis BW. Circulating 25-hydro
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65. Li Y, Navia JM, Bian JY. Caries
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91. Brownell MD, Guevremont A, Au W
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Chapter 7 - Conclusions This thesis
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This study provided an interesting
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esiding in disadvantaged communitie
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If you are taking vitamins during t
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Do you Eat? Never Rarely (less than
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What problems can early childhood c
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Prenatal Nutrition
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Did you ever add sugar to the bottl
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Enamel Hypoplasia Enamel Hypoplasia
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Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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