Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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vitamin D deficiency, and rickets) 5-9 or supplementation during periods <strong>of</strong> tooth development and enamel hypoplasia. 10,11 However, no study has ever examined the relationship between actual circulating levels <strong>of</strong> 25(OH)D during periods <strong>of</strong> tooth development and outcomes like enamel hypoplasia and caries. Although one study reported that maternal supplementation <strong>of</strong> vitamin D during pregnancy lowered the incidence <strong>of</strong> enamel hypoplasia, a risk factor in the development <strong>of</strong> caries, their analysis was restricted to a very small subset <strong>of</strong> the entire study cohort. 10 Further, their assessments for hypoplasia were not all performed during infancy and the statistics used were limited. 10 This was only reported at the bivariate level and not confirmed through multivariate analysis. Therefore, low vitamin D levels during this period are a plausible risk factor for enamel hypoplasia and may theoretically increase the risk for caries. The purpose <strong>of</strong> this longitudinal blinded study was to determine the vitamin D status <strong>of</strong> a cohort <strong>of</strong> pregnant urban women and to determine whether there was an association with the presence <strong>of</strong> enamel hypoplasia and dental caries in the primary teeth <strong>of</strong> their <strong>of</strong>fspring. A total <strong>of</strong> 207 women were enrolled into this prospective study. The majority were <strong>of</strong> self-declared Aboriginal heritage residing in urban Winnipeg, Canada. Many were young women with this being their first pregnancy. The first phase <strong>of</strong> this study involved a serum draw and completion <strong>of</strong> an interviewed questionnaire. Overall, nearly two-thirds <strong>of</strong> the cohort (64.3%) was maintained for the second phase <strong>of</strong> this study. A total <strong>of</strong> 135 infants returned for the dental examination by an examiner blind to the mother’s vitamin D level during pregnancy. Attrition <strong>of</strong> the cohort was expected at the outset <strong>of</strong> the study and considering the different life challenges faced by many <strong>of</strong> 6-2
these participants the loss <strong>of</strong> one-third <strong>of</strong> the cohort was not unexpected. However, as discussed later in this chapter it still is a limitation <strong>of</strong> this study. Determining the vitamin D status <strong>of</strong> these participants was a key objective <strong>of</strong> this prospective investigation. Very few participants indicated that they took prenatal vitamins during pregnancy even though many did report that they believed this to be important for good prenatal health. One possible explanation for this disconnect may be the fact that several participants were recruited at their first prenatal visit and might not have previously received any advice on the need to add supplements to their diets. However, it does signify a need to ensure that consistent and early messaging on vitamin use during the prenatal period is provided to all expectant women from their primary caregiver. Many in this study indicated that they did not receive any such advice. A recent article on the vitamin D status <strong>of</strong> Albertans suggests that the medical community has been slow to incorporate new revelations on vitamin D and health into practice. 12 Physicians may not be fully aware <strong>of</strong> the latest Canadian Paediatric Society (CPS) recommendations on supplementation. 13 Unfortunately, these recommended intakes are still too low to have any real effect. 14 Overall, there appeared to be a relatively low level <strong>of</strong> participant knowledge about vitamin D and its role in health. While nearly two-thirds <strong>of</strong> respondents had heard <strong>of</strong> vitamin D less than 25% correctly stated what vitamin D was important for. Even fewer could identify dietary sources <strong>of</strong> vitamin D. There is uncertainty about whether vitamin D awareness is lacking only in this segment <strong>of</strong> the population or whether overall public awareness is low. One possible way to improve and sustain maternal vitamin D levels during pregnancy may be to raise awareness <strong>of</strong> vitamin D; its role in health and also ways 6-3
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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
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have been used to prof</str
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health’. In addition, articles we
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36 month trial had ended. 45 The nu
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Recently, a cross-sectional study <
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andomized, placebo-controlled study
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Further, amelogenin and enamelin, p
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A study of Austral
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Both dietary interventions and supp
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incidence of carie
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important nutrient. However, many <
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caries, and more hardening
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controls. 106 Interestingly, childr
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A few years later, additional resea
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Delayed Tooth Eruption Vita
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Description of Pop
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Influence
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D has an effect on the dentition, p
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14. Utiger RD. The need for more vi
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42. Spiller WF, Jr. A clinical eval
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67. Itota T, Tashiro Y, Torii Y, Ni
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95. Bruszt P. Kariesuntersuchungen
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121. Seow WK, Needleman HL, Holm IA
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Chapter 2 - Methods for a Prospecti
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Each participant also completed an
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Table 2.2 - Recognized case definit
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Population The target population fo
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allowed the project to suffer some
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women of limited m
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involving the surface of</s
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and training cup. In addition, each
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The questionnaire was administered
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statistics including frequencies an
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elationship between the two. Poisso
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References 1. Combs GF. Vit
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27. Seow WK, Amaratunge A, Bennett
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Table 3.2 - Self-declared heritage
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Question Number Valid % Do you take
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Maternal Awareness
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time of recruitmen
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Table 3.6- Prenatal</strong
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A total of 77 care
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indicated that they were receiving
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and 11 hypoplasia). DDEs were also
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Caries rates for children in this p
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Table 3.12 - Frequency of</
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Chapter 4 - Results: Associations <
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II. Relationship Between 25(OH)D Le
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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
Page 164 and 165: Early Childhood Caries (ECC) Pr<str
Page 166 and 167: likely to have vitamin D levels at
Page 168 and 169: did not statistically differ from v
Page 170 and 171: Figure 4.4 - Predicted number <stro
Page 172 and 173: Table 4.7 - Relationship between ds
Page 174 and 175: frequently, and less likely to have
Page 176 and 177: health as average or poor, and more
Page 178 and 179: tail (p=.034) suggesting that early
Page 180 and 181: The next series of
Page 182 and 183: Results from the second model appea
Page 184 and 185: Table 5.6 - Multiple regression sta
Page 186 and 187: vitamin D. However, it did suggest
Page 188 and 189: significant at the bivariate level
Page 190 and 191: Table 5.12(a) - Logistic regression
Page 192 and 193: III. Multivariate Regression Analys
Page 194 and 195: Table 5.14 - Logistic regression fo
Page 200 and 201: Table 5.19(b) - Backwards logistic
Page 202 and 203: Table 5.20(a) - Logistic regression
Page 204 and 205: Table 5.21 - Poisson regression for
Page 206 and 207: If enamel hypoplasia is present and
Page 208 and 209: Since maternal calcium levels were
Page 212 and 213: to obtain it. Health literacy may b
Page 214 and 215: vitamin D from the diet as dietary
Page 216 and 217: home environment can be determinant
Page 218 and 219: hormone, calcium absorption and bon
Page 220 and 221: important nutrient. For many, this
Page 222 and 223: this potential relationship with ac
Page 224 and 225: genetic conditions, childhood medic
Page 226 and 227: vitamin D status including milk int
Page 228 and 229: y cariogenic oral flora. 49 Since e
Page 230 and 231: (49.8 ± 26.3 nmol/L vs. 45.1 ± 20
Page 232 and 233: pregnancy, which may have influence
Page 234 and 235: observed and it allowed multiple ou
Page 236 and 237: scientific evidence linking prenata
Page 238 and 239: cognizant that children who undergo
Page 240 and 241: preventive program would need to be
Page 242 and 243: makers in the formative stages. As
Page 244 and 245: Surprisingly, the final regression
Page 246 and 247: 13. First Nations IaMHCCPS. <strong
Page 248 and 249: 38. Hollis BW. Circulating 25-hydro
Page 250 and 251: 65. Li Y, Navia JM, Bian JY. Caries
Page 252 and 253: 91. Brownell MD, Guevremont A, Au W
Page 254 and 255: Chapter 7 - Conclusions This thesis
Page 256 and 257: This study provided an interesting
Page 258: 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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