Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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to obtain it. Health literacy may be an issue and may need to be part <strong>of</strong> any preventive strategy. Fortunately, Manitoba Health is now funding a demonstration project to provide expectant women in urban Winnipeg with high doses <strong>of</strong> vitamin D 3 (100,000 IU) during pregnancy in an attempt to improve perinatal and infant health. The mean 25(OH)D level for participants in this study was 48.1 ± 24.4 nmol/L; ranging from 4.7 to 145.0 nmol/L. The relatively low mean vitamin D levels in this study is concerning although it mirrors levels recently reported for expectant women in southern Manitoba. 15,16 <strong>Vitamin</strong> D deficiencies, defined as levels < 37.5 nmol/L, were present in 46% <strong>of</strong> mothers and 36% <strong>of</strong> infants at the time <strong>of</strong> delivery at the Health Sciences Centre in Winnipeg. 15 Deficiencies were more prevalent among non-white women. 15 The average vitamin D level for participants in this prospective investigation are similar to wintertime vitamin D concentrations for a small group <strong>of</strong> nonwhite women (e.g. Asian, Aboriginal, and Indo-Asian) participating in a study in Toronto, Canada. 17 Data from a recent case-control pilot study contrasting Winnipeg preschool children with Severe Early Childhood Caries (S-ECC) and those caries-free reported an average 25(OH)D <strong>of</strong> 59.8 ± 21.5 nmol/L (range 29 – 105 nmol/L) during the months <strong>of</strong> August and September. 18 However, the mean 25(OH)D level <strong>of</strong> women enrolled into this study were still higher than concentrations <strong>of</strong> expectant mothers residing in three northern First Nations communities during the late 1990s. 19 Median 25(OH)D concentrations for St. Theresa Point, Garden Hill, and Norway House were 21 nmol/L, 18 nmo/L, and 24 nmol/L, respectively. Meanwhile, results from the current Canadian Health Measures Survey by Statistics Canada reveals higher average vitamin D levels among participants age six to 6-4
70 years (66.9 nmol/L) than what is reported in this longitudinal cohort investigation. 20 In general, vitamin D deficiency appears to be a growing concern among pregnant women in Canada as the ability to endogenously produce vitamin D is restricted to only a few months during the summer. The need for vitamin D supplementation is quite apparent. In addition, these participants may have future increased risk for other chronic health conditions. 21 Many participants exhibited vitamin D levels consistent with vitamin D deficiency, depending on the different thresholds proposed. A recent recommendation to adopt values < 80 nmol/L as evidence <strong>of</strong> vitamin D deficieny is based on the inverse relationship between 25(OH)D and parathyroid hormone (PTH) levels; the threshold where PTH levels begin to plateau. When this threshold was applied to our participants, 90% were found to have deficient concentrations. This is somewhat alarming given the fact that the developing fetus is entirely dependent on maternal vitamin D concentrations. However, even when the different thresholds for deficiency that appeared in Chapter 3 were applied there were still a considerable proportion <strong>of</strong> participants that had levels in the deficient range; 46.5% (≤ 40 nmol/L) and 35.0% (≤ 35 nmol/L). Questionnaire responses relating to milk consumption were encouraging since it is vitamin D fortified. Half <strong>of</strong> those women recruited into this study were consuming milk on a daily basis while another one-third was drinking milk a few times per week. This is a positive sign considering concerns over possible lactose intolerance in some Aboriginal populations. Milk is a good source <strong>of</strong> vitamin D for women residing in urban centres, where milk is generally affordable compared with extreme prices in the northern regions <strong>of</strong> Canada. 22 Apart from dietary supplements, milk use may be a good means <strong>of</strong> obtaining 6-5
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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
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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 210 and 211: vitamin D deficiency, and rickets)
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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