Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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vitamin D from the diet as dietary intake <strong>of</strong> other vitamin D containing foods like fish and yogurt are not consumed as frequently. A recent Canadian study reported that the number <strong>of</strong> glasses <strong>of</strong> milk consumed daily was a strong determinant <strong>of</strong> overall vitamin D levels. 12 The majority <strong>of</strong> participants were single at the time <strong>of</strong> recruitment into the study and most had not completed high school (92.2%). This further reinforces the different life challenges faced by many young urban women and their vulnerability. Educational levels likely influence oral health literacy, and may pose another challenge in reaching young expectant mothers with health promotional materials that are clearly understood and easy to follow in the home setting with infants. Most participants in this study admitted to previously hearing <strong>of</strong> Early Childhood Caries (ECC) (77%). However, considering the socioeconomic and ethnic composition <strong>of</strong> this cohort, this comes as little surprise. The prevalence <strong>of</strong> ECC among urban disadvantaged groups in Manitoba is similar to that for some northern populations. 23,24 While 90.3% in this study felt that their own dental health was important during pregnancy, only 38.5% rated their oral health as being good. Further, 36.1% reported having dental problems at the time <strong>of</strong> enrollment. This suggests that oral health may be a concern for many expectant mothers. Access to care may be limited and other life challenges may make it difficult to seek dental care. This may even become more limited during pregnancy. With emerging evidence that maternal oral health during pregnancy may be associated with negative birth outcomes and the fact that cariogenic bacteria are most commonly transmitted vertically from mother to infant, improving the oral health status <strong>of</strong> high-risk women is important. 25-27 6-6
The vast majority <strong>of</strong> infants returning for follow-up were reported to be in good health. Surprisingly 12.7% <strong>of</strong> infants returning for the second phase <strong>of</strong> this study were reported to be premature and 4.6% were <strong>of</strong> low birth weight at birth. The incidence <strong>of</strong> preterm birth in this cohort appears to be higher than provincial statistics. 28 Between the 2001/02 and 2005/06 fiscal years the reported preterm birth rate was 7.7%. 28 The high rate in our study may be a reflection <strong>of</strong> the lower socioeconomic background <strong>of</strong> many <strong>of</strong> our participants. In fact, preterm birth rates for the Winnipeg neighbourhoods <strong>of</strong> Point Douglas and Downtown range from 9.4% to 10%. 28 Very few infants in this study had any medical issues although 16 children were reported to have signs <strong>of</strong> early asthma. This was likely wheezing rather than specialist diagnosed asthma. Infant feeding behaviours revealed that many were breastfed, although for those who had already been weaned at the time <strong>of</strong> dental examination, breastfeeding ceased before four months <strong>of</strong> age. Very few were still being breastfed at the time <strong>of</strong> their dental examination. The data reveal that bottle feeding was routine as a feeding method in this birth cohort. The majority were still bottle fed at the time <strong>of</strong> the dental follow-up examination as only 21 were weaned from the bottle. Common bottle contents included formula, water, milk and, apple juice. Such infant feeding practices have been reported to increase a child’s risk <strong>of</strong> developing ECC. However, we found no relationship between infant feeding practice and caries status in <strong>of</strong>fspring <strong>of</strong> women enrolled into this investigation. A considerable number <strong>of</strong> the mothers in this study were living independently and many moved during the period from enrollment into the cohort until the infant dental examination visit. The pressures <strong>of</strong> single parenting combined with the lack <strong>of</strong> a stable 6-7
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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
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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 212 and 213: to obtain it. Health literacy may b
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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