Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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this potential relationship with actual circulating 25(OH)D levels. The study by Cockburn and colleagues did report significantly less enamel hypoplasia among infants whose mothers regularly took vitamin D supplements during pregnancy. 10 As discussed in Chapter 1, Section 3, only a small subset <strong>of</strong> children in that study underwent the dental examination and the statistics used may have been limited. Several other variables were reported to be associated with the presence <strong>of</strong> enamel hypoplasia in this study. As enamel hypoplasia directly correlates with periods <strong>of</strong> tooth formation and maturation, we restricted our statistical analyses to those factors corresponding to the prenatal and birth periods. Some <strong>of</strong> the prenatal variables associated with enamel hypoplasia included not having heard <strong>of</strong> vitamin D, infrequent milk intake, infrequent margarine use, and no recommendation from their physician to take vitamins during pregnancy. Results <strong>of</strong> logistic regression were able to further substantiate these relationships. We undertook several smaller regression models for enamel hypoplasia based upon the themes <strong>of</strong> prenatal care and diet, SES and ethnicity, and awareness <strong>of</strong> calcium and vitamin D. The final model for enamel hypoplasia revealed that infrequent milk consumption and infrequent margarine use were significantly associated with increased risk. It is possible that mothers who consumed little <strong>of</strong> these two fortified dietary items had lower maternal vitamin D concentrations since the regression model for vitamin D did confirm milk intake as a significant predictor for 25(OH)D. This potentially may have resulted in disturbances <strong>of</strong> primary enamel formation during fetal development. Additionally, awareness <strong>of</strong> vitamin D also appeared to be related to enamel hypoplasia. Those with little awareness <strong>of</strong> vitamin D were more likely to have infants with enamel hypoplastic 6-14
defects. Low awareness <strong>of</strong> vitamin D may be a proxy measure for dietary and supplemental intake <strong>of</strong> vitamin D. These individuals may not be consciously looking for foods rich in vitamin D when they shop for groceries and may not be taking supplements. It is plausible that women who are generally unaware <strong>of</strong> vitamin D, its sources, and its role in health have lower vitamin D levels, which may have an impact on their infant’s oral health. As discussed in Chapter 1, Section 2, enamel hypoplasia and other developmental defects <strong>of</strong> enamel in the primary dentition can arise from a variety <strong>of</strong> genetic conditions and disturbances resulting from infections, nutritional deficiencies and metabolic disorders, perinatal disturbances (e.g. premature birth and low birth weight), and chemical agents including antibiotics. 47-49 One particular study examined 455 exfoliated primary incisors to evaluate the influence <strong>of</strong> both antenatal and postnatal factors on enamel hypoplasia. 47 The results <strong>of</strong> that study suggest that women who first present for prenatal care following the first trimester <strong>of</strong> pregnancy are significantly more likely to have a child who displays enamel hypoplasia in the primaray dentition. 47 It also reported that children who were born premature were more likely to have enamel defects in their primary incisors. 47 This certainly reinforces the importance <strong>of</strong> early access to prenatal care as it may have an impact for infant and childhood oral health. While others have reported that infant illness and medical conditions may be associated with an increased prevalence <strong>of</strong> hypoplastic enamel, we were unable to confirm such a finding in this prospective study. Our study collected information on possible risk factors for DDEs either directly or indirectly. However, this prospective investigation was limited as it did not directly capture information regarding specific 6-15
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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
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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
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 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 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
Page 271 and 272: 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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