Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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y cariogenic oral flora. 49 Since enamel hypoplasia was so strongly associated with ECC in this model, it was excluded from the model presented in Table 5.18 in Chapter 5. Backwards logistic regression including variables that were significantly associated with ECC in the earlier logistic regression models revealed that three factors were significantly associated with ECC, namely enamel hypoplasia, the age <strong>of</strong> the infant at the time <strong>of</strong> the dental assessment, and maternal 25(OH)D levels during pregnancy. Further, the final logistic regression model for ECC factored many <strong>of</strong> the previously identified variables associated with ECC from this investigation along with some other factors that have frequently been believed to contribute to caries risk. However, after controlling for income and government assistance, oral hygiene, and infant feeding practices, only three variables were found to be significantly associated with ECC. Enamel hypoplasia, infant age (≥ 14 months), and 25(OH)D levels were significantly associated with ECC. Enamel hypoplasia and age are already recognized risk factors for ECC. However, this is the first time that any association between actual circulating levels <strong>of</strong> 25(OH)D and caries has been reported. This blinded prospective study suggests that infants <strong>of</strong> mothers with lower 25(OH)D levels are significantly more likely to develop ECC. The exact mechanism is not clear, but it is likely that lower levels <strong>of</strong> vitamin D during periods <strong>of</strong> tooth development and maturation result in enamel that is less resistant to caries and more hypoplaisa. The last series <strong>of</strong> Poisson regression models that were constructed for dental caries in infants used the dt score as the dependent outcome. The first model only considered the relationship between circulating levels <strong>of</strong> metabolites measured from the serum sample obtained during pregnancy. This regression model revealed that there was 6-20
a significant association between 25(OH)D levels and the untreated decay rate (dt) (p=.046) while controlling for the influence <strong>of</strong> other serum metabolites. In addition, calcium levels were also significantly associated with dt scores. Lower prenatal calcium levels were indicative <strong>of</strong> higher dt scores. The second model included those same independent variables that were in the expanded logistic regression model for ECC. Again, the same variables <strong>of</strong> enamel hypoplasia, infant age, and 25(OH)D were found to be significantly associated with the untreated caries rate when adjusted for the other potential influencing variables. Lower vitamin D levels were associated with increased untreated primary tooth caries rates. Naturally, there were some limitations to this study that are worth mentioning. One <strong>of</strong> the limitations <strong>of</strong> this study was the relatively small sample size and attrition <strong>of</strong> the birth cohort. However, considering the nature <strong>of</strong> the study population, a retention rate <strong>of</strong> nearly two-thirds is remarkable. We had in fact anticipated a loss <strong>of</strong> half <strong>of</strong> the cohort. In order to deal with the foreseeable loss <strong>of</strong> participants, the decision was made to double our desired sample size at the outset <strong>of</strong> this prospective investigation. The small cohort size did restrict our ability to develop complex multivariate models for our outcomes <strong>of</strong> interest. Overall, several women and their <strong>of</strong>fspring were lost between the prenatal phase and infant study phase. This likely translated into limited statistical power and did result in several smaller regression models due to the small sample <strong>of</strong> infants. Fortunately, even though there were several losses to follow-up, it did not appear to negatively impact on vitamin D assessments as there was no significant difference in vitamin D levels between those who remained in the study and returned with their infant and those lost to follow-up 6-21
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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
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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
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 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 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
Page 273 and 274: Do you Eat? Never Rarely (less than
Page 275 and 276: What problems can early childhood c
Page 277 and 278: 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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