Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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makers in the formative stages. As mentioned earlier, the pilot project <strong>of</strong> MACHS that is looking at high dose vitamin D supplementation during pregnancy is one example as it has brought together decision-makers, clinicians, and researchers. Decision-makers and politicians may also find the cost-effectiveness <strong>of</strong> improving vitamin D status during pregnancy to improve host resistance to caries a compelling argument as treatment for ECC under GA is costly. This growing knowledge also needs to be transferred to a broad range <strong>of</strong> healthcare pr<strong>of</strong>essionals including physicians (e.g. obstetricians, pediatricians, and family practitioners), nurses and nurse practitioners, midwives, dieticians, dentists, and other dental pr<strong>of</strong>essionals. Research evidence can be reported through various channels apart from scientific publications such as pr<strong>of</strong>essional newsletters, presentations, forums and Grand Rounds to raise awareness that improved prenatal nutrition can have consequences on infant health, including oral health. Meetings with local public health pr<strong>of</strong>essionals will be necessary to inform them <strong>of</strong> the link between prenatal nutrition and infant oral health. Finally, the evidence needs to be shared with both dental and medical organizations (e.g. physician groups, nursing organizations, and others that have an interest in maternal and preschool health) as a coordinated team-approach to ECC prevention is needed. These organizations have the necessary funds, influence, and credibility to truly act on these findings. As mentioned earlier, the Canadian Dental Association is presently working on a national strategy to deal with this problem. Knowledge transfer is a complex process, but is fundamentally necessary in today’s society if research evidence is to help develop and modify health policy. Several 6-34
factors determine whether this data will help shape early childhood oral health policy in Manitoba. Considering that ECC has garnered tremendous negative attention for the provincial government and that treatment approaches are costly the current environment in the province may be receptive to affordable preventive strategies to curb the scourge <strong>of</strong> ECC. In fact, the former Minister <strong>of</strong> Health for the province <strong>of</strong> Manitoba was aware <strong>of</strong> the potential <strong>of</strong> inadequate vitamin D concentrations during pregnancy and dental decay among infants (Unscheduled Speech by Manitoba Minister <strong>of</strong> Health Tim Sale at the Conference on Wait Times - January 16, 2006). This coupled with the recent MACHS Task Force Report suggests that decision-makers in this province are open to early preventive approaches beginning during pregnancy to improve childhood health. In addition, such a partnership as mentioned above does exist with the HSHC project, which has caught the provincial government’s attention and has prompted a commitment to improving the oral health <strong>of</strong> children in this province. 33,34 Results <strong>of</strong> this study reveal that many expectant women in Manitoba have low vitamin D levels during pregnancy. This is <strong>of</strong> great concern as the developing fetus is dependent on the mother to meet its requirements for proper growth and development. <strong>Maternal</strong> 25(OH)D concentrations were influenced by ethnicity, education, milk intake, season, and intake <strong>of</strong> prenatal vitamins. While no direct association between enamel hypoplasia was found following logistic regression analyses, the relationship is still plausible. Although mothers <strong>of</strong> infants with enamel hypoplasia had lower 25(OH)D levels than those who did not exhibit these defects, this just failed to reach the threshold established for significance in this study (p=.072). However, we did determine that prenatal calcium levels are associated with enamel hypoplasia in their <strong>of</strong>fspring. 6-35
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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
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tail (p=.034) suggesting that early
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The next series of
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Results from the second model appea
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Table 5.6 - Multiple regression sta
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vitamin D. However, it did suggest
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significant at the bivariate level
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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 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 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
Page 279 and 280: Did you ever add sugar to the bottl
Page 281 and 282: Enamel Hypoplasia Enamel Hypoplasia
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Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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