Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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Chapter 7 – Conclusions This thesis focused on the relationship between vitamin D and oral health. Of particular interest was the influence that prenatal vitamin D concentrations could have on infant oral health, specifically enamel hypoplasia and Early Childhood Caries (ECC). <strong>Vitamin</strong> D deficiency is common in some Manitoba populations and ECC is also prevalent. A review <strong>of</strong> the ECC literature in Chapter 1, Section 1 revealed that Aboriginal children in Canada bear a higher burden <strong>of</strong> caries. It is not just a phenomenon in remote First Nations communities, but is also prevalent among Aboriginal children residing in urban centres. While ECC is a complex and multifactorial disease affecting infants and preschool children that is heavily influenced by the determinants <strong>of</strong> health, a key determinant is the presence <strong>of</strong> enamel defects, termed enamel hypoplasia. These defects are easily colonized by cariogenic microorganisms that can increase susceptibility to caries development. Numerous risk factors for enamel hypoplasia have been identified and were reviewed in Chapter 1, Section 2. These defects are the result <strong>of</strong> disturbances to ameloblasts that form enamel. It has been reported that low calcium and vitamin D concentrations can increase the risk for such developmental defects <strong>of</strong> enamel. Some <strong>of</strong> the earliest work in this area dates back to the first half <strong>of</strong> the twentieth century. Chapter 1, Section 3 reviewed this evidence relating to vitamin D and oral health outcomes including enamel hypoplasia and caries. In fact, there is historical literature reporting that vitamin D has an effect on the dentition, particularly in improving resistance to dental caries. <strong>Vitamin</strong> D fortified diets appeared to reduce and arrest caries in some children. Although there is evidence that vitamin D supplementation during 7-1
pregnancy may reduce the incidence <strong>of</strong> enamel defects, the missing link is that no research group has ever attempted to investigate whether circulating serum vitamin D and calcium levels during periods <strong>of</strong> tooth development with outcomes <strong>of</strong> hypoplasia and caries. This thesis is the first study to ever attempt to prospectively investigate the relationship between maternal 25-hydroxyvitamin D (25(OH)D) levels during pregnancy and the presence <strong>of</strong> enamel hypoplasia and ECC in <strong>of</strong>fspring. Findings from the prospective investigation undertaken in this thesis reveal that vitamin D deficiency and insufficiency were common in this cohort <strong>of</strong> primarily urban dwelling Aboriginal pregnant women. Many women were identified to have inadequate 25(OH)D levels; 35.0% were identified to be vitamin D deficient when the former definition was applied and as many as 90% had inadequate levels when the new guidelines were applied. Overall median and mean concentrations suggest a need to improve maternal vitamin D levels during pregnancy to promote perinatal health. <strong>Prenatal</strong> vitamin D concentrations <strong>of</strong> participants in this study were influenced by several factors including the ethnic background <strong>of</strong> the participant, personal ratings <strong>of</strong> their health during pregnancy, their intake <strong>of</strong> vitamins during pregnancy, and their socioeconomic status. In particular, Aboriginal women, those who were not part <strong>of</strong> a household where someone was employed full-time, and those who had not completed high school were significantly more likely to have lower concentrations. Further, those who drank milk daily and took prenatal vitamins had significantly higher 25(OH)D levels, while those who were recruited and sampled during the winter months had significantly lower concentrations. 7-2
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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
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III. Multivariate Regression Analys
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Table 5.14 - Logistic regression fo
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Table 5.19(b) - Backwards logistic
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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
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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 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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