Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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This study provided an interesting glimpse <strong>of</strong> the oral health <strong>of</strong> infants in Winnipeg, Canada. Nearly one fifth <strong>of</strong> the infants returning for the infant dental assessment were identified as having enamel hypoplasia in their primary anterior teeth. A total <strong>of</strong> 31 infants (23.0%) also had cavitated caries lesions involving primary teeth. When early incipiencies were included in the definition for ECC, 49 children (36.3%) were reported to have ECC. Several factors were identified to be associated with the presence <strong>of</strong> enamel hypoplasia in infants. Overall, lower calcium levels during pregnancy were significantly associated with the presence <strong>of</strong> enamel hypoplastic defects while drinking milk daily, daily margarine use, and maternal awareness <strong>of</strong> vitamin D were significantly protective against the presence <strong>of</strong> enamel hypoplasia. Unfortunately, despite the fact that there was a trend at the bivariate level towards lower maternal vitamin D levels and the presence <strong>of</strong> enamel hypoplasia, this was not substantiated upon logistic regression analyses. <strong>Prenatal</strong> 25(OH)D levels were not found to be associated with the presence <strong>of</strong> enamel hypoplasia in infants in this study. Daily milk consumption during pregnancy was identified to be protective against ECC while the absence <strong>of</strong> full-time employment in the household during pregnancy was significantly associated with ECC. Overall, key factors identified to be associated with ECC in these infants included their age at the time <strong>of</strong> the dental visit, the presence <strong>of</strong> enamel hypoplasia, along with lower maternal 25(OH)D levels during pregnancy. This relationship was identified at both the bivariate and multivariate levels. Further, the overall caries rate was also associated with lower prenatal vitamin D levels. 7-3
This is the first prospectively designed birth cohort study that has attempted to investigate the relationship between maternal levels <strong>of</strong> vitamin D and calcium and the presence <strong>of</strong> enamel hypoplasia and caries in the <strong>of</strong>fspring <strong>of</strong> study participants. Evidence from this study suggests that maternal calcium and vitamin D may be significant influencing factors in the development <strong>of</strong> enamel defects and caries. Further longitudinal assessment <strong>of</strong> this cohort is important. Operating grant funding from the Dairy Farmers <strong>of</strong> Canada provided an additional opportunity to assess this same birth cohort during preschool life to collect more evidence <strong>of</strong> whether maternal vitamin D status has a significant influence on enamel hypoplasia and ECC. Naturally, this research has the potential to shape health policy for pregnant women in Manitoba. Milk and fortified dairy products may be a simple, feasible, and affordable way to supplement women with much needed vitamin D and calcium during pregnancy. As maternal compliance with daily multivitamin supplementation can <strong>of</strong>ten be problematic and our endogenous production is severely restricted, fortified dairy products may remain a viable route to ensure women improve and maintain higher vitamin D concentrations so that their developing fetus has the best possible environment for healthy development. Providing expectant women from low income areas <strong>of</strong> Winnipeg with increased access to milk during pregnancy may not only improve their vitamin D and calcium levels, but may even impact the dental health <strong>of</strong> their <strong>of</strong>fspring. In addition to the Healthy Baby Benefit that some qualifying individuals receive during pregnancy, decision-makers should consider piloting or expanding interventions such like providing regular and affordable access to milk to all women <strong>of</strong> reproductive ages 7-4
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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
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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 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 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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