Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

o Metabolic Abnormalities and Health Disorders
Children with hyperbilirubinemia, galactosemia, nephrotic syndrome, intestinal
lymphangiectasia, celiac disease, and congenital cardiac disease may also display a
greater propensity for enamel hypoplasia and enamel opacities. 39,41-47
Some <strong>of</strong> the studies reporting a relationship between DDE and metabolic
abnormalities and health disorders were well-designed cohort or case-control studies
(level II-2), while many others were categorized as level III. Overall, much <strong>of</strong> this
literature would fall between these two groupings.
o Nutritional Deficiencies
Brief episodes <strong>of</strong> nutritional insufficiency <strong>of</strong> calcium can increase the likelihood <strong>of</strong>
enamel hypoplasia. Deficiencies <strong>of</strong> vitamin D (i.e. hypovitaminosis D, vitamin D
deficiency), a theory first proposed by the work <strong>of</strong> Lady May Mellanby, and vitamin A
(i.e. hypovitaminosis A) are primary systemic factors associated with enamel
hypoplasia. 17 Further, both vitamin D deficiencies and instances <strong>of</strong> vitamin D excess are
associated with enamel defects including enamel hypoplasia. 36 While some have tried to
discount the connection <strong>of</strong> vitamin D to enamel defects, which can predispose children to
ECC, research shows that the ameloblast and odontoblast cells, responsible for enamel
and dentin formation are target cells for 1,25-dihydroxyvitamin D. 82 Evidence indicates
that such deficiencies <strong>of</strong> vitamin D in utero can lead to enamel hypoplasia, because <strong>of</strong>
metabolic insult to ameloblasts. 24,25,31,34,83-85
Most <strong>of</strong> the above noted literature involving the relationship between nutritional
deficiencies and DDE would be considered to be <strong>of</strong> low quality, level III, although two
1.2-13