Lower maternal vitamin D levels during pregnancy were associated with increased risk of dental caries in offspring in early childhood.
Early childhood caries (defined as one or more decayed, missing, or filled teeth in children up to 71 months of age) is the most common noncommunicable disease among pediatric patients. A global evaluation across 193 countries found mean early childhood caries prevalence rates of approximately 24% among children younger than 3 years and 57% among children aged 3 to 6 years. Because dental caries impact academic performance, oral and systemic health, as well as the physiologic function and appearance of teeth, their prevention is an unmet public health need.
Certain prenatal and early postnatal factors have been known to increase the susceptibility to early childhood dental caries. Tooth mineralization begins during the second and third trimesters of pregnancy and requires sufficient levels of vitamin D levels to maintain calcium and phosphate homeostasis from enamel formation through eruption. In spite of worldwide recommendations for achieving 25-hydroxyvitamin D levels above 30 ng/mL during pregnancy, research continues to observe a high prevalence of low vitamin D levels across global populations.
In a prospective cohort study, investigators examined the plasma 25-hydroxyvitamin D levels of mothers during each trimester of pregnancy and oral health outcomes among 4,109 mother-child pairs—with the goal of determining whether maternal vitamin D status can predict the risk of dental caries in primary dentition. Participants with a median age of 29 years (interquartile range = 27–32 years) from the Zhoushan Pregnant Women Cohort were included in the study and followed from enrollment as early as August 2011 to November 2022. STROBE reporting guidelines were followed.
The investigators identified a total of 960 cases of early childhood dental caries; however, the risks were higher associated with maternal vitamin D status during pregnancy, particularly in the mid-to late-trimesters. Additionally, mothers with higher plasma 25-hydroxyvitamin D levels during pregnancy had offspring with lower likelihood of decayed, missing, or filled teeth (dmft). Subsequent generalized estimation equation models confirmed a negative correlation between vitamin D levels and dmft scores.
The risk of early childhood dental caries was greater among older children; those who had a higher gestational age at birth and birth weight; and those whose mothers were younger, multiparous, and had lower levels of educational attainment. Mothers of children with early childhood dental caries had median 25-hydroxyvitamin D levels of 26.9 ng/mL compared with 28.7 ng/mL among mothers of children without caries in the second trimester, and 26.1 ng/mL compared with 30.6 ng/mL in the third trimester.
When vitamin D status was categorized into four groups—sufficiency (≥30 ng/mL), insufficiency (20 to <30 ng/mL), deficiency (12 to <20 ng/mL), and severe deficiency (<12 ng/mL)—offspring of mothers with lower vitamin D status showed increased odds of caries compared with the sufficiency group, with the most consistent statistically significant associations observed in the third trimester.
The investigators emphasized that vitamin D status may be a modifiable risk factor in the oral health of children. As a result of the findings, they urged health care providers to integrate vitamin D screenings and necessary supplementation into standard prenatal care to reduce the risk of dental caries early in life. The study authors noted that vitamin D supplementation likely needs to begin before pregnancy or in early pregnancy to achieve maximum benefit, as vitamin D levels require approximately 3 months to reach optimal levels.
“These findings suggest that vitamin D supplementation during pregnancy and even before conception to maintain sufficient vitamin D status throughout pregnancy may help reduce the risk and severity of childhood dental caries,” concluded lead study author Nuo Xu, MPH, of the Departments of Public Health, Anesthesiology, and Epidemiology and Health Statistics at the Zhejiang University School of Medicine in China, and colleagues.
The study authors reported no conflicts of interest. The research was supported by grants from the National Key Research and Development Program of China and the 4+X Clinical Research Project of Women’s Hospital at the Zhejiang University School of Medicine.
Source: JAMA Network Open