Gestational Serum-25OHD/Retinol, Birth-Outcomes, Feeding-Practices, and Enamel-Hypoplasia Influences Early-Childhood-Caries: Birth-Cohort Study

Objectives: To evaluate influence of prenatal-maternal nutrition, birth outcomes, infant feeding-practices, maternal/child Streptococcus mutans (Sm) count and enamel-hypoplasia (EH) on early-childhood-caries (ECC) incidence in a 36-month birth-cohort.
Methods: Pregnant women (n=1450) on/before tenth-gestational-week were enrolled; 12-14-week prenatal nutritional-status (serum 25-hydroxycholecalciferol (25OHD)/retinol/hemoglobin/BMI), maternal caries-experience/Sm counts, birth-outcomes, demographics were recoded. Infant-feeding practices, child’s Sm count, brushing-habit, dental-visits and EH (modified developmental-defects of enamel index) were assessed. ECC was diagnosed using the d1-d4 criteria through a semi-annual dental evaluation. Independent statistical models were developed, and logistic-regression was used to estimate the odds-ratio for ECC risk-factors at year-one (dmft=0/>0); and Poisson-regression model with robust standard-error was built to estimate the rate-ratio for year-two/three (dmft=count data). Statistical significance was set at 5%*.
Results: After three-years, 754 mother-child pairs completed the study. At year-one, maternal age^* (OR=1.1), serum 25OHD^*/retinol^* (OR=5.9;1.9) deficiency, caesarean-section^* (OR=2.3), child’s Sm count^* >10⁵CFU (OR=12.9) increased the odds of ECC, but sugar-introduction ≥4-months^* (OR=0.23) was found to-be protective. At year-two/three, mother’s DMFT (RR~1.04), bottle-feeding (RR~1.02), child Sm count^* >10⁵CFU (RR~1.5), EH^* (RR=1.1; only-year-two) and higher dental-visits^* (RR=1.8;1.1) increased ECC-risk; additionally, underweight^* (Z-score≤-1; RR=1.03), Muslim^* (RR=1.04), breast-feeding+alternate-milk^* <3-months^* (RR=1.1), very-early preterm^* (RR=1.1), maternal-anaemia^* (RR=1.06) and serum-retinol deficiency^* (RR=1.03) increased year-three ECC-risk. Caries-increment at year-two/three significantly increased with bottle-feeding^*, preterm-birth^*, EH^* and child Sm count^* >10⁵CFU; additionally, in year-two, maternal anaemia^*, serum 25OHD deficiency^* and breast-feeding+alternate-milk <3-months^* also increased the risk of ECC.
Conclusions: Prenatal serum retinol/25OHD deficiency, followed by early sugar-introduction and prolonged bottle-feeding, higher child's Sm count (>10⁵CFU), preterm-birth and EH significantly increases the risk of ECC.