Monday, September 23, 2019

Prenatal vitamin D prevents enamel defects in children

           
 Enamel defects are fast becoming a global public health challenge, affecting more than 30 percent of school children and reducing quality of life, however new research finds they may be prevented by prenatal vitamin D supplementation.
Reporting in JAMA Pediatric, the study finds that high dose vitamin D supplementation during pregnancy was associated with approximately 50 percent reduced odds of enamel defects in the offspring at six years of age.
            A total of 496 children from 115 eligible women were examined in the study. While pregnant, women were randomised 1:1 to a daily dose of 2400 IU vitamin D3 supplementation or matching placebo tablets from pregnancy week 24 to 1 week post-partum. In addition, all women were instructed to continue supplementation of 400 IU of vitamin D3 during pregnancy as recommended by the Danish National Board of Health.
            Thus, the study was a dose comparison of 2800 IU/d vs 400 IU/d of vitamin D3 supplementation. All the women also participated in a concomitant factorial designed double blind randomised controlled trial of 2.4 g per day of omega-3 fatty acids during pregnancy.
             “Adherence to the intervention, defined as mothers taking more than 80 percent of the prescribed tablets, was 74% (n = 462 of 623) and the vitamin D intervention resulted in a significant increase in maternal serum vitamin D3 level in the treatment group from randomisation to the postpartum assessment but not in the control group,” the authors said.
             “Of the 496 examined children, 332 (66.9%) had at least 1 fully erupted first permanent molar and 234 (47.2%) had all four. Enamel defects in the permanent dentition and the deciduous dentition were diagnosed in 70 children (21.1%) and 61 children (12.3%), respectively, and in either the permanent or the deciduous dentition in 118 children (23.8%).
                “The prevalence of enamel defects in the permanent dentitions was lower in the children whose mothers received high-dose vitamin D supplementation in pregnancy compared with standard dose, and a similar association was observed for enamel defects in the deciduous dentition and in the combined analysis of both the deciduous and permanent dentition,” the authors reported.
                  With very little known about the aetiology of developmental enamel defects there are no causal preventive strategies and the authors of this study suggest that these results indicate a breakthrough in understanding and preventing the disease.
                  “Our finding suggests a simple and safe prevention strategy against enamel defects with a considerable effect size, which could have an important effect on long-term dental health. Considering the key role of vitamin D in enamel mineralisation, the association between vitamin D supplementation and enamel defects seems biologically plausible.”
                   “Enamel defects are a challenging dental health problem for many children and adults. Children with severe defects experience pain and need for dental treatments, have increased risk of caries, and may develop dental anxiety over time. In some cases, enamel defects lead to extensive and expensive treatment types, i.e. artificial crowns or orthodontic treatment as a consequence of extraction of permanent first molars, which pose a significant economic burden to society and negatively affect quality of life for the affected children.”
                   “The implications of our findings of prenatal high-dose vitamin D supplementation as a new and nontoxic primary preventive agent of enamel defects, with a clinically significant odds reduction of approximately 50%, may therefore have substantial effects on dental health and health care use,” the authors concluded.
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