How do maternal socioeconomic and behavioral patterns affect oral health in early childhood?

STUDY DESIGN

A prospective longitudinal observational cohort study.

COHORT SELECTION

The data analyzed were derived from a comprehensive observational study on BRISA prenatal cohort conducted in São Luís City, Brazil, between 2010 and 2013. A convenience sample included pregnant women recruited from both public and private prenatal health services in the city. To participate in the study, women needed to have undergone an obstetric ultrasound before the 20th week of pregnancy to estimate gestational age. Multiple pregnancies were excluded. Initially, the pregnant women were interviewed and assessed for oral health indicators between the 22nd and 25th weeks of pregnancy. A follow-up interview was conducted within 48 h after delivery. In the child's second year, the mothers were re-interviewed, and the children were examined for the second follow-up. The study received approval from the local ethics committee, and written informed consent was obtained from all participants. The research followed the STROBE guidelines for reporting observational studies.

DATA ANALYSIS

At baseline, a structured questionnaire was used to gather sociodemographic and lifestyle information like maternal age, family income, education level, occupation of the family head, pre-gestational BMI, alcohol and soft drink consumption, and smoking status during pregnancy. Dental examinations were conducted by 6 trained and calibrated dentists who assessed DMFT index and periodontal health indicators. In the second follow-up, children's oral health was evaluated using visible plaque index (VPI), gingival bleeding, and the modified dmft index. Children's weight and height were measured by a digital scale, and BMI z-scores were calculated based on WHO standards. Sugar-sweetened beverage intake was categorized by terciles based on the percentage of total daily energy from these beverages. Structural equation modeling (SEM) was used to analyze multiple pathways among a set of latent and observed variables. Three latent variables were proposed and measured: Socioeconomic Status and Periodontal Maternal Status in the mothers, and Chronic Oral Disease Burden (CODB) in the children. CODB was inferred from 3 observed indicators: VPI, gingival bleeding, and tooth decay. Total, direct, and indirect effects were calculated for variables from the gestational period and the child's second year of life.

RESULTS

In total, 1141 mother-child dyads were included. Periodontal Maternal Status correlated with more decayed teeth in pregnant women (standardized coefficient (SC) = 0.089; p = 0.008). Addictive risk behaviors were highly correlated, with SCs of 0.679 (p < 0.001) for alcohol and smoking, and 0.262 (p < 0.001) for soft drink and alcohol consumption. Obesity (SC = 0.081; p = 0.048) and added sugar consumption (SC = 0.142; p = 0.040) were interconnected across generations from pregnant women to their offspring. Children's consumption of sugar was strongly associated with CODB (SC = 0.357; p = 0.005).

CONCLUSION

Caries and periodontitis were correlated in pregnant women. Obesity and sugar consumption have intergenerational impacts. Early sugar intake relates to CODB in early childhood. Intergenerational behavioral risks affect oral health in the first 1000 days of life, influencing long-term health outcomes.