Use Of Baby Bottle Research Articles

A Children's Health Perspective on Nano- and Microplastics.

Background:Pregnancy, infancy, and childhood are sensitive windows for environmental exposures. Yet the health effects of exposure to nano- and microplastics (NMPs) remain largely uninvestigated or unknown. Although plastic chemicals are a well-established research topic, the impacts of plastic particles are unexplored, especially with regard to early life exposures.Objectives:This commentary aims to summarize the knowns and unknowns around child- and pregnancy-relevant exposures to NMPs via inhalation, placental transfer, ingestion and breastmilk, and dermal absorption.Methods:A comprehensive literature search to map the state of the science on NMPs found 37 primary research articles on the health relevance of NMPs during early life and revealed major knowledge gaps in the field. We discuss opportunities and challenges for quantifying child-specific exposures (e.g., NMPs in breastmilk or infant formula) and health effects, in light of global inequalities in baby bottle use, consumption of packaged foods, air pollution, hazardous plastic disposal, and regulatory safeguards. We also summarize research needs for linking child health and NMP exposures and address the unknowns in the context of public health action.Discussion:Few studies have addressed child-specific sources of exposure, and exposure estimates currently rely on generic assumptions rather than empirical measurements. Furthermore, toxicological research on NMPs has not specifically focused on child health, yet children’s immature defense mechanisms make them particularly vulnerable. Apart from few studies investigating the placental transfer of NMPs, the physicochemical properties (e.g., polymer, size, shape, charge) driving the absorption, biodistribution, and elimination in early life have yet to be benchmarked. Accordingly, the evidence base regarding the potential health impacts of NMPs in early life remains sparse. Based on the evidence to date, we provide recommendations to fill research gaps, stimulate policymakers and industry to address the safety of NMPs, and point to opportunities for families to reduce early life exposures to plastic. https://doi.org/10.1289/EHP9086

Prevalence of ankyloglossia and factors that impact on exclusive breastfeeding in neonates

ABSTRACT Objective: to determine the prevalence of ankyloglossia in neonates and verify factors that interfere with exclusive breastfeeding and cause difficulties in breastfeeding. Methods: an observational longitudinal study conducted at a public maternity hospital in Teresina, Piauí, Brazil. The sample comprised 397 mother-child pairs. Ankyloglossia was diagnosed with the part I of the Baby Lingual Frenulum Assessment Protocol with Scores. Six months after the children were born, the mothers were interviewed and answered questions on the indication and performance of frenotomy and time of breastfeeding. Descriptive analysis of the data, chi-square test and bivariate and multivariate Poisson regression were conducted (p < 0.05). Results: the prevalence of ankyloglossia was 4.3% (n = 17). The attendance rate for the second moment of the research was 70.8% (n = 281). Of the examined children, 14 were indicated for lingual frenotomy, but only one was submitted to the procedure. The time of exclusive breastfeeding of children with ankyloglossia was equal to that of children with a normal lingual frenulum (p-value = 0.876). Ankyloglossia was not associated with breastfeeding difficulties (PR = 1.0 95%CI 0.8-1.1, p-value = 0.441), neither was it a factor for not breastfeeding exclusively for 6 months (PR = 1.1 95%CI 0.9-1.2, p-value = 0.390). Conclusions: the prevalence of ankyloglossia in the studied population was 4.3%. Baby bottle use in the first month of life and breastfeeding difficulties were hindering factors for exclusive breastfeeding.

Prevalence of ankyloglossia and factors that impact on exclusive breastfeeding in neonates

ABSTRACT Objective: to determine the prevalence of ankyloglossia in neonates and verify factors that interfere with exclusive breastfeeding and cause difficulties in breastfeeding. Methods: an observational longitudinal study conducted at a public maternity hospital in Teresina, Piauí, Brazil. The sample comprised 397 mother-child pairs. Ankyloglossia was diagnosed with the part I of the Baby Lingual Frenulum Assessment Protocol with Scores. Six months after the children were born, the mothers were interviewed and answered questions on the indication and performance of frenotomy and time of breastfeeding. Descriptive analysis of the data, chi-square test and bivariate and multivariate Poisson regression were conducted (p < 0.05). Results: the prevalence of ankyloglossia was 4.3% (n = 17). The attendance rate for the second moment of the research was 70.8% (n = 281). Of the examined children, 14 were indicated for lingual frenotomy, but only one was submitted to the procedure. The time of exclusive breastfeeding of children with ankyloglossia was equal to that of children with a normal lingual frenulum (p-value = 0.876). Ankyloglossia was not associated with breastfeeding difficulties (PR = 1.0 95%CI 0.8-1.1, p-value = 0.441), neither was it a factor for not breastfeeding exclusively for 6 months (PR = 1.1 95%CI 0.9-1.2, p-value = 0.390). Conclusions: the prevalence of ankyloglossia in the studied population was 4.3%. Baby bottle use in the first month of life and breastfeeding difficulties were hindering factors for exclusive breastfeeding.

Intimate partner violence, breastfeeding, breastmilk substitutes and baby bottle use in the first year of life.

This article aims to investigate the relationship between intimate partner physical violence (IPPV) and breastfeeding (BF), use of breastmilk substitutes (BMS) and bottle-feeding among children aged 12 to 15 months. This is a cross-sectional study with mothers in primary care facilities of the city of Rio de Janeiro. IPPV was identified by the Brazilian version of the Conflict Tactics Scales 1-Form R and feeding practices were identified by a 24-hour Dietary Recall. Associations were verified by logistic regression with odds ratio (OR) estimates and 95% confidence intervals. BF was offered to 58.5% of the children and BMS to 88.5%. Also, 70.5% of the children used a baby bottle. Physical violence was observed in 26.7% of couples. Households where couples physically abuse each other are more likely to not breastfeed (OR=2.14, p-value=0.030), to use breastmilk substitutes (OR=5.15, p-value=0.03) and bottle-feed (OR=2.71; p-value=0.01), when compared to households without physical violence. The results highlight the need to investigate intrafamily relationships in cases where inadequate breastfeeding practices are identified, and to enable health professionals to support families in conflict situations.

Assessment of ECC Affecting Anterior Teeth in Children Visiting University Dental Hospital in India

Dental caries is one of the most infectious diseases of childhood resulting in chronic progression rate. They are of different types and patterns being rampant caries, nursing bottle caries. These are known to spread from the mother to the baby during infancy. Early childhood caries in the presence of one or more decayed or filled tooth surfaces in any primary teeth in a child 72 months age or younger. It is generally associated with unusual dietary patterns. Caries in children are mainly caused by the bacteria Streptococcus mutans. One of the reasons identified for ECC in children is the improper feeding patterns in children and prolonged use of baby bottles for milk feeding, especially at night. The aim of this study is to assess the prevalence of ECC anterior teeth in children. A retrospective study was carried out using digital records of 731 subjects. These data were collected from DIAS and coded in MS Excel sheets. The collected data was analysed by computer software SPSS version 21 using Chi-square test and graphical illustration was done. From the above study, it was found that ECC was more prevalent in 2-4 years and predominantly in male children (54.61%). Therefore, from this study, it can be concluded that ECC is highly prevalent in the maxillary anterior teeth in children.

Prevalence and risk factors of otitis media with effusion in primary school children in Mersin

Aim: To investigate the prevalence of otitis media with effusion (OME) and related risk factors among primary school children in Mersin.
 Material and Method: The study was conducted at eight primary government schools in the distinct socioeconomic district between October 2018 and December 2018. Using the combined physical examination and otoscopic evaluations, a total of 960 children included the study. 
 Findings: Of the children who were screened, 53.2% were girls and the mean age was 7.57 ± 0.45 years (min: 5 - max: 11 years). In this study, OME prevalence was 2,6% (20 of 761 children) and all children had bilateral OME. There was no statistically significant difference between the presence of OME and the number of people at home, incoming level, month of birth, birth weight, duration of breastfeeding, age average, class, gender, smoking in the house, presence of hearing loss in the family, history of otitis in the family, use of pacifier, use of baby bottle, presence of allergy, previous history of otitis, the presence of open mouth, snoring and tonsil grades.
 Conclusion: Although the low prevalence of OME in our study, considering that OME and its possible preventive severe complications, screening for OME should be a part of preventive health services, particularly for primary school children.

Knowledge, behaviours and beliefs of parents regarding the oral health of their children.

The purpose of this study was to assess the Saudi parent's knowledge, behaviours, and beliefs regarding the oral health of their children. Parents answered a questionnaire, which included questions about parental knowledge, behaviours, and beliefs regarding dental caries development, baby bottle use, and how to care for children's oral health as well as the reasons for their children's first visit to the dentist and other questions. There was a statistically significant difference in the mean scores of knowledge of participants, across all age groups. Age, number of children, and education level were statistically significantly related to the mean scores of behaviours. Beliefs scores of participants indicated statistically significant difference in relation to the education level, monthly family income, and use of smart phone. There is discrepancy between parental knowledge, behaviours, and beliefs regarding oral health of their children and there is association of these variables with their sociodemographic status.

Evaluation of the World Breastfeeding Trend Initiative Reports of the Countries Affiliated to the Turkish Cooperation and Coordination Agency

Breastfeeding has many benefits for the physical and psychological development of the baby and its positive effects continue for life. Breastfeeding correctly and properly whenever the baby wants, except in compulsory situations feeding only with breast milk during the first six months and breastfeeding is recommended in addition to supplementary food for at least two years of age. In most parts of the world, programs to encourage breastfeeding are implemented. In this study, the rates of countries that sent reports to World Breastfeeding Trend Initiavite (WBTI) from countries that are members of the Turkish Cooperation and Coordination Agency (TCCA) Presidency on breastfeeding and bottle use. It was observed that the rates were below the standards in the specified reports. Increasing breastfeeding rates, reduce baby bottle use and thus, it is thought that educational programs should be focused on in order to raise healthier generations

Risk factors for communication disorders and complaints of preschoolers in a School Health Program

ABSTRACT Purpose: to survey the prevalence of risk factors for communication disorders and complaints in preschoolers that participated in the School Health Program (SHP) and compare the findings with age and sex. Methods: the sample comprised 190 preschoolers reached by the SHP. The collection procedure involved the exploration of data in questionnaires previously filled out by their relatives. The risk factors and communication complaints were presented in the occurrence frequency. The evidence of associations between variables was verified with the Mann-Whitney and chi-square tests, and the 5% significance level was used for all comparisons. Results: baby bottle use was the most prevalent risk factor associated with age, being more frequent in younger children. The girls underwent more complications during pregnancy or birth and showed more nonnutritive sucking habits, whereas the boys had more hospital stays. Conclusion: regarding the investigated risk factors, the baby bottle use was the most reported one, followed by ear infections or other ear problems. Complaints related to speaking and hearing were seldom mentioned, although those related to speaking occurred more frequently.

미국 환경호르몬물질 관리의 정책과 법제

The US Endocrine Disruptors Management Policy focuses on product regulation that contains the substance rather than on the substance itself. The US Endocrine Disruptors Screening Program (EDSP) is underway to identify endocrine disruptors, but there is still an ongoing analysis of what substances are environmental hormones and how they are affected.<BR> Regarding the regulation of endocrine disruptor-containing products in the United States, I examined the regulation of phthalate-containing products in children’s products and the legislation on the regulation of BPA in food containers and bottles. The main basis for the regulation of phthalate-containing products in children’s products is the Consumer Product Safety Improvement Act(CPSIA). This Act aims specifically to prohibit the use of lead and phthalates in children’s products. Dec. 31, 2014. As CPSIA has been amended and applied to products manufactured and imported after April 25, 2018, DEHP, DBP, BBP and DINP have been banned and withdrawn from the temporary ban on DIDP and DNOP. In addition, four new phthalates (DIBP, DNPP, DNHP, DCHP) were identified as prohibited substances. CPSIA requires ⒜ third party certification from external testing agencies for children’s products, ⒝and it is mandatory to attach Tracking Labels on both products and packaging.<BR> In the case of BPA regulation in food containers and bottles, 21 FR part 177 prohibits the use of polycarbonate in bottles, etc. Also in California, October 10, 2011, the Toxin-Free Infants and Toddlers Act came into effect, The use of baby bottles, infant drink cups, and feeding devices was prohibited. Nov. 2015 BPA is listed on the Prop. 65 list so that all bottled or bottled bottles sold in the state, not limited to infant bottles and dishes, and bottles or caps of food or beverages containing BPA Sales, and imports of products are prohibited. Prop. 65 lists the chemicals that can cause carcinogenesis and reproductive toxicity as a List and imposes an obligation to display an exposure warning and prohibit the discharge of drinking water sources if the substance exceeds the Safe Harbor Level(SHL).<BR> The criteria for warning signs applied from August 30, 2018 are as follows. (A) be clear and reasonable; (b) be provided by the manufacturer, producer or packer, rather than by the retailer; (c) if no clear and clear warning is given on the packaging or labeling of the consumer product, It is necessary to fulfill a separate warning obligation to the consignee. Various warning methods such as consumer product labels, workplace covers, public service announcements, newspapers and online announcements can be utilized.

Anterior open bite and deleterious habits in preschool children from public schools

Objetivo: este estudo tem como objetivo avaliar a prevalência de mordida aberta anterior e sua associação com hábitos orais deletérios, como uso de chupeta, hábito de sucção de dedo e mamadeira em pré-escolares. Material e Métodos: foi realizado um estudo transversal com 142 crianças de três a cinco anos de nove escolas da cidade de Nova Venécia, ES. Um examinador devidamente calibrado realizou o exame de oclusão sob luz natural e com auxílio de exame médico. Além disso, um formulário semiestruturado com perguntas fechadas sobre hábitos orais deletérios em crianças foi enviado aos pais / responsáveis. Os dados sociodemográficos, econômicos e mordida aberta anterior foram verificados por meio do teste exato de Fisher e os valores de probabilidade foram calculados com intervalo de confiança de 95%. Resultados: foi encontrada uma prevalência de 31,69% (45) de mordida aberta anterior. Além disso, 45,8% (65) das crianças tinham hábito de sucção de chupeta, 14,8% (21) hábitos de sucção de dedo e 73,9% (105) usavam mamadeira. Crianças com hábito de chupar chupeta apresentaram 5,58 (2,54-12,24) mais chances de ter mordida aberta anterior do que crianças sem o hábito. Crianças pré-escolares com hábito de sucção de dedo mostraram 3,55 (1,37-9,21) mais chances de apresentar má oclusão. Crianças que usaram mamadeira apresentaram 2,29 (1,06-4,97) mais chances de ter mordida aberta anterior. Conclusão: alta prevalência de mordida aberta anterior é observada na população estudada e está associada ao hábito de sucção de chupeta, hábito de sucção de dedo e uso de mamadeira.

Association between feeding habits and severe - early childhood caries in children up to 24 month old

Abstract Introduction During the first two years of life children’s nutrition is mostly based on frequent, liquid and sweetened meals which can cause Severe-Early Childhood Caries (S-ECC) development. The aim of this research was to determine the relationship between dietary habits and S-ECC in children up to 24 month-old living in Banja Luka, Bosnia and Herzegovina. Methods Cross-sectional study included representative sample of 192 children. Before dental examination of children, each parent/caregiver was interviewed about the basic info, socio-demographic characteristics and children's eating habits. The questionnaire was conducted as interview (“face to face”). Subjects were divided into two groups: the first group - children with S-ECC and the second group - caries free children. For statistical analysis and presentation of results SPSS 16.0 for Windows, MS Office Word and Microsoft Office Excel were used. Results In the study sample 34.9% of children were suffering from S-ECC. About 50% of children who were breast-fed at night after first tooth eruption had S-ECC. The use of baby bottle with milk or other sweetened content during bedtime and during the night was identified as significant caries risk factor (P &lt;0.05). Conclusion Nighttime breastfeeding, use of bottle with milk during bedtime/nighttime or other sweetened content during night after eruption of first primary tooth were strongly associated with S-ECC in the examined children.

Evaluation of the migration of chemicals from baby bottles under standardised and duration testing conditions

ABSTRACTAfter the prohibition of bisphenol-A-containing polycarbonate baby bottles in the European Union (EU), alternative materials, such as polypropylene, polyethersulphone, Tritan™ copolyester, etc., have appeared on the market. Based on an initial screening and in vitro toxicity assessment, the most toxic migrating compounds were selected to be monitored and quantified using validated GC- and LC-QqQ-MS methods. The effect of several ‘real-life-use conditions’, such as microwave, sterilisation and dishwasher, on the migration of different contaminants was evaluated by means of duration tests. These results were compared with a reference treatment (filling five times with pre-heated simulant at 40°C) and with the legal EU ‘repetitive-use conditions’ (three migrations, 2 h at 70°C). Analysis of the third migration step of the EU repetitive-use conditions (which has to comply with the EU legislative migration limits) showed that several non-authorised compounds were observed in some baby bottles exceeding 10 µg kg−1. However, all authorised compounds were detected well below their respective specific migration limits (SMLs). The reference experiment confirmed the migration of some of the compounds previously detected in the EU repetitive-use experiment, though at lower concentrations. Analysis of extracts from the microwave and dishwasher experiments showed a reduction in the migration during the duration tests. In general, the concentrations found were low and comparable with the reference experiment. Similar observations were made for the two sterilisation types: steam and cooking sterilisation. However, steam sterilisation seems to be more recommended for daily use of baby bottles, since it resulted in a lower release of substances afterwards. Repeated use of baby bottles under ‘real-life’ conditions showed no increase in the migration of investigated compounds and, after some time, the migration of these compounds even became negligible.

Pediatricians' oral health recommendations for 0- to 3-year-old children: results of a survey in Thuringia, Germany.

BackgroundGerman societies of pediatricians and dentists disagree about oral health-related preventive recommendations (use of fluoride supplements, fluoride-containing toothpaste) for children aged 0–3 years. After failure to reach a consensus, there is no study that has evaluated the guidelines that pediatricians use in daily practice.MethodsA standardized questionnaire was sent to all 167 practicing pediatricians in the state of Thuringia, Germany, to assess the current oral health-related preventive recommendations. Data were analyzed using descriptive statistics.ResultsThe response rate was 52.0%. More than 9.0% of the pediatricians advise parents with regard to diet, use of baby bottles, oral hygiene and dental visits. The majority of pediatricians recommend to start tooth-brushing after the 1st birthday and recommend the use of toothpaste and a 1st dental visit after the 2nd birthday (78.0%). Additionally, 23.3% (n = 20) of pediatricians prescribe solely vitamin D, and 20.9% (n = 18) prescribe vitamin D combined with fluoride. Fluoride supplements are given as required by 37.2% (n = 32) of pediatricians, primarily between the 1st and 6th birthdays. The guidelines of the Pediatric Society were used by 1.2% of the pediatricians, the guidelines of the dentists were used by 5.8%, and a mix of both was used by 93.0%. The simultaneous use of fluoride supplements and fluoride toothpaste in the first three years was recommended by 45.9% of the pediatricians.ConclusionsPediatricians’ oral health recommendations are based on a mix of the guidelines from the German societies of pediatricians and dentists and led to no use or possible overdose of fluoride. Against the background of early childhood caries and dental fluorosis, there is a need for uniform guidelines.

Nursing habits in cleft lip and palate children

Cleft lip and palate anomalies are malformations that affect patients causing some alterations. These alterations can compromise maternal nursing and lead to early introduction of bottle feeding and sugar in the diet of cleft lip and palate infants, compromising their oral health and the surgical/rehabilitation process. Objective: The purpose of this study was to evaluate the nursing habits and the use of baby bottles in a group of cleft lip and palate infants. Material and methods: Two hundred and twenty nine mothers of cleft lip and palate infants in the age range from 6 to 36 months enrolled in the Hospital for Rehabilitation of Craniofacial Anomalies – USP/Bauru were interviewed. It was obtained data on family socioeconomic characteristics as well as mother educational level using the patient’s file. Using a pre-structured questionnaire accomplished always by the same interviewer, information on natural and artificial nursing pattern was obtained. Results: Only 21.4% of the mothers accomplished breastfed their babies. 98.25% of mothers used bottle feeding with milk and other sucrose liquids at one to ten times frequency. Nocturnal nursing habit was verified in 59.38% of total sample. Conclusion: Cleft lip and palate infants presented inadequate nursing habits in relation to both the content and the frequency ingestion, suggesting the need of a multidisciplinary guidance and following-up of infants during this age range.

Relação de escolaridade, faixa etária e profissão de mães com a oferta de chupeta e mamadeira a seus filhos

OBJETIVO: avaliar a relação do grau de escolaridade, faixa etária e a profissão das mães com a oferta de chupeta e mamadeira a seus filhos MÉTODO: participaram deste estudo 190 mães de crianças entre 0 e 10 anos de idade, com idades de 20 a 45 anos que responderam a um questionário com questões fechadas a respeito de profissão, nível de escolaridade e uso de chupeta e mamadeira de seus filhos RESULTADOS: não foi observada diferença significante entre o grau de escolaridade quanto ao uso de chupeta (p= 0,915). O uso de mamadeira foi significantemente maior nos filhos de mães com ensino superior (p= 0,0124). Não houve diferença significante quanto à faixa etária das mães e a presença desses hábitos nos filhos (chupeta: p=0,427; mamadeira: p=0,427); e, entre mães que trabalham em casa e que trabalham fora de casa (chupeta: p=0,061; mamadeira: p=0,798). Não houve diferença entre mães que trabalham na área da saúde e em outras áreas (chupeta: p=0,339; mamadeira: p=0,455) CONCLUSÃO: as mães com nível superior de escolaridade oferecem significantemente mais mamadeira aos seus filhos, o que não ocorreu quanto ao uso de chupeta. Não foi observada diferença significante quanto ao uso de chupeta e mamadeira em relação à faixa etária e profissão de mães.

The influence of social status on pre-school children’s eating habits, caries experience and caries prevention behavior

To assess the prevalence of Early Childhood Caries (ECC) in a county in Northern Hesse and to correlate this parameter to various independent variables. Additionally to investigate the relationship between preventive measures and the socioeconomic status (SES). In spring 2006, 1,082 preschool children were examined. According to WHO-criteria d(3+4)mft scores were recorded. Information about eating habits and preventive measures were collected by structured questionnaires. To compare the mean caries scores and preventive measures of various subgroups, non-parametric tests were performed. Variables associated with caries were included in a binary stepwise backward logistic regression analysis. The mean d(3+4)mft score amounted to 1.88. Children with high SES had significantly less caries than children with low SES. Significant positive and negative associations of feeding practices and preventive measures to d(3+4)mft scores were observed. Differences between feeding practices and preventive measures were dependent on SES. Long-term use of baby bottles at night is the most important factor of ECC. Differences in feeding practices and preventive measures in the various SES groups are evident but not that significant as supposed.

Postpartum women's knowledge about breastfeeding - a descriptive study

Introduction: Some mothers do not comply with breastfeeding due to unawareness of the practice. Aims: To characterize the demographic and obstetrical profile of postpartum women and to verify the influence of their instruction level and the number of prenatal consultations on breastfeeding knowledge. Design: Descriptive and quantitative study. Method: Individual interviews were carried out with 150 postpartum women at a public maternity rooming-in. The data were processed in the SPSS, version 13.0. Results: Most women were between 18 and 35 years old, less than eight schooling years; 91 (60.7%) were multiparae and 87 (58%) had not breastfed previously. Increased knowledge was verified on breastfeeding protection against ovarian and breast cancer (n=66; 89.2%), child development and promotion of mother and baby bonds (n=74; the 100%) and protection against child infections (n=73; 98.6%) among postpartum women with eight schooling years. The largest number of prenatal consultations positively influenced the understanding of maternal milk as an optimum food for children (n=109; 100%), the baby's bottle use to worsen breast suckling (n=88; 80.7%), the introduction of other foods affecting the child health (n=93; 85.3%) and painless breastfeeding of mothers who follow correct handling (n=74; 67.9%). Conclusion: The study reveals that factors such as instruction and number of prenatal consultations influence the knowledge level on breastfeeding, therefore reinforces the need for prenatal care promotion and educative approaches toward breastfeeding. Relevance for the clinical practice: This study brings to attention factors related to mother’s knowledge about breastfeeding. Thus, women awareness must be raised toward exclusive breastfeeding as the best health practice to the mother-baby binomial.

NTP‐CERHR expert panel report on the reproductive and developmental toxicity of bisphenol A

Robert E. Chapin, Jane Adams, Kim Boekelheide, L. Earl Gray Jr, Simon W. Hayward, Peter S.J. Lees, Barry S. McIntyre, Kenneth M. Portier, Teresa M. Schnorr, Sherry G. Selevan, John G. Vandenbergh, and Susan R. Woskie Pfizer, Inc., Groton, CT University of Massachusetts, Boston, MA Brown University, Providence, RI U.S. Environmental Protection Agency, Research Triangle Park, NC Vanderbilt University Medical Center, Nashville, TN Johns Hopkins University, Baltimore, MD Schering Plough Research Institute, Summit, NJ American Cancer Society, Atlanta, GA National Institute for Occupational Safety and Health, Cincinnati, OH U.S. Public Health Service (Ret), Silver Spring, MD North Carolina State University, Raleigh, NC University of Massachusetts, Lowell, MA

Are intrauterine growth restriction and preterm birth associated with dental caries?

To assess the association between two intrauterine growth restriction (IUGR) surrogates - IUGR [small for gestational age birth (SGA) and fetal growth restriction (FGR)] and preterm birth with dental caries. Data from the Third National Health and Nutritional Examination Survey (1988-1994) were used, including 2- to 5.9-year-old singletons (n = 3189). Dental caries was defined as presence of any teeth with dental caries (treated or untreated) and also as presence of at least two teeth with dental caries. Exposure variables were preterm birth (<37 gestational weeks), FGR, and SGA. Covariates included were poverty, race/ethnicity, age, sex, sucrose intake, environmental tobacco smoking, dental visits, education of head of household, breastfeeding, and use of baby bottle. Separate statistical analyses were conducted for IUGR and for preterm birth through the estimation of prevalence ratio (PR), taking complex sampling design into consideration and adjusting for confounders. Sensitivity analysis was conducted including and excluding 2-year-old children and also with the two definitions of dental caries. In general, the inclusion of 2-year-old children and the case definition of presence of any teeth with dental caries biased the results toward the null, but with no major changes in the results. In bivariate analysis, SGA and FGR birth were both negatively but not significantly associated with dental caries while a significant positive association was found for preterm birth. Sensitivity analysis showed that the PR for preterm in bivariate analysis varied from 1.65 (95% CI 1.14-2.40) to 1.84 (95% CI 1.19-2.83). After adjusting for confounders, the PR for preterm birth varied from 1.38 (95% CI 1.00-1.89) to 1.64 (95% CI 1.22-2.20). After adjustment, the PR for SGA varied from 0.79 (95% CI 0.56-101) to 0.66 (95% CI 0.33-0.96). For children from 3 to 5.9 years old, the adjusted PR for FGR using the category 'none' as reference were mild (PR 1.10; 95% CI 0.76-1.58), moderate (PR 0.66; 95% CI 0.26-167), and severe (PR 0.59; 95% CI 0.36-0.99). These values for FGR were very similar for the other models using other classifications of case definition or inclusion of 2-year-old children. Preterm birth was found to be positively associated with dental caries while there is an indication that SGA and FGR are negatively associated with dental caries. Although the negative association is counterintuitive, it is possible that increased antibiotic use and delayed tooth eruption may explain the negative association between IUGR and dental caries.