Impact of Prenatal Vitamin D Supplementation on Prenatal Vitamin D Concentrations and Early Childhood Caries

产前补充维生素D对胎儿维生素D浓度和胎儿发育的影响 儿童早期龋齿 摘要 阿拉斯加原住民（AN）儿童早期佝偻病和维生素D缺乏症的发病率较高， 其他美国人口。来自阿拉斯加州育空地区Kuskokwim（YK）三角洲的怀孕AN妇女增加了 维生素D缺乏率与从传统的海洋饮食过渡有关。阿拉斯加土著 来自YK三角洲的儿童经历了最高的幼儿龋齿（ECC）报告率之一。一 加拿大的一项研究表明，产前低25-羟基维生素D（25（OH）D）水平与 妇女和幼儿保育。我们评估了YKDelta产前25（OH）D 使用“母体有机物监测（监测）研究”的数据， 儿童的电子牙科记录，以评估ECC的龋缺和填补牙齿（dmft）评分。在 分析结果显示，24-35个月脐血25（OH）D <12 ng/ml儿童平均dmft评分为2.4 比非缺陷型儿童高10倍（p=0.003）。关于产前检查的影响的信息有限。 补充维生素D可以提高孕妇的维生素D浓度，但没有关于其影响的信息 在ECC。根据现有证据，目前还不清楚维生素D补充剂是否应该作为处方药。 常规产前护理的一部分。因此，目前美国妇产科医师学会 建议产前维生素中只含400 IU的维生素D。2004年至2005年期间 一项研究（2000-2010年）显示，91%的脐带血25（OH）D水平<20 ng/ml（不足），53%的脐带血25（OH）D水平<20 ng/ml（不足）， <12 ng/ml（缺乏）。2015年秋季，YK三角洲地区医院（YKDRH）评估了产前25（OH）D 妇女- 60%不足（<20纳克/毫升）。2016年秋季，YKDRH实施了增加1000 IU的指南 每日维生素D到常规推荐的产前维生素（400 IU）和钙（200 IU）。近期 维生素D补充指南在YK三角洲提供了一个机会，以评估产前 补充25（OH）D浓度和ECC。我们提出了一个队列研究，使用电子 健康记录和牙科记录，以评估：1）产前维生素D补充的有效性 在增加25（OH）D浓度到足够的水平，2）缺乏产前 （25（OH）D浓度与ECC; 3）产前补充维生素D对ECC的影响。我们 将测试25（OH）D水平的差异，在第一次产前检查和妊娠晚期的妇女之前和之后， 增强维生素D补充，并测量与依从性相关的因素。我们将评估 非缺乏和缺乏维生素D组之间的平均dmft评分，以及前后 补充。并探索协变量之间的关系。这些信息将帮助临床医生 决定在YK Delta和其他高危人群中进行产前维生素D补充。

The Impact of Prenatal Vitamin D Supplementation on Prenatal Vitamin D concentrations and Early Childhood Caries. Abstract Alaska Native (AN) children experience high rates of early rickets and vitamin D deficiency compared with other US populations. Pregnant AN women from Alaska`s Yukon Kuskokwim (YK) Delta have increased rates of vitamin D deficiency associated with transition from a traditional marine diet. Alaska Native children from the YK Delta experience one of the highest reported rates of early childhood caries (ECC). A Canadian study showed an association between low 25-hydroxyvitamin D (25(OH)D) levels in prenatal women and ECC in their infants. We evaluated the association between YK Delta prenatal 25(OH)D levels and ECC in their children using data from the "Maternal Organics Monitoring (MOM) Study”, and children's electronic dental records to assess ECC by decayed missing and filled teeth (dmft) scores. In the analysis, children 24-35 months of age with cord blood 25(OH)D <12 ng/ml had a mean dmft score 2.4 times higher than non-deficient” children (p=0.003). There is limited information on the impact of prenatal supplementation improving vitamin D concentrations in pregnant women and no information on the impact on ECC. With available evidence, it is unclear whether vitamin D supplementation should be prescribed as part of routine antenatal care. Therefore, the current American College of Obstetricians and Gynecologists recommends only the 400 IU of vitamin D in prenatal vitamins. Data in YK Delta women from the MOM study (2000-2010) showed 91% of 25(OH)D cord blood levels were <20ng/ml (insufficient), and 53% were <12ng/ml (deficient). In Fall 2015, YK Delta Regional Hospital (YKDRH) evaluated 25(OH)D in prenatal women – 60% were insufficient (<20ng/ml). In Fall 2016 YKDRH implemented guidelines to add 1000 IU of daily vitamin D to routinely recommended prenatal vitamins (400 IU) and calcium (200 IU). The recent Vitamin D supplementation guidelines in YK Delta offers an opportunity to evaluate the impact of prenatal supplementation on 25(OH)D concentrations and ECC. We propose a cohort study using the electronic health records and dental records to evaluate: 1) the effectiveness of prenatal vitamin D supplementation in increasing 25(OH)D concentrations to sufficient levels, 2) the association between deficient prenatal (25(OH)D concentrations and ECC, and 3) the impact of prenatal vitamin D supplementation on ECC. We will test the difference in 25(OH)D levels at first prenatal visit and third trimester in women before and after enhanced vitamin D supplementation, and measure factors associated with compliance. We will evaluate mean dmft scores between non-deficient and deficient Vitamin D groups, and before and after supplementation. and explore the relationship of covariates. This Information will help clinicians make decisions about prenatal vitamin D supplementation in YK Delta and other high risk populations.