Grand Rounds

Does Vitamin D Supplementation in Pregnancy Reduce the Risk of Enamel Defects in Children?

BACKGROUND AND PURPOSE:

Nørrisgaard et al. (JAMA Pediatrics, 2019) investigated whether vitamin D supplementation during the third trimester of pregnancy is associated with a lower risk of enamel defects and caries in offspring

Post hoc analysis of a double-blind, single-center RCT
- The clinical trial was the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort (COPSAC2010)
Participants
- Women recruited at 24 weeks gestation
- Offspring dental exam at 6 years
Intervention (from 24 weeks GA to 1 week postpartum)
- Vitamin D group: High-dose vitamin D3 (2400 IU/d)
- Control group: matching placebo tablets
- All women received 400 IU/d of vitamin D3 as part of standard care and therefore final comparison was 2800 IU/d vs 400 IU/d
Definitions (both deciduous and permanent teeth)
- Enamel defect: ≥1 molar with (1) demarcated opacity (2) enamel breakdown and/or (3) atypical restoration/ extractions
- Caries (WHO standard): (1) Decayed (2) missing or (3) filled surfaces

623 women | 588 children participated
- 6-year dental exam: 84% completion
- Vitamin D group: n=315
- Control group: n=308
Risk of enamel defects in permanent teeth was lower in high-dose Vitamin D group
- Vitamin D group: 15.1%
- Control group: 27.5%
- Odds ratio (OR) 0.47 (95% CI, 0.27 to 0.81)
Risk of enamel defects in deciduous teeth was also lower in high-dose Vitamin D group
- Vitamin D group: 8.6%
- Control group: 15.9%
- OR 0.50 (95% CI, 0.28 to 0.87)
Caries: There was no difference between groups

High-dose prenatal vitamin D supplementation resulted in an approximately 50% reduction in the odds for enamel defects in offspring at 6 years of age
The authors suggest that high-dose vitamin D supplementation may be “a preventive intervention to reduce the prevalence of enamel defects with a significant potential effect on dental health”

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