15 May 2023

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An exploratory study of maternal diabetes and offspring use of dental services

Northern Ireland national cohort study

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Introduction

A small number of literature has posited a link between prenatal exposure to gestational diabetes mellitus and an increased risk of developmental defects in the enamel of offspring. However, the evidence remains inconclusive.

Odontogenesis begins from the sixth week of fetal life and continues through gestation and after birth. As a part of odontogenesis, amelogenesis can be altered by local and systemic factors. Systemic factors include changes to and reduction of tissue oxygenation, exposure to gamma rays, fever, infections, vitamin A & D deficiency and gestational diabetes. These factors can influence odontogenesis and cause enamel hypoplasia or other amelogenesis defects.

Aims

This study examined the relationship between the diabetes status of mothers and the use of dental services by offspring to that pregnancy.

Material and methods

This study uses anonymized data secured from three sources: the Northern Ireland Maternity System (NIMATS), the Enhanced Prescribing Database (EPD), and the Dental Payment System (DPS). NIMATS is the regional administrative data repository for demographic and clinical information collected on mothers and their infants during antenatal check-ups, labor and delivery, and the postnatal period in Northern Ireland. The main source of data for NIMATS is the PatieAlsnt Administration System which captures details of hospital service use by patients.

The anonymized data from a cohort of mothers who carried a child to term in Northern Ireland between 2012 and 2017 and service use by the child were taken from these databases from March 2015 to September 2021. Descriptive statistics, differences in means and regression analyses were used to examine the relationship between service use and maternal diabetes status, controlling for covariates.

Results

A total of 144,599 mother-child dyads were included in this study. Out of this, 9138 (6.31%) of the mothers were diagnosed as having GDM or having filled a prescription for Metformin or Insulin during their pregnancy. We also found that (80%) of children had not used dental services (non-users) with respect to primary teeth by September 2021. Non-users were more likely to be younger and from a higher socioeconomic group.

In multivariate analyses that controlled inter alia for age and deprivation, diabetes status was negatively related to restoration, extraction, prevention, and total service use. In the analysis of the COVID period, pre-COVID prevention was negatively related to extractions, restorations, prevention and services in general.

Conclusion

Previous studies examining the relationship between maternal diabetic status and offspring dental caries level have produced heterogeneous results. Considering the limitations of the current study, it provides tentative support for the hypothesis that treatment need is not elevated as a result of maternal diabetes status though further work is needed. The team's results also underscore the value of prevention, especially within a context where access to services is disrupted.

Salami, A., El Karim, I., Lundy, F. et al. "An exploratory study of maternal diabetes and offspring use of dental services—Northern Ireland national cohort study." BDJ Open 9, 14 (2023). https://doi.org/10.1038/s41405-023-00140-0.