|Year : 2022 | Volume
| Issue : 2 | Page : 118-123
Impact of socioeconomic factors on deciduous teeth eruption among infants born after low-risk pregnancy compared to infants diagnosed with intrauterine growth restriction
Aditi Garg1, Gyanendra Kumar2, Mridula Goswami2, Devender Verma3
1 Department of Pediatric and Preventive Dentistry, Maulana Azad institute of Dental Sciences, New Delhi, India
2 Department of Pedodontics and Preventive Dentistry, Maulana Azad Istitute of Dental Sciences, New Delhi, India
3 Department of Obstretics and Gynecology, New Delhi, India
|Date of Submission||20-Apr-2022|
|Date of Decision||28-May-2022|
|Date of Acceptance||08-Jun-2022|
|Date of Web Publication||15-Jul-2022|
Dr. Aditi Garg
Department of Pedodontics and Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: The aim is to assess the impact of socioeconomic factors on deciduous teeth eruption among infants born after low-risk pregnancy and infants diagnosed with intrauterine growth restriction (IUGR). Materials and Methodology: The cross-sectional study included 110 neonates recruited at birth using stratified random sampling based on inclusion and exclusion criteria. Neonates diagnosed without IUGR were allocated to Group I (n = 55) and those diagnosed with IUGR were allocated to Group II (n = 55). The perinatal case history was recorded, followed by intraoral examination at birth, 6 months, and monthly up to 1 year or till first evidence of teeth eruption. Results: The difference between both groups based on socioeconomic status (SES) was found statistically significant (P = 0.043). The first evidence of eruption of deciduous teeth was found delayed in Group II (P = 0.0001). Secondary school education was found statistically significant between both the groups (P = 0.024). The difference between the two groups based on religion (P = 0.353) and gravidity (P = 0.571) was found statistically insignificant. Conclusion: Lower SES and secondary maternal education can be considered statistically significant risk factors of IUGR and delayed deciduous teeth eruption. No correlation of IUGR with religion and gravidity was found.
Keywords: Deciduous dentition, estimated fetal weight, gestational age, intrauterine growth restriction, low-birthweight
|How to cite this article:|
Garg A, Kumar G, Goswami M, Verma D. Impact of socioeconomic factors on deciduous teeth eruption among infants born after low-risk pregnancy compared to infants diagnosed with intrauterine growth restriction. J Indian Soc Pedod Prev Dent 2022;40:118-23
|How to cite this URL:|
Garg A, Kumar G, Goswami M, Verma D. Impact of socioeconomic factors on deciduous teeth eruption among infants born after low-risk pregnancy compared to infants diagnosed with intrauterine growth restriction. J Indian Soc Pedod Prev Dent [serial online] 2022 [cited 2022 Aug 17];40:118-23. Available from: http://www.jisppd.com/text.asp?2022/40/2/118/351044
| Introduction|| |
Intrauterine growth restriction (IUGR) also categorized as “fetal growth restriction” and “Intrauterine growth retardation,” is a medical condition of utmost concern for newborns due to its significant impact on physical and mental well-being. The risk of newborn death due to IUGR is reported 5–10 times higher with the prevalence of stillbirth up to 65%. According to a report by National Neonatal-Perinatal Database, the incidence of IUGR in India is 9.65% and among very low-birthweight infants (<1000 g), the incidence is 43%. IUGR can lead to increased risk of neural impairment, leading to neurological disorders which include cerebral palsy, learning, and behavioral difficulties.
According to Barker's hypothesis, chronic adult diseases, stroke, hypertension, type 2 diabetes, and coronary heart diseases are considered long-term associations with IUGR affecting growth and neurocognitive performance. The outcome of IUGR can vary depending on the level of severity causing short-term metabolic derangements to even neonatal morbidity. Premature delivery (below 28 weeks of gestational age), low-birthweight (<10th percentile of GA), estimated fetal weight <10th percentile of gestational age had been considered significant risk factors for IUGR., The diagnosis of IUGR is possible to be made up to the third trimester of pregnancy; however, due to various socioeconomic disparities the diagnosis may remain unnoticed, thereby affecting the neonatal outcome.
Tooth eruption is a physiologic process that strongly influences the normal development of the craniofacial complex. Often, delayed tooth eruption (DTE) might be the primary or sole manifestation of local or systemic pathology. DTE can have a significant impact on the physiological development of the child. There are various local and systemic factors affecting tooth eruption. In the present study, one such systemic factor, i.e., IUGR is studied for its impact on tooth eruption. Since the impact of IUGR on the development of the child is well studied in the literature, its role on dentition is not reported yet. The present study is aimed to highlight the importance of early diagnosis of IUGR and possible risk factors associated with IUGR with a significant impact on the dentition. The study highlights the need of further studies to evaluate and report possible changes in the pattern of the regular eruption of the primary dentition in IUGR fetuses and neonates.
The determinants of IUGR pregnancy are well studied and reported in the literature however its impact on the chronology of deciduous teeth eruption is scanty in the literature. In the present study, socioeconomic factors, such as socioeconomic status (SES) of family, maternal education, religion, and gravidity, have been studied and correlated with the chronology of deciduous teeth eruption.
The cross-sectional study was conducted in the Department of Pedodontics and Preventive Dentistry and Department of Obstetrics and Gynecology after obtaining prior approval from the Ethical Committee of the M.A.I.D.S. Permission for conducting the study was obtained from the Department of Obstetrics and Gynecology, Lok Nayak Hospital, New Delhi.
A total sample of 110 neonates were recruited at birth from the antenatal and postnatal ward of the Department of Obstetrics and Gynecology. The sample size was selected based on the availability of cases and control in the postnatal ward at the time of recruitment. The sample population was divided equally into two groups of cases and controls considering 55 neonates each by stratified random sampling based on inclusion and exclusion criteria. The inclusion criteria for Group I included neonates presented without IUGR and for Group II neonates diagnosed with IUGR antenatally. All the mothers willing to participate in the study and attending the dental outpatient department for follow-ups were included in the study. The neonates with a history of meconium-stained liquor, congenital infections, and malformations or infants with the sign of rickets at 6 months of age or before were excluded from the study.
Informed consent was obtained, followed by the detailed perinatal case history of mother at birth. Since the diagnosis of IUGR is possible by ultrasonographic assessment in the third trimester, the recruitment was done during the third trimester of pregnancy. Further allocation of neonates in Group I and Group II was done based on estimated fetal weight recorded during the third trimester of pregnancy by ultrasonographic examination. The neonates with estimated fetal weight >10th percentile of its gestational age were included in Group I and <10th percentile were included in Group II (as per fetal foundation weight charts by Nicolaides et al.)
The Modified Kuppuswammy socioeconomic scale was used to record the SES of the family. It included three determinants such as the occupation of the head of the family, annual income of the head, and the educational status of the head. Maternal educational status, religion, and gravidity were also recorded and compared in both the groups.
The intraoral examination was performed at birth, followed by recording sociodemographic details of the mother. The emergence of cusp in the oral cavity was considered first evidence of tooth eruption. Follow-up examinations were done at 6 months of age, followed by monthly examination up to 1 year of age or till the first evidence of teeth eruption, to record the first evidence of eruption of deciduous teeth, followed by comparative evaluation.
Data analysis was performed using the Statistical Package for the Social Science version 21.0 (SPSS Inc. Chicago, IL, USA). Descriptive statistics that included mean, median, standard deviation, and percentages were calculated for each of the variables. Statistical analysis was performed using Chi-square test and Student's “t”-test. Significance for all statistical tests was predetermined at a probability value of 0.05 or less.
| Results|| |
A total of 110 neonates were recruited at birth with 55 neonates each allocated to Group I and Group II. There were reported dropouts of 9 cases in Group I and 8 cases in Group II, with the net total sample size of 93 with 46 neonates in Group I and 47 in Group II.
The distribution of neonates based on maternal age was recorded. It was found that in Group I, out of a sample of 46 mothers, 34.8% were 23 years old, 15.2% were 24 years old, and 13% were 21 years old. The mean maternal age of mothers was 23.43 ± 23 years. In Group II, out of a sample of 47 mothers, 36.2% of mothers were 23 years old, 14.9% were 24 years old, and 12.8% were 21 years old. The mean maternal age of mothers was 23.43 ± 2.272 years. The maternal age difference in Groups I and II was found statistically insignificant (P = 1.000, P > 0.005). The maternal age range in both groups was found between 18 and 30 years with no case of <18 or >30 years, as shown in [Figure 1].
It was found that 52.17% study population in Group I and 53.2% in Group II were Muslims. About 76.1% of the study population in Group I and 66% in Group II had upper lower SES with the difference being statistically significant (P < 0.05), as shown in [Table 1]. About 52.17% of mothers in Group I and 59.57% in Group II had secondary school education with the difference being statistically insignificant (P > 0.05), as shown in [Table 2].
|Table 1: Comparison of percentage distribution based on socioeconomic status in Group I and Group II|
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|Table 2: Demographic details of study population in Group I and Group II|
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The mean estimated fetal weight in Group I was 2865.37 ± 547.28 g and in Group II was 1927.72 ± 647.18 g, with the difference being statistically significant (P < 0.05), as shown in [Table 3]. The average gestational age in Group I based on estimated fetal weight is 39 weeks (full term) and in Group II is, 32 weeks (preterm).
In the present study, gravidity was assessed in the perinatal history. It was found that in Group I, 67.4% of mothers and in Group II, and 57.4% were primigravida. The Chi-square test result depicted that there is no statistically significant difference based on gravidity between the two groups (P = 0.517, P > 0.05), as shown in [Table 4]. The mean age of first evidence of tooth eruption in Group I was 6.9 ± 0.37 and in Group II was 12.88 ± 1.16, with the difference being statistically significant (P < 0.05), as shown in [Table 5].
| Discussion|| |
The association of sociodemographic factors among infants born after low-risk pregnancy and infants diagnosed with IUGR with delayed deciduous teeth eruption was studied. The median age in both groups was found 23 years. The results were similar to a study conducted by Ortigosa Rocha et al., in which mean maternal age was 25.1 ± 5.5 years with no statistically significant difference between IUGR and appropriate for gestational age (AGA) groups (P > 0.05). It was similar to a study conducted by Ashwani et al. in which the mean maternal age was 20.2 ± 2.857 years. The results were in contrast to a study conducted by Muhammad et al., in which the mean maternal age was 22.9 ± 4.5 years for IUGR neonates and for AGA neonates 26.8 ± 4.8 with the difference being statistically significant (P = 0.001). Stewart et al. reported higher maternal age in both the groups, i.e., 30.4 ± 6 years in the IUGR group and 30.2 ± 5.7 in the non-IUGR group with the result being statistically insignificant.
The distribution of the study population in the present study based on religion showed no statistically significant difference between the two groups (P = 0.353, P > 0.05). The distribution included the majority of Muslim subjects which can be explained as the hospital is situated near to Muslim dominated area so that cohort has maximum representation in data. The findings were similar to a study conducted by Surve et al. in which 63.1% of IUGR cases were Hindu and 64.6% of AGA cases were Hindu with the difference being statistically insignificant (P = 0.968). Similar results were reported in a study by Dabi et al. in which 88% small for gestational age cases were Hindu and 86% of AGA cases were Hindu with the difference being statistically insignificant. The results in the present study suggested that no specific religion can be considered a risk predictor of IUGR. Therefore, in the present study, no association of religion with delayed deciduous teeth eruption was correlated.
The association of SES with IUGR and chronology of teeth eruption was studied. The difference between both groups based on SES was found statistically significant (P = 0.043, P < 0.05), as shown in [Table 1]. There was no case of upper and upper-middle SES in Group I and upper and lower SES in Group II. The results in the present study depicted that SES can be considered a risk predictor for IUGR. Similar association was found in a study conducted by Muhammad et al. in which 79% of mothers of IUGR neonates had lower SES and 19.5% had middle SES. Among AGA neonates, 60.5% of mothers had lower SES and 36.5% of mothers had middle SES. Surve et al. found that among 130 control cases, 7.7% had Class IV SES, whereas, among 130 IUGR cases, 50% had Class IV SES. Chourasia et al. concluded that among 200 IUGR neonates, 54% had lower SES.
These findings were explained by a study conducted by Kramer et al. which reported that factors associated with low SES such as short stature, low gestational weight, low pre-pregnancy body mass index, and low intakes of micronutrients are potential mediators for IUGR outcome. This was similar to a study conducted by Okubo et al. reporting that continued exposure to diets of low quality across early childhood was linked to the timing of the eruption of primary dentition (1–2 years of age) and is affected by maternal smoking during pregnancy, SES, size at birth, maternal ethnicity, and physical activity (assessed by reported walking speed).
In the present study, it was found that lower SES is a predictor of delayed deciduous teeth eruption. However, these findings were in contrast to a study conducted by Singh et al. in which no strong evidence of the association between SES and timing patterns of tooth emergence was found. Similar results were found in a study conducted by Ntani et al. in which children of socially-deprived mothers were more likely to have >16 primary teeth at age 2 years. In addition, children of mothers who took less physical activity (proxied by walking speed) were more likely to have advanced dental development.
In the present study, maternal educational status was recorded and compared in both groups. It was found that 52.17% of mothers in Group I and 59.57% in Group II had middle school certificates. About 19.56% of mothers in Group I and 8.51% of mothers in Group II had primary school certificates with the difference being statistically significant (P = 0.024, P < 0.05), as shown in [Table 2]. This could be explained as illiterate and highly educated mothers had more fear toward pregnancy. Secondary school educational status showed less care and importance to the antenatal visits.
Based on occupation of mother, Manandhar et al. reported, that out of 60 IUGR cases, 56.7% of mothers were manual workers and 43.4% were housewives and sedentary workers. It was observed that mothers engaged in manual labor such as agriculture, lifting heavy weights, and constructive activities were vulnerable for the development of IUGR. In a study conducted by Muhammad et al. it was found that among 200 AGA cases, 91% were illiterate and among 200 IUGR cases, 86.5% were illiterate with the result being statistically insignificant. The results in our study showed that illiterate and graduated mothers had more antenatal visits and regular follow-ups.
In the present study, gravidity was assessed in the perinatal history. The Chi-square test result depicted no statistically significant difference based on gravidity between the two groups (P = 0.517, P > 0.05). This was similar to the study conducted by Fikree and Berendes. in which primipara women had 23.3% incidence of IUGR as opposed to only 12.9% in control women (OR 2.3). This was in contrast to a study conducted by Manandhar et al. in which 75% of IUGR cases were multigravida and 15% were primigravida. Muhammad et al. reported that 46.5% of AGA mothers were multigravida and 50.5% of IUGR mothers were primigravida.
The results of the present study were similar to a study conducted by Surve et al. in which among 130 controls, 57.7% were primigravida, 39.2% were multigravida and 3.1% were grand multipara, whereas, among 130 IUGR neonates, 50.8% were primigravida, 32.3% were multigravida and 16.9% were grand multipara. The difference in this study was found statistically significant (P = 0.001). It was found that gravidity does not have a statistical association with the timing of deciduous teeth eruption. There was no study depicting a similar association of gravidity with timing of deciduous teeth eruption.
The mean first evidence of tooth eruption in Group I was 6.9 ± 0.37 months and in Group II, was 12.88 ± 1.16. The results in both group depicted statistically significant differences based on the first evidence of tooth eruption (P = 0.0001, P < 0.05). According to the American Dental Association the range of eruption of the deciduous central incisor is 8–12 months. According to a study conducted by Indira et al. in a population of 1392 participants aged 3 months to 36 months, it was found that the first primary tooth to erupt was mandibular central incisor at 10.24 ± 2.47 months, followed by maxillary central incisor at 11.06 ± 2.65 months. Therefore, it can be concluded that the emergence of deciduous teeth in Group II was delayed.
Considering that there are few studies in the literature reporting the influence of socioeconomic disparities over the period of tooth eruption, further studies should be carried out to evaluate and report possible changes in the pattern of the eruption of primary dentition. Moreover, works to improve the prenatal, neonatal, and postnatal care and to propose more efficient conduct aiming to avoid the dental and systemic changes of children can be accomplished by health-care programs to mothers.
Strengths of the study
The study highlights the positive association of DTE with IUGR which is not reported in the literature. This forms the ground for further investigation considering the larger sample size and parameters.
Limitations of the study
The sample size included in the study (n = 110) was small thus the statistical power of the study is decreased. The small sample size of the study was due to time constraints and the long duration of follow-ups. There were 9 cases in Group I and 8 cases in Group II, which were not present for the follow-ups. Therefore, the net sample size was further decreased to 46 in Group I and 47 in Group II. There is nonavailability of similar studies in the databases which makes the comparison with the present study difficult.
| Conclusion|| |
From the present study, it was concluded that SES can be considered risk factor of IUGR and is associated with delayed deciduous teeth eruption. It was found that IUGR was not predominant in one specific religion. Mothers with secondary school education delivered most of the IUGR neonates which on the account had delayed deciduous teeth eruption. This depicted that illiterate mothers and highly educated mothers were more aware and educated during the antenatal period. In both groups, primigravida was more prevalent and showed no correlation with a high risk of developing IUGR and delayed deciduous teeth eruption. The study highlighted the need of further studies to evaluate risk predictors influencing eruption of the primary dentition in IUGR fetuses and neonates.
What is already known?
The various risk factors for IUGR have been reported in the literature. There is limited literature reporting the evidence of delayed deciduous teeth eruption among infants born with low-risk pregnancies and IUGR.
What this study adds?
In the present study, socioeconomic factors, such as SES of the family, maternal education, religion, and gravidity, have been studied and correlated with the chronology of deciduous teeth eruption.
The study is conducted in a centrally located hospital of New Delhi and there is no study conducted yet, reporting the demographics and socioeconomic factors in Delhi.
The study adds the relevance of SES as a significant risk predictor of IUGR which can further assist in evaluating the deciduous teeth eruption. This will further guide to establishing anticipatory guidance in intrauterine life specific for neonates diagnosed with IUGR.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]