Maternal vitamin D levels during pregnancy linked to dental caries risk in offspring

A prospective cohort study from the Zhoushan Pregnant Women Cohort evaluated whether maternal vitamin D status in pregnancy is associated with early childhood caries (ECC) risk in offspring. Findings from more than 4000 mother-child pairs showed that higher gestational 25-hydroxyvitamin D (25[OH]D) levels were associated with lower odds of ECC, reduced decayed, missing, or filled teeth (DMFT) scores, and lower caries rates in children aged 1 to 6 years.¹

Is maternal vitamin D associated with childhood dental caries?

ECC is a common chronic condition affecting early primary dentition. The study notes that ECC “remains the leading oral disease affecting children’s oral health as well as the most common chronic noncommunicable disease in children.” The investigators examined maternal plasma 25(OH)D levels measured during the first, second, and third trimesters and compared these with dental outcomes in offspring.²

Among 4109 mother-offspring pairs, 960 children (23.4%) had ECC at their last dental examination. Maternal 25(OH)D levels in the second and third trimesters were significantly lower among mothers of children with ECC compared with those without, as illustrated in the vitamin D distribution graphs on page 5 of the study.

Across all trimesters, higher vitamin D levels were associated with lower odds of ECC. For example, in adjusted models, the odds ratio for ECC was 0.98 (95% CI, 0.97-0.99) in the second trimester.

How did vitamin D status vary across trimesters?

The study used both continuous 25(OH)D levels and categorical classifications: vitamin D sufficiency, insufficiency, deficiency (VDD), and severe VDD. When vitamin D status was examined categorically using 4-level grouping:

• In the third trimester, vitamin D insufficiency was associated with higher ECC odds (OR, 1.44).
• Severe VDD in the third trimester was also associated with increased risk (OR, 1.63).
• Similar patterns were seen in the first and second trimesters, although some associations were attenuated after false-discovery rate correction.

Cox proportional hazards models supported these findings. Higher maternal 25(OH)D levels were associated with reduced hazards of ECC from ages 1 to 6 years, with the strongest association in the second trimester (HR, 0.98).

Are maternal vitamin D levels related to DMFT scores and caries rates?

Beyond ECC diagnosis, the researchers analyzed caries severity using DMFT scores and caries rates. As shown in Table 4 (page 8):

• Higher maternal 25(OH)D levels in the third trimester were associated with lower DMFT scores (β = −3.95) and lower caries rates (β = −20.02).
• VDD in the second trimester was associated with higher DMFT scores and higher caries rates.
• Children of mothers with third-trimester vitamin D insufficiency or deficiency demonstrated worse dental outcomes than those with vitamin D sufficiency.

These results were confirmed using generalized estimation equation models that incorporated repeated dental measures.

What mechanisms may explain the association?

The authors describe several plausible biologic pathways. Vitamin D regulates mineral homeostasis necessary for enamel formation and remineralization. The study highlights that “adequate maternal vitamin D levels ensure sufficient mineral supply for fetal tooth development,” and that ameloblasts and odontoblasts express vitamin D receptors involved in enamel matrix formation.

Vitamin D may also enhance innate immunity through antimicrobial peptide production in oral tissues, potentially reducing cariogenic bacterial activity.

Implications for prenatal care

The authors conclude that “maternal 25(OH)D levels throughout pregnancy were inversely associated with odds of offspring ECCs.” They note that maintaining adequate vitamin D status before and during pregnancy may support healthier primary tooth development and reduce caries risk.

Given these findings, integrating vitamin D screening and supplementation into routine prenatal care may be beneficial, particularly in populations where deficiency is prevalent.

References

1. Xu N, Chen Z, Wang B, et al. Vitamin D levels during pregnancy and dental caries in offspring. JAMA Netw Open. 2025;8(12):e2546166. doi:10.1001/jamanetworkopen.2025.46166
2. American Academy on Pediatric Dentistry Council on Clinical Affairs. Policy on early childhood caries (ECC): unique challenges and treatment option. Pediatr Dent. 2008;30(suppl 7):44-46.