Zhejiang University School of Medicine investigators reported that higher maternal plasma 25-hydroxyvitamin D levels across pregnancy aligned with lower odds of early childhood caries in children.
Early childhood tooth decay, defined as one or more cavities or noncavitated lesions, missing tooth surfaces due to caries, or filled tooth surfaces in children up to 71 months of age, is a major pediatric health burden.
Painful teeth can derail chewing, invite secondary pulp and apical diseases, alter appearance, and spill into school life. Chewing problems, secondary pulp and apical diseases, appearance-related impacts, academic performance effects, and added family and societal costs are downstream consequences of early disease.
An evaluation across 193 United Nations countries from 2007 to 2017 reported a mean early childhood caries prevalence of 23.8% in children younger than 3 years and 57.3% in children aged 3 to 6 years. China’s 2015 Fourth National Oral Health Survey reported dental caries prevalence reaching 71.9% among 5-year-olds.
Tooth mineralization begins during pregnancy. Some studies have suggested gestational weeks 13 to 17 as a critical period for mineralization of maxillary anterior teeth, and most primary teeth begin to mineralize from the second to the third trimester.
Vitamin D supports calcium and phosphate homeostasis during enamel formation and later supports remineralization after enamel eruption. Functional vitamin D receptors appear in ameloblasts and odontoblasts at levels described as sufficient to support enamel matrix formation and prismatic organization.
Current recommendations call for maintaining maternal 25-hydroxyvitamin D above 30 ng/mL during pregnancy, though vitamin D deficiency remains prevalent.
In the study, “Vitamin D Levels During Pregnancy and Dental Caries in Offspring,” published in JAMA Network Open, researchers tracked maternal 25-hydroxyvitamin D across pregnancy to evaluate links with early childhood caries in children.
Clinic visits in Zhoushan, Zhejiang Province, China, created a trimester-by-trimester trail of blood measurements that later met dental examinations in early childhood. No treatment and control groups appear in the design.
The Zhoushan Pregnant Women Cohort included 4,109 mother-offspring pairs. Early childhood caries appeared in 960 children at the last dental examination, with 3,149 children without early childhood caries.
Maternal plasma 25-hydroxyvitamin D measurements were taken in the first, second, and third trimesters, alongside categories that included vitamin D deficiency defined as less than 20 ng/mL.
Pediatric dental examinations recorded decayed, missing, or filled teeth in primary dentition, with early childhood caries defined as a score of 1 or higher. Observational epidemiologic modeling linked trimester vitamin D levels with caries status, time to first diagnosis from ages 1 to 6 years, and repeated dental examinations across early childhood.
Vitamin D and cavity odds
Maternal 25-hydroxyvitamin D levels tracked with early childhood caries in several ways. At the last dental examination, higher trimester-specific 25-hydroxyvitamin D aligned with lower odds of early childhood caries, with odds ratios of 0.98 in the first trimester, 0.98 in the second trimester, and 0.99 in the third trimester when treated as a continuous measure.
Group comparisons placed second-trimester and third-trimester maternal 25-hydroxyvitamin D levels lower among mothers of children with early childhood caries, while first-trimester levels showed no difference in that comparison.
Follow-ups from ages 1 to 6 years told a similar story for timing, with hazard ratios of 0.99 in the first trimester, 0.98 in the second trimester, and 0.99 in the third trimester for maternal 25-hydroxyvitamin D treated as a continuous measure.
Higher maternal vitamin D levels across pregnancy aligned with lower odds of early childhood caries in offspring, suggesting supplementation before conception or during pregnancy as a potential lever for lowering the risk and severity of childhood tooth decay.
Mid-to-late pregnancy stood out as a window where higher vitamin D levels had the strongest correlation with fewer childhood caries and less decayed, missing, or filled primary teeth.
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More information
Nuo Xu et al, Vitamin D Levels During Pregnancy and Dental Caries in Offspring, JAMA Network Open (2025). DOI: 10.1001/jamanetworkopen.2025.46166
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