Prospective Cohort Study of Thai Children
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Prospective Cohort Study of Thai Children
SECONDHAND SMOKING IN PREGNANT WOMEN
AND TIME OF THE FIRST TOOTH ERUPTION
DIEN HOA ANH VUPhD Student – Faculty of Dentistry
Khon Kaen University
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CONTENT
• INTRODUCTION
• OBJECTIVE
•METHODS
• RESULTS
• DISCUSSION
• CONCLUSION
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ABBREVIATION
• BW Birth Weight
• DTE Delayed first Tooth Eruption
• PCTC Prospective Cohort study of Thai Children
• SHS Secondhand Smoking
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INTRODUCTION
• DTE: problems / dental development
• hold space
• align into correct position
• chew and speak
• Influence factors
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INTRODUCTION
• Secondhand smoking (SHS)
• Negative effect
• Common in Thai males
• High prevalence (29.8%) of SHS
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OBJECTIVE
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To determine whether SHS during pregnancy period delayed
the time of first tooth eruption in Thai infants
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METHODS – Study Design
• Part of PCTC
• Large birth cohort study: 4,300 infants, 5 sites in Thailand
• October 15, 2000 and September 14, 2002
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• Inclusion criteria:
• accessible year-round
• 800 to 900 newborns on average each year
• intend to live 5 years
• long-term commitment with the project
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METHODS – Study Design
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• Family members
• In-person interview, diary records, medical records
• Secondary data – community and demographic variables
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METHODS – Study Design
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• Informed consent
• The National Ethics Committee of the Ministry of Public Health of Thailand
• Khon Kaen University Ethics Committee for Human Research
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METHODS – Study Design
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Independent variables
•SHS during pregnancy: Yes/No•Number of cigarettes: • 0• 0 < CIG < 50th percentile• 50th percentile +
Outcomes
•DTE: Yes/No
•Time to eruption of the first tooth
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METHODS – Independent variables and outcomes
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METHODS – Potential bias
• Parents’ education level
•Mother’s age
• Child’s gender
• Birth weight
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METHODS – Statistical Analysis
• Description analysis
• Pearson regression
• Cox proportional regression
• Generalized estimating equation
• Stata SE 12.0
• p-value < .05
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RESULTS – Study sites
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Figure 1. Number of study members and location of PCTC sites in Thailand
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RESULTS – Demographic Characteristics
Characteristics Total Sites
North(n=xxx)
Northeast(n=xxx)
Central(n=xxx)
South(n=xxx)
Bangkok(n=xxx)
Mother’s age (years)Mother’s highest education Father’s age (years)Father’s highest education Child’s genderBirth weight
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Table 1. Demographic characteristics in five study sites
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RESULTS
Table 2. Odds ratio of having DTE among five study sites04/21/23 16
Area Number % DTE Crude OR 95%CI p-value
North xxx xx.x 1.00 Reference 0.xxx
Northeast xxx xx.x x.xx x.xx – x.xx
Central xxx xx.x x.xx x.xx – x.xx
South xxx xx.x x.xx x.xx – x.xx
Bangkok xxx xx.x x.xx x.xx – x.xx
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RESULTS
n % Crude HR (95% CI) Adjusted HR* (95% CI)
Non-SHS xxxx xx.xx 1 Reference 1 Reference
SHS < 50th percentile xxxx xx.xx x.xx x.xx – x.xx x.xx x.xx – x.xx
SHS ≥ 50th percentile xxxxx xx.xx x.xx x.xx – x.xx x.xx x.xx – x.xx
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Table 3. Crude and adjusted hazard ratio of DTE between levels of smoking groups and non-smoking group
* Hazard ratio adjusted for child’s gender, maternal age, parents’ highest education level, birth weight, and alcohol drinking and caffeine consumption during pregnancy
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RESULTS
Figure 2. Positive association between the number of cigarettes smoked by the fathers and the time of first tooth eruption
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RESULTS
Figure 3. Difference in the probability of DTE between SHS group and non-SHS group
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DISCUSSION
• The time of first tooth eruption was delayed in SHS women
• Biological plausible
• Consistent with other previous studies
• Similar with the study of Adler et al.
• Lawoyin et al. – Opposite relationship between BW and time of first tooth eruption.
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DISCUSSION – Strength
• Strongest observational design
•Multiple risk factors
• Large birth cohort study
• National representative
•Minimal loss to follow-up
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DISCUSSION – Limitation
• Information bias – trained and calibrated the interviewers
• Potential confounding factors – adjusting
• Causal inferences – suspect
• Change of association over time?
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CONCLUSION
• SHS in Thai pregnant women was associated with delayed time of the first tooth eruption in infants up
•Many problems in the dental and nutritional development of infants
• Further studies
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REFERENCES