Association of Maternal Stress and Social Support During Pregnancy With Growth Marks in Children's Primary Tooth Enamel

Abstract

IMPORTANCE Exposure to maternal psychosocial stressors during the prenatal and perinatal periods can have major long-term mental health consequences for children. However, valid and inexpensive biomarkers are currently unavailable to identify children who have been exposed to psychosocial stress and the buffers of stress exposure. OBJECTIVE To assess whether a growth mark in tooth enamel, the neonatal line, is associated with exposure to prenatal and perinatal maternal psychosocial factors. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study used exfoliated primary canine teeth and epidemiological survey data from 70 children enrolled in the Avon Longitudinal Study of Parents and Children, a birth cohort based in Bristol, England. Exfoliated teeth were collected from children at 5 to 7 years of age. Data were collected from January 1, 1991, to December 31, 1998, and were analyzed from January 1, 2019, to August 10, 2021. EXPOSURES Four types of prenatal and perinatal maternal psychosocial factors were studied: stressful life events, psychopathological history, neighborhood disadvantage, and social support. Data were collected from mailed-in questionnaires completed during and shortly after pregnancy. MAIN OUTCOMES AND MEASURES Neonatal line width measured within 3 portions of the tooth crown (the cuspal, middle, and innermost third) in exfoliated primary canines. RESULTS A total of 70 children (34 of 70 [48.7%] male; 63 of 67 [94.0%] White)were studied. Most children were born full term (57 [83.8%]) and to mothers of typical child-bearing age (60 [88.2%]). Neonatal lines were wider in the canines of children born to mothers who self-reported severe lifetime depression (β = 3.35; 95%CI, 1.48-5.23; P = .001), any lifetime psychiatric problems (β = 2.66; 95%CI, 0.92-4.41; P = .003), or elevated anxiety or depressive symptoms at 32 weeksβ gestation (β = 2.29; 95%CI, 0.38-4.20; P = .02). By contrast, neonatal lines were narrower in children born to mothers who self-reported high social support shortly after birth (β = .2.04; 95%CI, .3.70 to .0.38; P = .02). The magnitude of these associationswas large, up to 1.2 SD unit differences, and persisted after adjusting for other risk factors. CONCLUSIONS AND RELEVANCE In this cohort study, neonatal line width was associated with exposure to maternal perinatal psychosocial factors. Replication and validation of these findings can further evaluate teeth as possible new biomarkers.