Supplementary Material for: Maternal Psychological Wellbeing and Caries Experience in 3-year-old offspring: Growing Up in Singapore Towards healthy Outcomes (GUSTO) study

Introduction: Dental caries is a biofilm-mediated, multifactorial disease of the dental hard tissues. Maternal psychosocial and behavioral factors can affect a child’s risk for many chronic childhood conditions including dental caries. We examined the relationship between maternal psychological wellbeing during and after pregnancy on caries experience in 3-year-old offspring.
Methods: Using data from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study (N=667), maternal psychological wellbeing including depressive symptoms [Edinburg Postnatal Depression scale (EPDS), anxiety symptoms [State Trait Anxiety Inventory (STAI)], and sleep quality were measured. Offspring dental caries experience was defined as having at least one decayed, missing, and filled teeth or surface (dmft ≥1 vs.0 /dmfs ≥1 vs. 0). We estimated associations between maternal psychological wellbeing in the pre- and post-natal periods with offspring dental caries experience using logistic regression models adjusted for several maternal and child demographic and socioeconomic factors.
Results: The mean maternal age at delivery was 31 (SD: 5.1) years with ethnic distribution of 55% Chinese, 28% Malay, and 17% Indian; 8.6% of mothers had a prenatal EPDS score ≥15 indicating probable depression and 44% of the children had dmft ≥1. Children of mothers with high prenatal EPDS scores (≥15) had 1.57 times (95% CI: 0.85 – 2.93) the adjusted odds of dental caries experience as compared to children of mothers with prenatal EPDS score <15, although this association was not statistically significant. Moreover, children of mothers with consistently high/changing EPDS and STAI scores in the pre- and postnatal periods had adjusted odds of caries experience of 1.65 (95% CI: 1.01 - 2.72) and 1.24 (95% CI: 0.89 - 1.74), respectively when compared to children whose mothers had consistently low EPDS and STAI scores, though only EPDS association was statistically significant. Associations with poor sleep quality followed a similar direction, although not statistically significant.
Conclusion: While the current findings did not consistently demonstrate statistically significant associations, they suggest a potential role of maternal psychological wellbeing during and after pregnancy on children's oral health status. These observations point to a need for further research to validate our findings and the addition of maternal psychological wellbeing status as a preventive measure to promote offspring oral health.