Expired NOT-DE-23-005: Notice of Special Interest (NOSI): Maternal Health and the Dental, Oral, and Craniofacial Development of their Children

The National Institute of Dental and Craniofacial Research (NIDCR) is issuing this Notice of Special Interest (NOSI) to encourage research on prenatal environmental and physical stressors experienced by women during pregnancy that affect their child's dental, oral, and craniofacial (DOC) tissues through altered maternal physiology. The purpose of this NOSI is to support research elucidating the impact of maternal, environmental, nutritional, pharmaceutical, and/or infectious exposures upon the developing and formed oral and craniofacial complex.

In the United States, the childbirth-associated maternal morbidity and mortality rate is one of the highest worldwide. Maternal morbidity and mortality have been associated with diabetes, hemorrhage, poor prenatal care, and limited access to hospitals. It is widely recognized that the highest rates of maternal morbidity and mortality disproportionately impact underserved groups, including lower socioeconomic, and rural populations. Maternal health has significant implications for birth outcomes and may predispose their infant/offspring to downstream effects that include craniofacial anomalies and associated dental and orofacial complications. Poor maternal health is associated with premature deliveries and lower birth weights. Placental epigenetic changes have been associated with antenatal depression and stress. Maternal gestational diabetes and oligohydramnios have been associated with non-syndromic craniosynostosis. Maternal viral infections have been shown to result in microcephaly, altered tooth formation, and enamel hypoplasia in their children. Because fetal teeth and craniofacial structures are developing in utero, deciduous teeth defects can be linked to deleterious maternal environmental exposures or other factors. For example, enamel hypoplasia in the primary dentition has been associated with differences in maternal and neonatal calcium homeostasis. Prenatal maternal stressors during gestation, both physiologic and emotional, result in microscopic changes within the child’s deciduous dentition. Exfoliated deciduous teeth (such as those available in biorepositories) have served as a proxy for maternal environmental exposures and their timing and intensity, providing an important objective window into fetal exposures.

However, the link between maternal prenatal health (e.g., diabetes, hypertension, autoimmune disease), environmental exposures (e.g., diet, pharmaceuticals, or other substances or exposome), and a child’s DOC development is still poorly understood. There is a need to elucidate the impact of maternal environmental exposures, such as nutritional, pharmaceutical, and/or infectious exposures upon the developing and formed oral and craniofacial complex. Identification and characterization of mechanisms by which maternal exposures impact a child's DOC development may elucidate modifiable prenatal maternal risk factors and inform the development of potential preventive, diagnostic and therapeutic modalities for DOC anomalies in their children.

Specific Areas of Interest

This NOSI encourages studies addressing the relationship between maternal health and the developing craniofacial complex of their children. Research areas of interest includes, but is not limited to, the following:

• Studies elucidating the interplay of prenatal maternal health including biologic, immunologic, infectious, and/or downstream signaling pathways that disrupt DOC tissues in human offspring and in animal models.
• Existing cohort studies using exfoliated deciduous teeth as biomarkers that measure intensity and timing of maternal environmental exposures to correlate with DOC phenotypes in their children.
• Observational and mechanistic studies of pregnant mothers who have undergone emotional stress during pregnancy and its impact on the developing teeth and craniofacial structures of their children.
• Epidemiologic studies comparing maternal prenatal health and disease and their children’s dental and craniofacial development to gain a better understanding of underlying disease mechanisms.
• Observational and mechanistic studies monitoring the maternal prenatal exposome (e.g., dietary habits, tobacco, opioids, trauma) and the DOC development of their children.