标题：Maternal Allostatic Load, Caretaking Behaviors, and Child Dental Caries Experience: A Cross-Sectional Evaluation of Linked Mother–Child Data From the Third National Health and Nutrition Examination Survey
摘要：Objectives. We evaluated the associations between chronic maternal stress measured by allostatic load (AL), maternal caretaking behaviors, and child dental caries experience. We also assessed the role of socioeconomic status in these associations. Methods. We used data from the Third National Health and Nutrition Examination Survey (1988–1994). We included children aged 2 to 6 years who linked to a maternal record (n = 716 maternal–child pairs). The main exposure was maternal AL index (0, 1, or ≥ 2). The primary outcome of interest was child dental caries experience (none or any). We evaluated the association between maternal AL and (1) maternal caretaking behaviors, and (2) child caries status and the role of socioeconomic status in these relationships. Results. Children of mothers with an AL index of at least 2 were significantly more likely to have not been breastfed and to have dental caries than were children of mothers with a normal AL before adjusting for measures of socioeconomic status. Conclusions. Maternal chronic stress, indicated by elevation in markers of AL, has an important role in child caretaking behaviors and in children’s oral health. Childhood dental caries are among the most studied dental conditions. Several studies have addressed the behavioral and biological risk factors 1–7 and the socioeconomic determinants of dental caries among preschool children. 1,8,9 Fewer studies have specifically examined the particular pathways that may link socioeconomic status (SES) with pediatric dental caries. One potential pathway for the SES–pediatric caries relationship—which has not been specifically evaluated—is maternal stress. It is important to better understand the dynamics of the persistent SES–dental caries association to develop and target effective public health programs and interventions. The association between SES and stress has been documented in the literature. 10,11 Frequent exposure over time to adverse life events induces biological responses to cope with these events, leading to wear and tear on the autoimmune, cardiovascular, metabolic, and nervous systems. This exposure is primarily marked by elevated adrenaline and cortisol levels in the body, a phenomenon known as allostatic load (AL). 10,12–14 Several biological changes have been depicted as markers of AL, including changes in high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, plasma glucose, C-reactive protein, fibrinogen, waist circumference, blood pressure, and triglycerides. 11,12 Several studies have examined the elevation of AL as a marker of chronic stress—the outcome of cumulative adverse events over the life course—and established its relationship with various chronic conditions, 10,12,15 including clinical measures of oral health. 11,16 Chronic exposure to stressful events also affects behavior, because individuals tend to adopt unhealthy habits such as smoking, drinking, and comfort eating. 17 Evidence suggests that frequent exposure to adverse life events may also alter maternal caretaking behaviors, which in turn may influence the well-being of their children. 2,18,19 Maternal anxiety, self-efficacy, sense of coherence, and depression have been linked to child caries. 1,2,20–22 Maternal stress has also been linked to health-related behaviors that affect children’s general health, including poorer patterns of feeding children, 23 poorer child-rearing behaviors, and child abuse. 18,19,24 However, the relationship between SES, chronic maternal stress, maternal caretaking behaviors, and pediatric dental caries has not been jointly examined. 25 We set out to evaluate whether a mother’s chronic stress indicated by individual and aggregate markers of AL is associated with (1) maternal caretaking behaviors (including breastfeeding, 4 dental visits, 26 and eating breakfast daily 27 ), and (2) the dental caries experience of her child. We also assessed the role of SES in these relationships.
