Is gestational diabetes mellitus associated with developmental defects of enamel in children? A systematic review with meta-analysis.

Objective: The present systematic review aimed to verify the association between Gestational Diabetes Mellitus (GDM) and Developmental Defects of Enamel (DDE) in children. Design A systematic search was conducted in four databases and the grey literature. The risk of bias of the studies was analyzed with the aid of the Newcastle-Ottawa scale. A quantitative synthesis was performed through meta-analysis. The quality of the evidence was assessed for each result using the Grading of Recommendations: Assessment, Development and Evaluation approach.

Results: Thirteen studies (seven cross-sectional, two cohort and four case-control studies) were included in the qualitative analysis and eleven were included in the meta-analyses. Meta-analyses were conducted considering general DDE (regardless of the type of defect), hypoplasia, molar incisor hypomineralization (MIH) and hypomineralized primary second molars (HPSM). Subgroups based on the type of dentition were also analyzed. Children of mothers who had GDM presented a greater likelihood of general DDE (OR = 2.72; 95% CI: 1.66-4.44), MIH (OR = 3.14; 95% CI: 1.20-8.25) and hypoplasia (OR = 2.17; 95% CI: 1.36-3.46). No association was found between HPSM and GDM (OR = 0.60; 95% CI: 0.17-2.20). An association was found between GDM and DDE in the permanent dentition. Therefore, children whose mothers had GDM were more likely to present DDE compared to those whose mothers did not have this metabolic disorder.

Conclusions: The results should be interpreted with caution due to the low evidence of the primary studies.