Influence of sociodemographic factors and family structure in patients with Molar Incisive Hypomineralization (MIH)

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This study aimed to determine if there are coincident family or sociodemographic patterns in the group of pediatric patients diagnosed with MIH. Method A cross-sectional descriptive observational study. An oral examination was performed to diagnose the presence or absence of MIH in children aged 6 to 14 years who attended the Dentistry Service of the Primary Care Center in Roquetes, Catalunya, Spain, plus a questionnaire created ad hoc with sociodemographic and family structure variables that the parents filled out during the visit. Results A total sample of 305 patients was recruited; 153 had MIH and 152 did not. The sample was grouped, according to the country of maternal origin: 1) children with a mother of Spanish nationality (44.92%), and 2) children with a mother of foreign nationality (55.08%). In group 1, a significant association was found between having MIH and the variables "Mother with higher education" (p-value = 0.002); "Child does not live with both parents" (p-value = 0.012); "Place of birth of the child other than the place of current residence" (p-value = 0.002). In group 2, the variables correlated with MIH were: "Mother's locality different from the father's locality" (p-value = 0.002); "Mother's locality different from the child's birth" (p-value = 0.001). Conclusions Unfavorable sociodemographic factors, the phenomenon of migration, and the family structure of not living with both parents were associated with the presence of MIH in the children in the present study. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Molar Incisor Hypomineralization Family structure Sociodemographic Factors Figures Figure 1 Introduction Molar Incisive Hypomineralization (MIH) is a clinical picture with a worldwide prevalence ranging from 2.4 to 40.2% ( 1 , 2 ). It is estimated that the average prevalence is 13.5%, with moderate to severe involvement in 36% of patients with MIH and, in 36.6% of cases, with incisor involvement. In Spain, there are heterogeneous analyses, with their estimated prevalence, depending on the different studies ( 2 – 4 ), ranging between 14% ( 4 ) and 21%, varying according to the regions ( 3 ). Its etiology, according to studies carried out so far ( 1 , 5 – 9 ), is multifactorial and, in turn, unknown. It has been observed that there is a correlation between certain diseases in early childhood, or conditions during pregnancy, and the occurrence of MIH, suggesting that there are physiological stressors that can alter the function of ameloblasts ( 1 , 7 ). The hypoxia and pyrexia that they may suffer in case of fever or other adverse systemic circumstance in certain stages, can generate this clinical picture. Genetic predisposition and the role of epigenetic influences are increasingly present in terms of their etiology ( 7 ). Taking into account the World Health Organization's (WHO) definition of health, as "a complete state of physical, mental and social well-being", it is considered that there is an interaction between social support and health: a greater availability of interpersonal contacts means greater social support; and, in turn, people who perceive less social support are more predisposed to experience emotional and physical disorders when they face high levels of stress. compared to people who have that support. ( 10 ) In this sense, the housing factor (residential stability) has been proven to directly and indirectly affect health in various ways and represents one of the key social determinants ofhealth. ( 11 ) When we focus on the development of children in their early childhood, we focus our social focus on the family as a structure, taking into account that the family is the element of the structure of society responsible for the biological and social reproduction of the human being; it is the element that synthesizes the production of health at the microsocial scale. For the proper development of children and for their health, a solid family structure is necessary that provides them with all the necessary factors for their full development. In the family nucleus, the needs that are at the basis of the conservation, promotion and recovery of health are satisfied. Therefore, the family plays important roles in the biological, psychological, and social development of the individual ( 12 ) . The roles of the mother and father figure in terms of the couple relationship and domestic organization, as well as social and family aspects, are fundamental in the health and adequate development of children. Assuming that MIH triggers act in the period between pregnancy and early childhood ( 1 , 6 , 7 , 9 ), it is critical to consider the influence that maternal health plays on child well-being ( 13 , 14 ). There is evidence that a situation of parental conflict ( 15 ), a lack of maternal social support( 13 ) or residential instability( 11 ) are factors that can have an impact on maternal health, generating a difficulty in the psychological development of the child and, in turn, negatively affecting his health ( 15 ). Therefore, the aim of this study was to assess whether certain family patterns and maternal sociodemographic aspects are related to the appearance of the clinical picture of MIH in the patients studied. Material and Method Study design and population: A cross-sectional, observational, case-control study was conducted to evaluate the associations between sociodemographic and family factors and the presence of MIH in children seen between May and October 2024 in the dentistry clinic of the Primary Care Center (CAP) of Roquetes, in Terres de l'Ebre, Tarragona, Spain. This CAP belongs to the Catalan Institute of Health (ICS) and serves part of the population of the Tortosa Oest Basic Health Area (ABS), within the Terres de l'Ebre Health Region. The Ethics Committee of the Jordi Gol i Gorina Foundation approved the study with the CEIm code: 24/051-P in May 2024. Inorder to obtain a representative sample, assuming an alpha risk of 5% and a beta risk of 20%, the minimum participation of 304 patients (152 with MIH and 152 as a control group, without MIH) was calculated as necessary. The inclusion criteria for the sample were those patients aged between 6 and 14 years who attended the dentistry clinic of CAP Roquetes and agreed to participate in the study. Patients who had amelogenesis imperfecta or fluorosis, or who did not have erupted permanent first molars were excluded from the study. The study was conducted in accordance with the Declaration of Helsinki (last updated in October 2013) and the International Conference on Harmonisation (ICH) Good Clinical Practice (GCP) guidelines. Procedure Data collection and subsequent processing was performed by a single examiner (SLP), trained in the detection of MIH according to the Standardized Guidelines for the Diagnosis and Recording of MIH introduced by Ghanim et al. (2015) and referenced by the EAPD ( 16 ), considering as MIH lesions the demarcated opacities, white, yellow or brown, which may or may not present caries lesions or atypical fillings, with or without enamel rupture, present in 1 or more first permanent molars, with or without involvement of the permanent incisors and, ruling out other local or systemic enamel lesions, not MIH compatible. Intra-examiner calibration was performed through 50 photographs of cases with MIH, cases of caries lesions in permanent molars and cases of healthy molars, obtaining an intra-examiner Kappa index = 1. Patients aged 6 to 14 years who attended the dentistry clinic at the CAP Roquetes health centre were proposed by the same dentist to participate in the study. The characteristics of the project were explained to the family, giving them an explanatory sheet on the motivation of the child and the steps that would be followed; If they agreed to participate, they were given an informed consent form and a questionnaire created for this study, mostly qualitative and multiple-test, which consisted of 11 questions; in the first 2, the variables of family structure were collected, in the next 7 questions, data related to the sociodemographic variables were collected, and in the last 2, Data were collected for the socioeconomic variable of the family. The questionnaire was created for this study in order to collect sociodemographic and family structure data. It was delivered and filled in by the parents on the same day of the appointment. Taking into account that in this study the link between the patient and the mother was considered, with maternal health and well-being being a conditioning factor in the child during pregnancy and early childhood, the sociodemographic and family variables that directly affected the mother were taken into account; that is why, based on the nationality of the child's mother, a dichotomous variable was created to classify the children's mothers as Spanish or foreign. A Spanish mother was considered to be one who spent her childhood and was educated within Spain. The clinical data and those obtained in the questionnaire were recorded by coding, in accordance with the Data Protection Law, in an Excel sheet designed for the study. Once the study questionnaire was completed, the patient's medical history was accessed through the eCAP computer program, used by the health professionals of the ICS, which records their medical history, clinical course, notes of the actions carried out on the day of the visit, and, in the case of the Dentistry specialty, there is a section within the medical record. the odontogram, where the diagnoses and treatments of the dental activity are recorded, as well as the presence or not of MIH. Statistical analysis: A descriptive analysis of the total sample was carried out, stratified by nationality of the child's mother and whether the child had MIH, using frequency and percentage of the variables. To detect statistically significant differences between the variables depending on whether the child had MIH or not, the Z test of differences in proportions was performed. To quantify this relationship, odds ratios (ORs) and their 95% confidence intervals (95% CIs) were calculated using logistic regression models. Statistical analyses were performed with IBM's SPSS.20 statistical package and p < 0.05 was taken as a statistical significance level. Results A study sample of 305 children was recruited: 153 diagnosed with MIH and 152 without MIH as a control group. 136 males (44.6%) and 169 females (55.4%), with a mean age of 10.6 years and a standard deviation (SD) of 2.33. Of the total sample, 44.92% were children of mothers with Spanish nationality and 55.08% of mothers with foreign nationality, with the majority of mothers of Moroccan nationality (41.64%) being in this group. As shown in Table 1 , the sample was grouped according to the different variables that were the object of this study: sociodemographic and family structure variables. Table 1 Description of the sample of children in the study according to sociodemographic and family structure variables. n % Total 305 MIH 153 50,16 Child's age (mean , ads ) 10,6 2,33 Mother nationality Spain 137 44,92 Morocco 127 41,64 Pakistan 8 2,62 Romania 8 2,62 Ecuador 4 1,31 Honduras 4 1,31 Moldova 3 0,98 Brazil 2 0,66 Colombia 2 0,66 Gambia 2 0,66 Mali 2 0,66 Ukraine 2 0,66 Argentina 1 0,33 Cuba 1 0,33 Peru 1 0,33 China 1 0,33 Nationality of maternal origin Foreigner 168 55,08 Spaniard 137 44,92 Family structure In the 1st year of life he lived with both his parents 280 91,80 She currently lives with both parents 249 81,64 He currently lives only with his mother 34 11,15 She currently lives only with her father 7 2,30 Joint custody 10 3,28 Currently living in a nursing home/shelter 2 0,66 Marital status of the parents Parents live together 249 81,64 Separated/divorced/widowed parents 50 16,39 Single-parent family 5 1,64 Adopted child 2 0,66 Socio-demographic factor The mother's place of origin is the same as the father's 196 64,26 The mother's place of origin is the same as that of the child's birth 160 52,46 The child's place of birth is the same as the child's current place of residence 190 62,30 He is an only child 29 9,51 The child has 1 sibling 104 34,10 The child has 2 or more siblings 172 56,39 Mother's age (in years) 18–25 3 0,98 26–35 66 21,64 36–45 160 52,46 46–65 75 24,59 Primary caregiver studies Higher education 110 36,07 Secondary education 92 30,16 Primary education 63 20,66 Not a school graduate 38 12,46 Family income €30,000 36 11,80 a Standard deviation. Initially, the total of 305 patients were grouped into 2 groups according to nationality: 137 patients with a Spanish mother and 168 with a foreign mother, to assess the relationship between the presence or absence of MIH and maternal nationality. Of the children of a Spanish mother; 81 of them (59.1%) had MIH and, in the group of foreign mothers, 72 children (42.9%) were affected by this clinical picture. Similarly, in the group of Spanish mothers, 56 children (40.9%) did not have MIH and 96 children (57.1%) of foreign mothers were free of MIH. In both cases, statistically significant differences were found in relation to whether or not they had MIH according to maternal nationality (p-value = 0.005) (Table 2 ). Table 2 Comparison between the relationship between the variable of Spanish or foreign maternal nationality and the presence or absence of MIH, respectively Spanish mothers Foreign mothers n % n % p Total 137 168 MIH 81 59,1 72 42,9 0,005 No MIH 56 40,9 96 57,1 0,005 Among the children of Spanish mothers who had MIH, statistically significant differences were found associated with the following variables: "Mother with higher education" (p-value = 0.002); "Child does not live with both parents" (p-value = 0.012); "Separated/divorced/widowed parents" (p-value = 0.020); "Child's place of birth different from the current place of residence" (p-value = 0.002) (Table 3 ). The variables in the group of foreign mothers that showed a statistically significant association with MIH were: "Mother's locality different from the father's locality" (p-value = 0.002) and "Mother's locality different from the child's birthplace (p-value < 0.001). The mother's age equal to or greater than 46 years was a protective factor for MIH (p-value = 0.039) (Table 3). When the variables in the group of patients with MIH were compared, depending on whether the mother was of Spanish or foreign nationality, the main statistically significant differences (p-value: < 0.001) were obtained in the following variables: "Main caregiver with higher education", "Not living with both parents", "Parents do NOT live together", "Separated/divorced/widowed parents" and "DIFFERENT mother locality birth of child" (Table 4). Among the results found in the overall sample, low socioeconomic status was related to the presence of MIH, although when the sample was separated according to maternal nationality, the result was no longer statistically significant (Tables 5 and 6). Table 5 Description of the relationship between the socioeconomic variable and the presence of MIH in the total sample. MIH Yes No n % n % p Total 153 152 Family income €30,000 19 12,26 17 11,26 0,786 Table 6 Description of the relationship between the socioeconomic variable and the presence of MIH, grouping the sample according to maternal nationality. Spanish mother Foreign mother MIH MIH Yes No Yes No n % n % p n % n % p Total 81 56 72 96 Family income €30,000 18 21,95 15 26,79 0,513 1 1,37 2 2,11 0,721 Regarding the calculation of the Odds Ratio (OR) of probability of presenting MIH according to the different variables, the following significant results were found (Fig. 1): The variable "Primary caregiver with higher education" obtained, in the group of mothers of Spanish nationality, a probability OR of 3.09 with a 95% CI of 1.52–6.27, being not significant in the group of foreign mothers. The variable "Currently does not live with the 2 parents" obtained, in the group of mothers of Spanish nationality, an OR of 2.65 with a 95% CI of 1.22–5.76, resulting in non-significant in the group of foreign mothers. Regarding the variable "Separated/divorced/widowed parents", in the group of mothers of Spanish nationality obtained an OR of 2.53 with a 95% CI of 1.14–5.63. In the group of foreign mothers, an OR of 2.31 was obtained, and the 95% CI was 0.53–10.02. The variable "Mother's locality other than father's locality" obtained an OR of 3.19 in the foreign mother group, with a 95% CI: 1.49–6.84, resulting in non-significant in the group of Spanish mothers. The variable "Mother's locality other than the child's place of birth" obtained an OR of 4.69 with a 95% CI: 2.2-10.01 in the group of mother of foreign nationality, being less significant in the group of mother of Spanish nationality (OR: 1.75, 95% CI: 0.74–3.98). Finally, the variable "Child's place of birth other than current place of residence" obtained, in the group of mothers of Spanish nationality, an OR of 4.17, with a 95% CI of 1.59–10.93, while in the group of mothers of foreign nationality, it did not obtain significant results. Discussion When we analyze the current literature on the etiology of MIH, the factors most commonly related to its occurrence are a history of illness during pregnancy, low birth weight, general illness in childhood, antibiotic use, and high fever during early childhood ( 1 , 6 , 7 , 9 ). Currently, there is little evidence about the impact of sociodemographic factors and family structure on the occurrence of MIH. In the present study, taking into account the description of health from the social perspective and focusing on the family nucleus as the basic structure of the individual, an association has been found between certain maternal sociodemographic factors and specific family structures with the presence of this clinical picture. We found a statistically significant difference (p-value = 0.005) regarding the presence of MIH when we compared the group of children with a Spanish mother with that of a foreign mother, with the presence of MIH being more prevalent in children of a Spanish mother than in those of a foreign mother. These results are consistent with the estimated prevalence of MIH in Spain (14–21%) and Africa (11.6%), taking into account that there are still no studies with sufficient sample and scientific strength to evaluate the prevalence of MIH in the Moroccan population ( 17 ). In the case of families with a foreign mother, the sociodemographic factors associated with MIH were the mother's locality other than the father's locality and the mother's locality other than the child's birth, with the mother's age greater than or equal to 46 years being a protective factor. These results could be due to the fact that this population analyzed has suffered a separation from their close family environment due to the fact of changing their place of residence due to the migratory phenomenon; There is a process called "acculturation", which explains why immigrants see their state of health deteriorate when they arrive in their country of destination, due to the fact that they are uprooted from their social network, a phenomenon that affects immigrant women in greater proportion. In addition, the Moroccan family model (population that makes up 41.64% of the sample of our study) must be taken into account. There is the traditional Moroccan family model or the current one, which has emerged as a result of adapting to the changes in contemporary society, with greater autonomy for women and an increase in families whose members emigrate ( 18 ) ( 19 ) ; in both models, their main characteristic is a strong cohesion, structure and hierarchy between family members. the family being the main social structure on which their education and vital dynamics are based. It is logical then that the fact that the mother is over 46 years of age is a protective factor of the MIH, since it is inferred that when the mother had the baby, she had already been in the new country of residence for some time, having adapted to the environment and having woven a social network and a new family structure (18). this being consistent with the fact that the immigrant population, with the time of residence, can adapt to the preventive strategies of our country, improving access to treatment for the benefit of their health ( 20 ) ; taking into account, in addition, that the Moroccan immigrant group is in good health in proportion to the "time of residence" factor, compared to other groups ( 19 ). Our result regarding the variable "mother with higher education" is consistent with the existing literature, where it is considered that higher education can be a stressor ( 21 ). Although a higher level of education is considered to be a protective factor in terms of the individual's longevity, it has also been detected that the level of stress and demand of higher education has an impact on greater psychological pressure, which can predispose to less personal care in terms of diet and physical exercise. and have an impact on a worse state of psychological health ( 22 ), generating stress that, in the case of the maternal figure, could be a factor that can affect the baby's health and lead to its deterioration ( 13 ). On the other hand, the variable "child's place of birth other than the current place of residence" is associated with the residential instability factor, being consistent with the literature where children's residential mobility and its negative relationship with their health are associated( 23 ) and, in turn, is consistent with the literature that suggests residential instability as an important maternal stressor ( 24 ). The variables of non-cohabitation of the child with his two parents and parental separation associated with MIH are consistent with different studies in which family conflicts are related to the presence of MIH; ( 5 , 25 ) in the same way that parental separation is related to the deterioration of child health. The Spanish family model is essentially different from the foreign population studied; it has undergone a series of modifications, especially today, characterized by a greater tendency towards a society in which individuality is more valued, the diversification of the family structure or model with gender policies and with modifications in marriage and child custody laws; For this same reason, it is more likely to find in our country very heterogeneous families in terms of their structure and with maternal roles with a significant labor and economic weight and not only as caregivers of their children in the family home. In short, the family as a structure in itself does not have a social or cultural relevance in our country today. In both the group of Spanish mothers and the group of foreign mothers in this study, the factors mentioned above have in common an alteration of the maternal family structure; that is, in families with a foreign mother, there is a separation from her family nucleus and, as for the Spanish mother, there is a breakdown of the family structure (due to the separation of the parents or due to the change of mother-child residence). There are numerous references in the literature as to how stress or a maternal depressive state can affect the health of the baby in the postpartum period; their social support and family being determining factors ( 10 , 13 , 14 , 25 ); In fact, when there is parental conflict between the parents, it can affect the child's physical, emotional, psychological, and social health, increasing their anxiety and even presenting a greater inflammatory response ( 14 , 15 ). Both the breakdown of the family structure and the separation from her family or social network are disruptive factors that could cause a stressful situation for a mother, and this maternal stress can be associated with the appearance of the clinical picture of MIH in her children. Recent cross-sectional studies have associated maternal stress with the occurrence of MIH ( 11 , 12 ), although more longitudinal studies are needed to draw clear conclusions about this. Also, the association between maternal stress and the respiratory pathology of the baby has been recently confirmed ( 26 ), including a greater tendency of the latter to suffer from infectious diseases ( 27 ); these pathologies may present with clinical pictures considered as etiological factors of MIH. It should be mentioned that maternal depression has been associated prior to or during pregnancy with an alteration in the mineralization of the enamel in the primary dentition, causing an increase in the neonatal line ( 28 ); these hypotheses being consistent with the results of this study. Therefore, taking into account that stress can be an aggravating factor of pathology( 10 , 13 , 14 , 28 ) and that a family breakdown( 14 ) or residential instability can enhance stress ( 11 ), it is advisable to evaluate the clinical picture of MIH from a more global perspective in order to find, within its multifactorial etiology, a common factor that can predict the appearance of MIH and, thus, to be able to apply more efficient preventive measures ( 5 ). When we look at the socioeconomic factor, analyzing the total sample, we see that there is a statistically significant association between presenting MIH and the variable "Annual family income less than 12,000" (p-value = 0.046). These results are consistent with results from previous studies linking MIH to low household income ( 29 , 30 ). This socioeconomic factor associated with MIH can be explained by maternal stress generated by an unfavorable economic situation; often associated with residential instability, a situation that, as we have mentioned above, can generate a deterioration of maternal health and affect the health of the baby. However, when we stratify according to maternal nationality (Spanish or foreign), this association is no longer statistically significant. Probably, the explanation for these results is related to the size of the sample; when we stratify according to nationality it is reduced and the result loses statistical weight. This study has strengths and limitations. The limitations are especially in the sample, which belongs to a rural area of Catalonia, with specific sociodemographic characteristics and composed mostly of patients with dental pathologies who were referred to the fillings portfolio service (a public service run by the ICS, through which fillings are performed in permanent dentition of children aged 6 to 14 years in primary care centers of reference). The strengths of this study were that data collection was performed by a single examiner, thus eliminating inter-examiner bias; In turn, to eliminate the recall bias, subjective questions were eliminated from the questionnaire, providing concrete information from which it can be inferred whether there was any change in the family structure or in their sociodemographic status that could be significant. In order to provide more light on this topic, a multicenter and longitudinal study would be necessary, starting during pregnancy and in which the maternal emotional state, family structure and sociodemographic status could be recorded at different times; and to assess, a posteriori, whether there is MIH in their children. Conclusions Unfavorable sociodemographic factors, the phenomenon of migration and the family structure of not living with both parents were associated with the presence of Incisive Molar Hypomineralization (MIH) in the children in the present study. The relationships between the sociodemographic and family variables studied and the presence of MIH showed a different pattern depending on maternal nationality. The alteration of the maternal family structure, within their social context, was associated with the presence of MIH in the patients in this study. Declarations Acknowledgements. Thanks to the Universitat Internacional de Catalunya and Doctor Ferran Foundation for its support and accompaniment in this work; Thanks also to the Servei d'Atenció Primària de Terres de l'Ebre, the Dentistry team that has participated, and the research team of Jordi Gol and Gorina of the territory for having actively supported this study. Funding This research received no external funding or grant support. Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. References Ghanim A, Manton D, Bailey D, Mariño R, Morgan M. Risk factors in the occurrence of molar-incisor hypomineralization amongst a group of Iraqi children. Int J Paediatr Dent. 2013 May; 23(3):197-206. doi: 10.1111/j.1365-263X.2012.01244.x. Epub 2012 May 31. Martínez Gómez TP, Guinot Jimeno F, Bellet Dalmau LJ, Giner Tarrida L. 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Psychological adaptation of Moroccan and Ecuadorean immigrant adolescents in Spain. Int J Psychol. 2012; 47(1):28-38. doi: 10.1080/00207594.2011.569722. Epub 2011 May 23.. Domínguez-Rodríguez A, González-Rábago Y. Self-rated health, time of residence and social determinants of health in immigrant populations: A complex relationship in groups of different origins in a Southern European region. J Migr Health. 2024 Feb 2;9:100216. DOI: 10.1016/J.JMH.2024.100216. Veloso Duran A, Framis-de-Mena B, Vázquez Salceda MC, Guinot Jimeno F. Evaluation and Comparison of Oral Health Status between Spanish and Immigrant Children Residing in Barcelona, Spain. Children (Basel). 2022 Sep 4; 9(9):1354. doi: 10.3390/children9091354. Nomaguchi KM, Brown SL. Parental Strains and Rewards among Mothers: The Role of Education. J Marriage Fam. 2011 Jun; 73(3):621-636. doi: 10.1111/j.1741-3737.2011.00835.x. Epub 2011 May 19. 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Adgent MA, Buth E, Noroña-Zhou A, Szpiro AA, Loftus CT, Moore PE, Wright RJ, Barrett ES, LeWinn KZ, Zhao Q, Nguyen R, Karr CJ, Bush NR, Carroll KN. Maternal stressful life events during pregnancy and childhood asthma and wheeze. Ann Allergy Asthma Immunol. 2024 May; 132(5):594-601.e3. DOI: 10.1016/J.ANAI.2023.12.015. Epub 2023 Dec 18. Bush NR, Savitz J, Coccia M, Jones-Mason K, Adler N, Boyce WT, Laraia B, Epel E. Maternal Stress During Pregnancy Predicts Infant Infectious and Noninfectious Illness. J Pediatr. 2021 Jan;228:117-125.e2. doi: 10.1016/j.jpeds.2020.08.041. Epub 2020 Aug 19. Mountain RV, Zhu Y, Pickett OR, Lussier AA, Goldstein JM, Roffman JL, Bidlack FB, Dunn EC. Association of Maternal Stress and Social Support During Pregnancy With Growth Marks in Children's Primary Tooth Enamel. JAMA Netw Open. 2021 Nov 1; 4(11):e2129129. doi: 10.1001/jamanetworkopen.2021.29129. Harz D, Catalán Gamonal B, Matute García S, Jeremias F, Martin J, Fresno MC. Prevalence and severity of molar-incisor hypomineralization, is there an association with socioeconomic status? A cross-sectional study in Chilean schoolchildren. Eur Arch Paediatr Dent. 2023 Oct; 24(5):577-584. DOI: 10.1007/S40368-023-00820-3. Epub 2023 Jul 11. Balmer R, Toumba J, Godson J, Duggal M. The prevalence of molar incisor hypomineralisation in Northern England and its relationship to socioeconomic status and water fluoridation. Int J Paediatr Dent. 2012 Jul; 22(4):250-7. doi: 10.1111/j.1365-263X.2011.01189.x. Epub 2011 Oct 20. Table 3,4 Table 3 and 4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":362860,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u0026nbsp;\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8058339/v1/530f7faca2c4193ade1de77d.png"},{"id":102785329,"identity":"a0b3292e-7425-4d34-8da3-7813a2f5ee56","added_by":"auto","created_at":"2026-02-16 16:05:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1144035,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8058339/v1/5c7b3a6a-333d-4714-a603-ec561cbd21f8.pdf"},{"id":98107091,"identity":"a0d6c8cf-f4f9-4dda-ac60-2c0039a601a8","added_by":"auto","created_at":"2025-12-13 00:21:15","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":21296,"visible":true,"origin":"","legend":"","description":"","filename":"Table34.docx","url":"https://assets-eu.researchsquare.com/files/rs-8058339/v1/d0476ff51ce2b4e8193bae47.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eInfluence of sociodemographic factors and family structure in patients with Molar Incisive Hypomineralization (MIH)\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMolar Incisive Hypomineralization (MIH) is a clinical picture with a worldwide prevalence ranging from 2.4 to 40.2% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). It is estimated that the average prevalence is 13.5%, with moderate to severe involvement in 36% of patients with MIH and, in 36.6% of cases, with incisor involvement. In Spain, there are heterogeneous analyses, with their estimated prevalence, depending on the different studies (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), ranging between 14% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) and 21%, varying according to the regions (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Its etiology, according to studies carried out so far (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), is multifactorial and, in turn, unknown. It has been observed that there is a correlation between certain diseases in early childhood, or conditions during pregnancy, and the occurrence of MIH, suggesting that there are physiological stressors that can alter the function of ameloblasts (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The hypoxia and pyrexia that they may suffer in case of fever or other adverse systemic circumstance in certain stages, can generate this clinical picture. Genetic predisposition and the role of epigenetic influences are increasingly present in terms of their etiology (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTaking into account the World Health Organization's (WHO) definition of health, as \"a complete state of physical, mental and social well-being\", it is considered that there is an interaction between social support and health: a greater availability of interpersonal contacts means greater social support; and, in turn, people who perceive less social support are more predisposed to experience emotional and physical disorders when they face high levels of stress. compared to people who have that support. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) In this sense, the housing factor (residential stability) has been proven to directly and indirectly affect health in various ways and represents one of the key social determinants ofhealth. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eWhen we focus on the development of children in their early childhood, we focus our social focus on the family as a structure, taking into account that the family is the element of the structure of society responsible for the biological and social reproduction of the human being; it is the element that synthesizes the production of health at the microsocial scale. For the proper development of children and for their health, a solid family structure is necessary that provides them with all the necessary factors for their full development. In the family nucleus, the needs that are at the basis of the conservation, promotion and recovery of health are satisfied. Therefore, the family plays important roles in the biological, psychological, and social development of the individual (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) .\u003c/p\u003e\u003cp\u003eThe roles of the mother and father figure in terms of the couple relationship and domestic organization, as well as social and family aspects, are fundamental in the health and adequate development of children. Assuming that MIH triggers act in the period between pregnancy and early childhood (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), it is critical to consider the influence that maternal health plays on child well-being (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). There is evidence that a situation of parental conflict (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), a lack of maternal social support(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) or residential instability(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) are factors that can have an impact on maternal health, generating a difficulty in the psychological development of the child and, in turn, negatively affecting his health (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Therefore, the aim of this study was to assess whether certain family patterns and maternal sociodemographic aspects are related to the appearance of the clinical picture of MIH in the patients studied.\u003c/p\u003e"},{"header":"Material and Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and population:\u003c/h2\u003e\u003cp\u003e A cross-sectional, observational, case-control study was conducted to evaluate the associations between sociodemographic and family factors and the presence of MIH in children seen between May and October 2024 in the dentistry clinic of the Primary Care Center (CAP) of Roquetes, in Terres de l'Ebre, Tarragona, Spain. This CAP belongs to the Catalan Institute of Health (ICS) and serves part of the population of the Tortosa Oest Basic Health Area (ABS), within the Terres de l'Ebre Health Region.\u003c/p\u003e\u003cp\u003e The Ethics Committee of the Jordi Gol i Gorina Foundation approved the study with the CEIm code: 24/051-P in May 2024. Inorder to obtain a representative sample, assuming an alpha risk of 5% and a beta risk of 20%, the minimum participation of 304 patients (152 with MIH and 152 as a control group, without MIH) was calculated as necessary.\u003c/p\u003e\u003cp\u003eThe inclusion criteria for the sample were those patients aged between 6 and 14 years who attended the dentistry clinic of CAP Roquetes and agreed to participate in the study. Patients who had amelogenesis imperfecta or fluorosis, or who did not have erupted permanent first molars were excluded from the study.\u003c/p\u003e\u003cp\u003e The study was conducted in accordance with the Declaration of Helsinki (last updated in October 2013) and the International Conference on Harmonisation (ICH) Good Clinical Practice (GCP) guidelines.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eData collection and subsequent processing was performed by a single examiner (SLP), trained in the detection of MIH according to the Standardized Guidelines for the Diagnosis and Recording of MIH introduced by Ghanim \u003cem\u003eet al.\u003c/em\u003e (2015) and referenced by the EAPD (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), considering as MIH lesions the demarcated opacities, white, yellow or brown, which may or may not present caries lesions or atypical fillings, with or without enamel rupture, present in 1 or more first permanent molars, with or without involvement of the permanent incisors and, ruling out other local or systemic enamel lesions, not MIH compatible. Intra-examiner calibration was performed through 50 photographs of cases with MIH, cases of caries lesions in permanent molars and cases of healthy molars, obtaining an intra-examiner Kappa index\u0026thinsp;=\u0026thinsp;1.\u003c/p\u003e\u003cp\u003ePatients aged 6 to 14 years who attended the dentistry clinic at the CAP Roquetes health centre were proposed by the same dentist to participate in the study. The characteristics of the project were explained to the family, giving them an explanatory sheet on the motivation of the child and the steps that would be followed; If they agreed to participate, they were given an informed consent form and a questionnaire created for this study, mostly qualitative and multiple-test, which consisted of 11 questions; in the first 2, the variables of family structure were collected, in the next 7 questions, data related to the sociodemographic variables were collected, and in the last 2, Data were collected for the socioeconomic variable of the family. The questionnaire was created for this study in order to collect sociodemographic and family structure data. It was delivered and filled in by the parents on the same day of the appointment.\u003c/p\u003e\u003cp\u003eTaking into account that in this study the link between the patient and the mother was considered, with maternal health and well-being being a conditioning factor in the child during pregnancy and early childhood, the sociodemographic and family variables that directly affected the mother were taken into account; that is why, based on the nationality of the child's mother, a dichotomous variable was created to classify the children's mothers as Spanish or foreign. A Spanish mother was considered to be one who spent her childhood and was educated within Spain.\u003c/p\u003e\u003cp\u003eThe clinical data and those obtained in the questionnaire were recorded by coding, in accordance with the Data Protection Law, in an Excel sheet designed for the study. Once the study questionnaire was completed, the patient's medical history was accessed through the eCAP computer program, used by the health professionals of the ICS, which records their medical history, clinical course, notes of the actions carried out on the day of the visit, and, in the case of the Dentistry specialty, there is a section within the medical record. the odontogram, where the diagnoses and treatments of the dental activity are recorded, as well as the presence or not of MIH.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis:\u003c/h2\u003e\u003cp\u003eA descriptive analysis of the total sample was carried out, stratified by nationality of the child's mother and whether the child had MIH, using frequency and percentage of the variables. To detect statistically significant differences between the variables depending on whether the child had MIH or not, the Z test of differences in proportions was performed. To quantify this relationship, odds ratios (ORs) and their 95% confidence intervals (95% CIs) were calculated using logistic regression models.\u003c/p\u003e\u003cp\u003eStatistical analyses were performed with IBM's SPSS.20 statistical package and p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was taken as a statistical significance level.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA study sample of 305 children was recruited: 153 diagnosed with MIH and 152 without MIH as a control group. 136 males (44.6%) and 169 females (55.4%), with a mean age of 10.6 years and a standard deviation (SD) of 2.33.\u003c/p\u003e\u003cp\u003eOf the total sample, 44.92% were children of mothers with Spanish nationality and 55.08% of mothers with foreign nationality, with the majority of mothers of Moroccan nationality (41.64%) being in this group. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the sample was grouped according to the different variables that were the object of this study: sociodemographic and family structure variables.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescription of the sample of children in the study according to sociodemographic and family structure variables.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e305\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMIH\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50,16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChild's age (mean\u003c/b\u003e, \u003csup\u003e\u003cb\u003eads\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e10,6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2,33\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMother nationality\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e44,92\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMorocco\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e41,64\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePakistan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2,62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRomania\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2,62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEcuador\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1,31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHonduras\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1,31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMoldova\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBrazil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eColombia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGambia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMali\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUkraine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArgentina\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCuba\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeru\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChina\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNationality of maternal origin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eForeigner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55,08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpaniard\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44,92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily structure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIn the 1st year of life he lived with both his parents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e280\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e91,80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShe currently lives with both parents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81,64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHe currently lives only with his mother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11,15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShe currently lives only with her father\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2,30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJoint custody\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3,28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrently living in a nursing home/shelter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status of the parents\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParents live together\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81,64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeparated/divorced/widowed parents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16,39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle-parent family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1,64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdopted child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSocio-demographic factor\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe mother's place of origin is the same as the father's\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64,26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe mother's place of origin is the same as that of the child's birth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52,46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe child's place of birth is the same as the child's current place of residence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62,30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHe is an only child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9,51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe child has 1 sibling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34,10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe child has 2 or more siblings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56,39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMother's age (in years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21,64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52,46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e46\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24,59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrimary caregiver studies\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigher education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36,07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30,16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20,66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot a school graduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12,46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily income\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt; \u0026euro;12,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24,26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12.000\u0026ndash;30.000\u0026euro;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64,26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt; \u0026euro;30,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11,80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e \u003cb\u003eStandard deviation.\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eInitially, the total of 305 patients were grouped into 2 groups according to nationality: 137 patients with a Spanish mother and 168 with a foreign mother, to assess the relationship between the presence or absence of MIH and maternal nationality. Of the children of a Spanish mother; 81 of them (59.1%) had MIH and, in the group of foreign mothers, 72 children (42.9%) were affected by this clinical picture. Similarly, in the group of Spanish mothers, 56 children (40.9%) did not have MIH and 96 children (57.1%) of foreign mothers were free of MIH. In both cases, statistically significant differences were found in relation to whether or not they had MIH according to maternal nationality (p-value\u0026thinsp;=\u0026thinsp;0.005) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison between the relationship between the variable of Spanish or foreign maternal nationality and the presence or absence of MIH, respectively\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSpanish mothers\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eForeign mothers\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e168\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMIH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59,1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e42,9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0,005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo MIH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40,9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e57,1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0,005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAmong the children of Spanish mothers who had MIH, statistically significant differences were found associated with the following variables: \"Mother with higher education\" (p-value\u0026thinsp;=\u0026thinsp;0.002); \"Child does not live with both parents\" (p-value\u0026thinsp;=\u0026thinsp;0.012); \"Separated/divorced/widowed parents\" (p-value\u0026thinsp;=\u0026thinsp;0.020); \"Child's place of birth different from the current place of residence\" (p-value\u0026thinsp;=\u0026thinsp;0.002) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe variables in the group of foreign mothers that showed a statistically significant association with MIH were: \u0026quot;Mother\u0026apos;s locality different from the father\u0026apos;s locality\u0026quot; (p-value\u0026thinsp;=\u0026thinsp;0.002) and \u0026quot;Mother\u0026apos;s locality different from the child\u0026apos;s birthplace (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The mother\u0026apos;s age equal to or greater than 46 years was a protective factor for MIH (p-value\u0026thinsp;=\u0026thinsp;0.039) (Table 3).\u003c/p\u003e\n\u003cp\u003eWhen the variables in the group of patients with MIH were compared, depending on whether the mother was of Spanish or foreign nationality, the main statistically significant differences (p-value: \u0026lt; 0.001) were obtained in the following variables: \u0026quot;Main caregiver with higher education\u0026quot;, \u0026quot;Not living with both parents\u0026quot;, \u0026quot;Parents do NOT live together\u0026quot;, \u0026quot;Separated/divorced/widowed parents\u0026quot; and \u0026quot;DIFFERENT mother locality birth of child\u0026quot; (Table\u0026nbsp;4).\u003c/p\u003e\n\u003cdiv\u003eAmong the results found in the overall sample, low socioeconomic status was related to the presence of MIH, although when the sample was separated according to maternal nationality, the result was no longer statistically significant (Tables 5 and 6).\u003c/div\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eDescription of the relationship between the socioeconomic variable and the presence of MIH in the total sample.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eMIH\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e153\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e152\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily income \u0026lt; \u0026euro;12,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19,35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29,14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,046\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily income \u0026euro;12,000\u0026ndash;30,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68,39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59,60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,109\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily income \u0026gt; \u0026euro;30,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12,26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11,26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,786\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 6\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eDescription of the relationship between the socioeconomic variable and the presence of MIH, grouping the sample according to maternal nationality.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eSpanish mother\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eForeign mother\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eMIH\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eMIH\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e81\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e56\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e72\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e96\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily income \u0026lt; \u0026euro;12,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12,20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17,86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27,40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35,79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,248\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily income \u0026euro;12,000\u0026ndash;30,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65,85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55,36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71,23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62,11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,215\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily income \u0026gt; \u0026euro;30,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21,95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26,79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,721\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eRegarding the calculation of the Odds Ratio (OR) of probability of presenting MIH according to the different variables, the following significant results were found (Fig.\u0026nbsp;1):\u003c/p\u003e\n\u003cp\u003eThe variable \u0026quot;Primary caregiver with higher education\u0026quot; obtained, in the group of mothers of Spanish nationality, a probability OR of 3.09 with a 95% CI of 1.52\u0026ndash;6.27, being not significant in the group of foreign mothers. The variable \u0026quot;Currently does not live with the 2 parents\u0026quot; obtained, in the group of mothers of Spanish nationality, an OR of 2.65 with a 95% CI of 1.22\u0026ndash;5.76, resulting in non-significant in the group of foreign mothers.\u003c/p\u003e\n\u003cp\u003eRegarding the variable \u0026quot;Separated/divorced/widowed parents\u0026quot;, in the group of mothers of Spanish nationality obtained an OR of 2.53 with a 95% CI of 1.14\u0026ndash;5.63. In the group of foreign mothers, an OR of 2.31 was obtained, and the 95% CI was 0.53\u0026ndash;10.02. The variable \u0026quot;Mother\u0026apos;s locality other than father\u0026apos;s locality\u0026quot; obtained an OR of 3.19 in the foreign mother group, with a 95% CI: 1.49\u0026ndash;6.84, resulting in non-significant in the group of Spanish mothers. The variable \u0026quot;Mother\u0026apos;s locality other than the child\u0026apos;s place of birth\u0026quot; obtained an OR of 4.69 with a 95% CI: 2.2-10.01 in the group of mother of foreign nationality, being less significant in the group of mother of Spanish nationality (OR: 1.75, 95% CI: 0.74\u0026ndash;3.98). Finally, the variable \u0026quot;Child\u0026apos;s place of birth other than current place of residence\u0026quot; obtained, in the group of mothers of Spanish nationality, an OR of 4.17, with a 95% CI of 1.59\u0026ndash;10.93, while in the group of mothers of foreign nationality, it did not obtain significant results.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWhen we analyze the current literature on the etiology of MIH, the factors most commonly related to its occurrence are a history of illness during pregnancy, low birth weight, general illness in childhood, antibiotic use, and high fever during early childhood (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Currently, there is little evidence about the impact of sociodemographic factors and family structure on the occurrence of MIH. In the present study, taking into account the description of health from the social perspective and focusing on the family nucleus as the basic structure of the individual, an association has been found between certain maternal sociodemographic factors and specific family structures with the presence of this clinical picture.\u003c/p\u003e\u003cp\u003eWe found a statistically significant difference (p-value\u0026thinsp;=\u0026thinsp;0.005) regarding the presence of MIH when we compared the group of children with a Spanish mother with that of a foreign mother, with the presence of MIH being more prevalent in children of a Spanish mother than in those of a foreign mother. These results are consistent with the estimated prevalence of MIH in Spain (14\u0026ndash;21%) and Africa (11.6%), taking into account that there are still no studies with sufficient sample and scientific strength to evaluate the prevalence of MIH in the Moroccan population (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn the case of families with a foreign mother, the sociodemographic factors associated with MIH were the mother's locality other than the father's locality and the mother's locality other than the child's birth, with the mother's age greater than or equal to 46 years being a protective factor. These results could be due to the fact that this population analyzed has suffered a separation from their close family environment due to the fact of changing their place of residence due to the migratory phenomenon; There is a process called \"acculturation\", which explains why immigrants see their state of health deteriorate when they arrive in their country of destination, due to the fact that they are uprooted from their social network, a phenomenon that affects immigrant women in greater proportion. In addition, the Moroccan family model (population that makes up 41.64% of the sample of our study) must be taken into account. There is the traditional Moroccan family model or the current one, which has emerged as a result of adapting to the changes in contemporary society, with greater autonomy for women and an increase in families whose members emigrate (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) ; in both models, their main characteristic is a strong cohesion, structure and hierarchy between family members. the family being the main social structure on which their education and vital dynamics are based. It is logical then that the fact that the mother is over 46 years of age is a protective factor of the MIH, since it is inferred that when the mother had the baby, she had already been in the new country of residence for some time, having adapted to the environment and having woven a social network and a new family structure (18). this being consistent with the fact that the immigrant population, with the time of residence, can adapt to the preventive strategies of our country, improving access to treatment for the benefit of their health (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) ; taking into account, in addition, that the Moroccan immigrant group is in good health in proportion to the \"time of residence\" factor, compared to other groups (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur result regarding the variable \"mother with higher education\" is consistent with the existing literature, where it is considered that higher education can be a stressor (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Although a higher level of education is considered to be a protective factor in terms of the individual's longevity, it has also been detected that the level of stress and demand of higher education has an impact on greater psychological pressure, which can predispose to less personal care in terms of diet and physical exercise. and have an impact on a worse state of psychological health (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), generating stress that, in the case of the maternal figure, could be a factor that can affect the baby's health and lead to its deterioration (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOn the other hand, the variable \"child's place of birth other than the current place of residence\" is associated with the residential instability factor, being consistent with the literature where children's residential mobility and its negative relationship with their health are associated(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and, in turn, is consistent with the literature that suggests residential instability as an important maternal stressor (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The variables of non-cohabitation of the child with his two parents and parental separation associated with MIH are consistent with different studies in which family conflicts are related to the presence of MIH; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) in the same way that parental separation is related to the deterioration of child health.\u003c/p\u003e\u003cp\u003eThe Spanish family model is essentially different from the foreign population studied; it has undergone a series of modifications, especially today, characterized by a greater tendency towards a society in which individuality is more valued, the diversification of the family structure or model with gender policies and with modifications in marriage and child custody laws; For this same reason, it is more likely to find in our country very heterogeneous families in terms of their structure and with maternal roles with a significant labor and economic weight and not only as caregivers of their children in the family home. In short, the family as a structure in itself does not have a social or cultural relevance in our country today.\u003c/p\u003e\u003cp\u003eIn both the group of Spanish mothers and the group of foreign mothers in this study, the factors mentioned above have in common an alteration of the maternal family structure; that is, in families with a foreign mother, there is a separation from her family nucleus and, as for the Spanish mother, there is a breakdown of the family structure (due to the separation of the parents or due to the change of mother-child residence). There are numerous references in the literature as to how stress or a maternal depressive state can affect the health of the baby in the postpartum period; their social support and family being determining factors (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e); In fact, when there is parental conflict between the parents, it can affect the child's physical, emotional, psychological, and social health, increasing their anxiety and even presenting a greater inflammatory response (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Both the breakdown of the family structure and the separation from her family or social network are disruptive factors that could cause a stressful situation for a mother, and this maternal stress can be associated with the appearance of the clinical picture of MIH in her children.\u003c/p\u003e\u003cp\u003eRecent cross-sectional studies have associated maternal stress with the occurrence of MIH (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), although more longitudinal studies are needed to draw clear conclusions about this. Also, the association between maternal stress and the respiratory pathology of the baby has been recently confirmed (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), including a greater tendency of the latter to suffer from infectious diseases (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e); these pathologies may present with clinical pictures considered as etiological factors of MIH. It should be mentioned that maternal depression has been associated prior to or during pregnancy with an alteration in the mineralization of the enamel in the primary dentition, causing an increase in the neonatal line (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e); these hypotheses being consistent with the results of this study. Therefore, taking into account that stress can be an aggravating factor of pathology(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) and that a family breakdown(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) or residential instability can enhance stress (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), it is advisable to evaluate the clinical picture of MIH from a more global perspective in order to find, within its multifactorial etiology, a common factor that can predict the appearance of MIH and, thus, to be able to apply more efficient preventive measures (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhen we look at the socioeconomic factor, analyzing the total sample, we see that there is a statistically significant association between presenting MIH and the variable \"Annual family income less than 12,000\" (p-value\u0026thinsp;=\u0026thinsp;0.046). These results are consistent with results from previous studies linking MIH to low household income (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). This socioeconomic factor associated with MIH can be explained by maternal stress generated by an unfavorable economic situation; often associated with residential instability, a situation that, as we have mentioned above, can generate a deterioration of maternal health and affect the health of the baby. However, when we stratify according to maternal nationality (Spanish or foreign), this association is no longer statistically significant. Probably, the explanation for these results is related to the size of the sample; when we stratify according to nationality it is reduced and the result loses statistical weight.\u003c/p\u003e\u003cp\u003eThis study has strengths and limitations. The limitations are especially in the sample, which belongs to a rural area of Catalonia, with specific sociodemographic characteristics and composed mostly of patients with dental pathologies who were referred to the fillings portfolio service (a public service run by the ICS, through which fillings are performed in permanent dentition of children aged 6 to 14 years in primary care centers of reference). The strengths of this study were that data collection was performed by a single examiner, thus eliminating inter-examiner bias; In turn, to eliminate the recall bias, subjective questions were eliminated from the questionnaire, providing concrete information from which it can be inferred whether there was any change in the family structure or in their sociodemographic status that could be significant. In order to provide more light on this topic, a multicenter and longitudinal study would be necessary, starting during pregnancy and in which the maternal emotional state, family structure and sociodemographic status could be recorded at different times; and to assess, a posteriori, whether there is MIH in their children.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eUnfavorable sociodemographic factors, the phenomenon of migration and the family structure of not living with both parents were associated with the presence of Incisive Molar Hypomineralization (MIH) in the children in the present study.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe relationships between the sociodemographic and family variables studied and the presence of MIH showed a different pattern depending on maternal nationality.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe alteration of the maternal family structure, within their social context, was associated with the presence of MIH in the patients in this study.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks to the Universitat Internacional de Catalunya and Doctor Ferran Foundation for its support and accompaniment in this work; Thanks also to the Servei d\u0026apos;Atenci\u0026oacute; Prim\u0026agrave;ria de Terres de l\u0026apos;Ebre, the Dentistry team that has participated, and the research team of Jordi Gol and Gorina of the territory for having actively supported this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003cbr\u003e\u003c/strong\u003eThis research received no external funding or grant support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eGhanim A, Manton D, Bailey D, Mariño R, Morgan M. 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Social support, stress, and maternal postpartum depression: A comparison of supportive relationships. Soc Sci Res. 2015 Nov;54:246-62. doi: 10.1016/j.ssresearch.2015.08.009. Epub 2015 Aug 31.\u003c/li\u003e\n \u003cli\u003eRudd BN, Holtzworth-Munroe A, D'Onofrio BM, Waldron M. Parental relationship dissolution and child development: the role of child sleep quality. Sleep. 2019 Feb 1; 42(2):zsy224. doi: 10.1093/sleep/zsy224.\u003c/li\u003e\n \u003cli\u003eGhanim A, Silva MJ, Elfrink MEC, Lygidakis NA, Mariño RJ, Weerheijm KL, Manton DJ. Molar incisor hypomineralisation (MIH) training manual for clinical field surveys and practice. Eur Arch Paediatr Dent. 2017 Aug; 18(4):225-242. DOI: 10.1007/S40368-017-0293-9. Epub 2017 Jul 18.\u003c/li\u003e\n \u003cli\u003eKühnisch J, Fresen KF. Prevalence of Enamel Hypomineralisation/Molar Incisor Hypomineralisation: A Scoping Review. Monogr Oral Sci. 2024;32:100-116. DOI: 10.1159/000538876. Epub 2024 Jul 1.\u003c/li\u003e\n \u003cli\u003eBriones E, Verkuyten M, Cosano J, Tabernero C. Psychological adaptation of Moroccan and Ecuadorean immigrant adolescents in Spain. Int J Psychol. 2012; 47(1):28-38. doi: 10.1080/00207594.2011.569722. Epub 2011 May 23..\u003c/li\u003e\n \u003cli\u003eDomínguez-Rodríguez A, González-Rábago Y. Self-rated health, time of residence and social determinants of health in immigrant populations: A complex relationship in groups of different origins in a Southern European region. J Migr Health. 2024 Feb 2;9:100216. DOI: 10.1016/J.JMH.2024.100216.\u003c/li\u003e\n \u003cli\u003eVeloso Duran A, Framis-de-Mena B, Vázquez Salceda MC, Guinot Jimeno F. Evaluation and Comparison of Oral Health Status between Spanish and Immigrant Children Residing in Barcelona, Spain. Children (Basel). 2022 Sep 4; 9(9):1354. doi: 10.3390/children9091354.\u003c/li\u003e\n \u003cli\u003eNomaguchi KM, Brown SL. Parental Strains and Rewards among Mothers: The Role of Education. J Marriage Fam. 2011 Jun; 73(3):621-636. doi: 10.1111/j.1741-3737.2011.00835.x. Epub 2011 May 19.\u003c/li\u003e\n \u003cli\u003eMonserrat-Hernández M, Checa-Olmos JC, Arjona-Garrido Á, López-Liria R, Rocamora-Pérez P. Academic stress in university students: the role of physical exercise and nutrition. Healthcare (Basel). August 26, 2023; 11(17):2401. DOI: 10.3390/healthcare11172401.\u003c/li\u003e\n \u003cli\u003eSimsek M, Costa R, by Valk HAG. Childhood residential mobility and health outcomes: A meta-analysis. Health Place. 2021 Sep;71:102650. DOI: 10.1016/J.HealthPlace.2021.102650. Epub 2021 Aug 21.\u003c/li\u003e\n \u003cli\u003eSuglia SF, Duarte CS, Sandel MT. Housing quality, housing instability, and maternal mental health. J Urban Health. 2011 Dec; 88(6):1105-16. DOI: 10.1007/S11524-011-9587-0.\u003c/li\u003e\n \u003cli\u003eKacenelenbogen N, Dramaix-Wilmet M, Schetgen M, Roland M, Godin I. Parental separation and behaviours that influence the health of infants aged 28 to 32 months: a cross-sectional study. BMC Pediatr. 2018 Feb 27; 18(1):88. DOI: 10.1186/S12887-018-1062-6.\u003c/li\u003e\n \u003cli\u003eAdgent MA, Buth E, Noroña-Zhou A, Szpiro AA, Loftus CT, Moore PE, Wright RJ, Barrett ES, LeWinn KZ, Zhao Q, Nguyen R, Karr CJ, Bush NR, Carroll KN. Maternal stressful life events during pregnancy and childhood asthma and wheeze. Ann Allergy Asthma Immunol. 2024 May; 132(5):594-601.e3. DOI: 10.1016/J.ANAI.2023.12.015. Epub 2023 Dec 18.\u003c/li\u003e\n \u003cli\u003eBush NR, Savitz J, Coccia M, Jones-Mason K, Adler N, Boyce WT, Laraia B, Epel E. Maternal Stress During Pregnancy Predicts Infant Infectious and Noninfectious Illness. J Pediatr. 2021 Jan;228:117-125.e2. doi: 10.1016/j.jpeds.2020.08.041. Epub 2020 Aug 19.\u003c/li\u003e\n \u003cli\u003eMountain RV, Zhu Y, Pickett OR, Lussier AA, Goldstein JM, Roffman JL, Bidlack FB, Dunn EC. Association of Maternal Stress and Social Support During Pregnancy With Growth Marks in Children's Primary Tooth Enamel. JAMA Netw Open. 2021 Nov 1; 4(11):e2129129. doi: 10.1001/jamanetworkopen.2021.29129.\u003c/li\u003e\n \u003cli\u003eHarz D, Catalán Gamonal B, Matute García S, Jeremias F, Martin J, Fresno MC. Prevalence and severity of molar-incisor hypomineralization, is there an association with socioeconomic status? A cross-sectional study in Chilean schoolchildren. Eur Arch Paediatr Dent. 2023 Oct; 24(5):577-584. DOI: 10.1007/S40368-023-00820-3. Epub 2023 Jul 11.\u003c/li\u003e\n \u003cli\u003eBalmer R, Toumba J, Godson J, Duggal M. The prevalence of molar incisor hypomineralisation in Northern England and its relationship to socioeconomic status and water fluoridation. Int J Paediatr Dent. 2012 Jul; 22(4):250-7. doi: 10.1111/j.1365-263X.2011.01189.x. Epub 2011 Oct 20.\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 3,4","content":"\u003cp\u003eTable 3 and 4 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Molar Incisor Hypomineralization, Family structure, Sociodemographic Factors","lastPublishedDoi":"10.21203/rs.3.rs-8058339/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8058339/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eMolar Incisive Hypomineralization (MIH) is a condition in the dental enamel of multifactorial etiology and, in part unknown. This study aimed to determine if there are coincident family or sociodemographic patterns in the group of pediatric patients diagnosed with MIH.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eA cross-sectional descriptive observational study. An oral examination was performed to diagnose the presence or absence of MIH in children aged 6 to 14 years who attended the Dentistry Service of the Primary Care Center in Roquetes, Catalunya, Spain, plus a questionnaire created ad hoc with sociodemographic and family structure variables that the parents filled out during the visit.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total sample of 305 patients was recruited; 153 had MIH and 152 did not. The sample was grouped, according to the country of maternal origin: 1) children with a mother of Spanish nationality (44.92%), and 2) children with a mother of foreign nationality (55.08%). In group 1, a significant association was found between having MIH and the variables \"Mother with higher education\" (p-value\u0026thinsp;=\u0026thinsp;0.002); \"Child does not live with both parents\" (p-value\u0026thinsp;=\u0026thinsp;0.012); \"Place of birth of the child other than the place of current residence\" (p-value\u0026thinsp;=\u0026thinsp;0.002). In group 2, the variables correlated with MIH were: \"Mother's locality different from the father's locality\" (p-value\u0026thinsp;=\u0026thinsp;0.002); \"Mother's locality different from the child's birth\" (p-value\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eUnfavorable sociodemographic factors, the phenomenon of migration, and the family structure of not living with both parents were associated with the presence of MIH in the children in the present study.\u003c/p\u003e","manuscriptTitle":"Influence of sociodemographic factors and family structure in patients with Molar Incisive Hypomineralization (MIH)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-13 00:21:11","doi":"10.21203/rs.3.rs-8058339/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-07T23:23:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-02T19:44:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-01T05:20:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-30T18:14:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15749806934584583349203727401137296736","date":"2025-12-18T03:18:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318099178925620269395146096540512686913","date":"2025-12-16T19:36:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4976728702943657023153505982648210122","date":"2025-12-09T16:36:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-09T12:40:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-09T12:36:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-08T13:49:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-02T09:41:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-12-02T08:50:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8451de75-3706-4394-b853-7815445efd93","owner":[],"postedDate":"December 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":59561363,"name":"Health sciences/Diseases"},{"id":59561364,"name":"Health sciences/Health care"},{"id":59561365,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-02-16T16:01:51+00:00","versionOfRecord":{"articleIdentity":"rs-8058339","link":"https://doi.org/10.1038/s41598-026-39879-5","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-02-11 15:58:51","publishedOnDateReadable":"February 11th, 2026"},"versionCreatedAt":"2025-12-13 00:21:11","video":"","vorDoi":"10.1038/s41598-026-39879-5","vorDoiUrl":"https://doi.org/10.1038/s41598-026-39879-5","workflowStages":[]},"version":"v1","identity":"rs-8058339","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8058339","identity":"rs-8058339","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}