{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T13:05:56Z","timestamp":1770469556978,"version":"3.49.0"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000072","name":"National Institute of Dental and Craniofacial Research","doi-asserted-by":"publisher","award":["R01DE031025"],"award-info":[{"award-number":["R01DE031025"]}],"id":[{"id":"10.13039\/100000072","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000077","name":"Division of Social and Economic Sciences","doi-asserted-by":"publisher","award":["2238208"],"award-info":[{"award-number":["2238208"]}],"id":[{"id":"10.13039\/100000077","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Candida albicans<\/jats:italic>\n , a pathogenic fungus implicated in early childhood caries (ECC), plays a crucial role in oral health. While its colonization usually begins at birth, the extent of maternal involvement in yeast transmission to their offspring, particularly across different racial groups, remains unclear. Studies have shown elevated levels of\n C. albicans<\/jats:italic>\n in both mothers and children, with genetically related fungal strains, suggesting maternal transmission, but the racial component, notably higher levels in Black children, lacks thorough investigation of underlying factors. Our research aimed to address this gap by investigating how maternal and demographic factors such as socioeconomic status and oral health affect\n C. albicans<\/jats:italic>\n levels in infants across Black and non-Black populations. Employing a partial linear semiparametric mixed-effects model (PLSMM) with variable selection and race-based stratification, we identified predictors that have different effects depending on the infant\u2019s race among a large pool of predictors. Through this stratified analysis, we aimed to discern crucial factors significantly contributing to\n C. albicans<\/jats:italic>\n colonization while minimizing the impact of irrelevant or redundant variables. In this stratified analysis, exclusive breastfeeding (\n \n \n \n \n \n \u03b2<\/mml:mi>\n =<\/mml:mo>\n \u2212<\/mml:mo>\n 1.06<\/mml:mn>\n ,<\/mml:mo>\n p<\/mml:mi>\n <<\/mml:mo>\n 0.0001<\/mml:mn>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n ) and maternal marriage (\n \n \n \n \n \n \u03b2<\/mml:mi>\n =<\/mml:mo>\n \u2212<\/mml:mo>\n 1.09<\/mml:mn>\n ,<\/mml:mo>\n p<\/mml:mi>\n =<\/mml:mo>\n 0.01<\/mml:mn>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n ) were significant predictors among non-Black infants, while maternal employment (\n \n \n \n \n \n \u03b2<\/mml:mi>\n =<\/mml:mo>\n \u2212<\/mml:mo>\n 1.55<\/mml:mn>\n ,<\/mml:mo>\n p<\/mml:mi>\n =<\/mml:mo>\n 0.03<\/mml:mn>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n ) and post-delivery maternal\n C. albicans<\/jats:italic>\n (\n \n \n \n \n \n \u03b2<\/mml:mi>\n =<\/mml:mo>\n 1.66<\/mml:mn>\n ,<\/mml:mo>\n p<\/mml:mi>\n =<\/mml:mo>\n 0.049<\/mml:mn>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n ) were significant among Black infants. Our findings highlighted race-specific associations between\n C. albicans<\/jats:italic>\n levels in children and factors such as breastfeeding practices, marital status, maternal oral hygiene, and maternal\n C. albicans<\/jats:italic>\n levels. Our study underscores the importance of race-specific considerations in understanding\n C. albicans<\/jats:italic>\n colonization in infants, offering insights for tailored interventions and healthcare strategies, particularly for vulnerable populations.\n <\/jats:p>","DOI":"10.1371\/journal.pone.0340317","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T18:45:28Z","timestamp":1770403528000},"page":"e0340317","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal and demographic factors influencing oral Candida albicans in infants: A stratified analysis using a novel partial linear semiparametric mixed-effects 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quantitative PCR","volume":"7","author":"EW Bachtiar","year":"2018","journal-title":"F1000Research."},{"issue":"2","key":"pone.0340317.ref002","first-page":"131","article-title":"Retrospective analysis of candida-related conditions in infancy and early childhood caries","volume":"40","author":"J Jean","year":"2018","journal-title":"Pediatr Dent."},{"key":"pone.0340317.ref003","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1159\/000481833","article-title":"Candida albicans and early childhood caries: a systematic review and meta-analysis","volume":"52","author":"J Xiao","year":"2018","journal-title":"Caries Res."},{"issue":"10","key":"pone.0340317.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0164242","article-title":"Candida albicans Carriage in Children with Severe Early Childhood Caries (S-ECC) and Maternal Relatedness","volume":"11","author":"J Xiao","year":"2016","journal-title":"PLoS One."},{"issue":"12","key":"pone.0340317.ref005","article-title":"Candida-streptococcal interactions in biofilm-associated oral diseases","volume":"14","author":"H Koo","year":"2018","journal-title":"PLoS Pathog."},{"issue":"6","key":"pone.0340317.ref006","doi-asserted-by":"crossref","DOI":"10.1371\/journal.ppat.1006407","article-title":"Candida albicans mannans mediate Streptococcus mutans exoenzyme GtfB binding to modulate cross-kingdom biofilm development in vivo","volume":"13","author":"G Hwang","year":"2017","journal-title":"PLoS Pathog."},{"issue":"5","key":"pone.0340317.ref007","doi-asserted-by":"crossref","first-page":"1968","DOI":"10.1128\/IAI.00087-14","article-title":"Symbiotic relationship between Streptococcus mutans and Candida albicans synergizes virulence of plaque biofilms in vivo","volume":"82","author":"ML Falsetta","year":"2014","journal-title":"Infect Immun."},{"key":"pone.0340317.ref008","doi-asserted-by":"crossref","first-page":"104876","DOI":"10.1016\/j.archoralbio.2020.104876","article-title":"Candida and dental caries in children, adolescents and adults: a systematic review and meta-analysis","volume":"119","author":"G Eidt","year":"2020","journal-title":"Arch Oral Biol."},{"issue":"1","key":"pone.0340317.ref009","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1177\/00220345211012385","article-title":"Oral Candida Predicts Streptococcus mutans Emergence in Underserved US Infants","volume":"101","author":"N Alkhars","year":"2022","journal-title":"J Dent Res."},{"key":"pone.0340317.ref010","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.3389\/fmicb.2015.01391","article-title":"Clinical Appearance of Oral Candida Infection and Therapeutic Strategies","volume":"6","author":"S Patil","year":"2015","journal-title":"Front Microbiol."},{"issue":"1","key":"pone.0340317.ref011","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0290938","article-title":"Multilocus sequence typing of Candida albicans oral isolates reveals high genetic relatedness of mother-child dyads in early life","volume":"19","author":"N Alkhars","year":"2024","journal-title":"PLoS One."},{"issue":"2","key":"pone.0340317.ref012","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.3390\/ijms24021449","article-title":"Vertical transmission and antifungal susceptibility profile of yeast isolates from the oral cavity, gut, and breastmilk of mother-child pairs in early life","volume":"24","author":"MJ Azevedo","year":"2023","journal-title":"Int J Mol Sci."},{"issue":"1","key":"pone.0340317.ref013","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1111\/prd.12323","article-title":"Recent epidemiologic trends in periodontitis in the USA","volume":"82","author":"PI Eke","year":"2020","journal-title":"Periodontol 2000"},{"key":"pone.0340317.ref014","unstructured":"Lin M, Griffin SO, Gooch BF, Espinoza L, Wei L, Li CH, et al. Oral health surveillance report: trends in dental caries, sealants, tooth retention,, edentulism and United States: 1999 \u20132004 to 2011\u20136. 2019."},{"key":"pone.0340317.ref015","article-title":"Comparison of longitudinal trajectories using a high-dimensional partial linear semiparametric mixed-effects model","author":"S Leon","year":"2025","journal-title":"J Am Stat Assoc."},{"key":"pone.0340317.ref016","doi-asserted-by":"crossref","unstructured":"Leon S, Wu TT. plsmmLasso: variable selection and inference for partial semiparametric linear mixed-effects model. 2024. https:\/\/CRAN.R-project.org\/package=plsmmLasso","DOI":"10.32614\/CRAN.package.plsmmLasso"},{"issue":"1","key":"pone.0340317.ref017","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0290938","article-title":"Multilocus sequence typing of Candida albicans oral isolates reveals high genetic relatedness of mother-child dyads in early life","volume":"19","author":"N Alkhars","year":"2024","journal-title":"PLoS One."},{"issue":"2","key":"pone.0340317.ref018","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1214\/aos\/1176344136","article-title":"Estimating the dimension of a model","volume":"6","author":"G Schwarz","year":"1978","journal-title":"Ann Statist."},{"issue":"2","key":"pone.0340317.ref019","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1214\/12-AOS1077","article-title":"Valid post-selection inference","volume":"41","author":"R Berk","year":"2013","journal-title":"Ann Statist."},{"issue":"1","key":"pone.0340317.ref020","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1111\/j.1467-9868.2012.01032.x","article-title":"Estimation of the mean of functional time series and a two-sample problem","volume":"75","author":"L Horv\u00e1th","year":"2012","journal-title":"Journal of the Royal Statistical Society Series B: Statistical Methodology."},{"issue":"1","key":"pone.0340317.ref021","doi-asserted-by":"crossref","DOI":"10.1371\/journal.ppat.1011025","article-title":"Race and ethnicity: risk factors for fungal infections?","volume":"19","author":"JD Jenks","year":"2023","journal-title":"PLoS Pathog."},{"issue":"3","key":"pone.0340317.ref022","doi-asserted-by":"crossref","first-page":"438","DOI":"10.3390\/healthcare11030438","article-title":"Listen to the whispers before they become screams: addressing black maternal morbidity and mortality in the United States","volume":"11","author":"A Njoku","year":"2023","journal-title":"Healthcare (Basel)."},{"issue":"1","key":"pone.0340317.ref023","doi-asserted-by":"crossref","first-page":"16870","DOI":"10.1038\/s41598-021-96495-1","article-title":"Oral microflora and pregnancy: a systematic review and meta-analysis","volume":"11","author":"H Jang","year":"2021","journal-title":"Sci Rep."},{"key":"pone.0340317.ref024","doi-asserted-by":"crossref","first-page":"849012","DOI":"10.3389\/fimmu.2022.849012","article-title":"Human breast milk: from food to active immune response with disease protection in infants and mothers","volume":"13","author":"GAG Lokossou","year":"2022","journal-title":"Front Immunol."},{"issue":"19","key":"pone.0340317.ref025","doi-asserted-by":"crossref","DOI":"10.14814\/phy2.15469","article-title":"The effects of breastfeeding and formula feeding on the metabolic factors and the expression level of obesity and diabetes-predisposing genes in healthy infants","volume":"10","author":"S Cheshmeh","year":"2022","journal-title":"Physiol Rep."},{"issue":"4","key":"pone.0340317.ref026","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1089\/bfm.2014.0152","article-title":"Racial and ethnic disparities in breastfeeding","volume":"10","author":"KM Jones","year":"2015","journal-title":"Breastfeed Med."},{"issue":"2","key":"pone.0340317.ref027","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1353\/foc.2010.0007","article-title":"Parental relationships in fragile families","volume":"20","author":"S McLanahan","year":"2010","journal-title":"Fut Child."},{"issue":"3","key":"pone.0340317.ref028","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/s11222-013-9380-x","article-title":"LASSO-type estimators for semiparametric nonlinear mixed-effects models estimation","volume":"24","author":"A Arribas-Gil","year":"2013","journal-title":"Stat Comput."}],"container-title":["PLOS 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