Prevention of Orofacial Clefts: Does Pregnancy Planning Have a Role?

2007 ◽  
Vol 44 (3) ◽  
pp. 244-250 ◽  
Author(s):  
Peter A. Mossey ◽  
Janet A. Davies ◽  
Julian Little
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Unplanned Pregnancy ◽  
First Trimester ◽  
Inverse Association ◽  
Orofacial Cleft ◽  
Orofacial Clefts ◽  
Pregnancy Planning ◽  
The United Kingdom ◽  
First Trimester Of Pregnancy

Objective: To investigate the association between pregnancy planning and orofacial clefts in the United Kingdom. Design: Case–control study. Setting: Scotland and the Manchester and Merseyside regions of England. Participants: One hundred and ninety-one children born with nonsyndromic orofacial cleft, 1997 to 2000, and 247 controls. Main outcome measure: Cleft lip with and without cleft palate, and cleft palate. Results: There was an inverse association between planning for pregnancy and orofacial cleft in the offspring (odds ratio [OR] = 0.51, 95% confidence interval [CI] = 0.33–0.79). An unplanned pregnancy together with smoking in the first trimester of pregnancy resulted in almost treble the risk of a child with an orofacial cleft when compared with those who planned their pregnancy and did not smoke (OR = 2.92, CI = 1.50–5.65). Conclusions: Planned pregnancies were associated with a lower risk of orofacial clefts. Isolation of the elements of pregnancy planning implicated in these results is difficult. Current preconception advice needs to reach a wider audience; however, for maximum impact, efforts are needed to reduce the numbers of unplanned pregnancies.

scholarly journals First trimester exposure to ambient gaseous air pollutants and risk of orofacial clefts: a case–control study in Changsha, China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wen Jiang ◽  
Wanqin Xie ◽  
Bin Ni ◽  
Haiyan Zhou ◽  
Zhiyu Liu ◽  
...  
Keyword(s):  
Particulate Matter ◽  
Cleft Palate ◽  
Air Pollutants ◽  
Cleft Lip ◽  
Case Control Study ◽  
First Trimester ◽  
Case Control ◽  
Orofacial Clefts ◽  
First Trimester Of Pregnancy ◽  
Control Study

Abstract Background A growing body of studies have investigated the association between air pollution exposure during early pregnancy and the risk of orofacial clefts, but these studies put more emphasis on particulate matter and reported inconsistent results, while research on the independent effects of gaseous air pollutants on orofacial clefts has been quite inadequate, especially in China. Methods A case–control study was conducted in Changsha, China from 2015 to 2018. A total of 446 cases and 4460 controls were included in the study. Daily concentrations of CO, NO2, SO2, O3, PM2.5 and PM10 during the first trimester of pregnancy were assigned to each subject using the nearest monitoring station method. Multivariate logistic regression models were applied to evaluate the associations of monthly average exposure to gaseous air pollutants with orofacial clefts and its subtypes before and after adjusting for particulate matter. Variance inflation factors (VIFs) were used to determine if the effects of gaseous air pollutants could be independent of particulate matter. Results Increase in CO, NO2 and SO2 significantly increased the risk of cleft lip with or without cleft palate (CL/P) in all months during the first trimester of pregnancy, with aORs ranging from 1.39 to 1.48, from 1.35 to 1.61 and from 1.22 to 1.35, respectively. The risk of cleft palate only (CPO) increased with increasing NO2 exposure levels in the first trimester of pregnancy, with aORs ranging from 1.60 to 1.66. These effects sustained and even exacerbated after adjusting for particulate matter. No significant effect of O3 was observed. Conclusions Our study suggested that maternal exposure to CO, NO2, and SO2 during the first trimester of pregnancy might contribute to the development of orofacial clefts, and the associations were potentially independent of particulate matter.

Maternal Drug Use and Infant Cleft Lip/Palate with Special Reference to Corticoids

2003 ◽  
Vol 40 (6) ◽  
pp. 624-628 ◽  
Author(s):  
Bengt Källén
Keyword(s):  
Drug Use ◽  
Cleft Palate ◽  
Early Pregnancy ◽  
Cleft Lip ◽  
First Trimester ◽  
Orofacial Cleft ◽  
Orofacial Clefts ◽  
Maternal Drug Use ◽  
Median Cleft ◽  
Cleft Lip Palate

Objective To study the association between maternal drug use in early pregnancy and orofacial cleft in the infant. Design Register analysis based on prospectively collected information. Patients All delivered women in Sweden July 1, 1995, through December 31, 2001. Main outcome measure Presence of orofacial cleft in infant. Results Prospective information on maternal drug use during the first trimester, as reported in early pregnancy, was studied in 1142 infants with orofacial clefts, isolated or with other malformations, excluding chromosome anomalies. Any drug use was not associated with clefts (odds ratio [OR] = 0.98, 95% confidence interval [95% CI] = 0.85 to 1.13), with isolated clefts (OR = 0.92) with isolated median cleft palate (OR = 1.03, 95% CI = 0.79 to 1.36) or with isolated cleft lip with or without cleft palate (OR = 0.86, 95% CI = 0.71 to 1.05). Reported use of multivitamins, folic acid, or B12 was not associated with a decrease in orofacial cleft risk (OR = 1.00, 95% CI = 0.63 to 1.52). ORs above 2 were seen for some drugs: sulfasalazine, naproxen, and anticonvulsants, but only a few exposed cases occurred. An association between glucocorticoid use and infant cleft was indicated and seemed to be strongest for median cleft palate. Conclusion Maternal drug use seems to play only a small role for the origin of orofacial clefts, at least in Sweden.

Folate and Clefts of the Lip and Palate—A U.K.-Based Case-Control Study: Part II: Biochemical and Genetic Analysis

2008 ◽  
Vol 45 (4) ◽  
pp. 428-438 ◽  
Author(s):  
J. Little ◽  
M. Gilmour ◽  
P. A. Mossey ◽  
D. FitzPatrick ◽  
A. Cardy ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Mthfr C677t ◽  
Serum Folate ◽  
Inverse Association ◽  
Folic Acid Fortification ◽  
Regression Methods ◽  
The United Kingdom ◽  
Increased Risk ◽  
Log Linear

Objective: To investigate associations between nonsyndromic oral clefts and biochemical measures of folate status and the MTHFR C677T variant in the United Kingdom, where there has been no folic acid fortification program. Method: Dietary details were obtained from the mothers of 112 cases of cleft lip with or without cleft palate (CL±P), 78 cleft palate only (CP) cases, and 248 unaffected infants. Infant and parental MTHFR C677T genotype was determined. Red blood cell (RBC) and serum folate and homocysteine levels were assessed in 12-month postpartum blood samples from a subset of mothers. The data were analyzed by logistic and log-linear regression methods. Results: There was an inverse association between CL±P and maternal MTHFR CT (odds ratio [OR]  =  0.5, 95% confidence interval [CI]  =  0.31–0.95) and TT (OR  =  0.6, 95% CI  =  0.21–1.50) genotypes, with similar risk estimates for CP. There was no clear association with infant MTHFR genotype. Higher levels of maternal postpartum RBC and serum folate were associated with a lower risk for CL±P and an increased risk for CP. Higher levels of serum homocysteine were associated with a slightly increased risk for both CL±P and CP. Conclusion: While the inverse relation between the mother's having the MTHFR C677T variant and both CL±P and CP suggests perturbation of maternal folate metabolism is of etiological importance, contrasting relations between maternal postpartum levels of RBC and serum folate by type of cleft are difficult to explain.

Prevalence and Characteristics of Non-Syndromic Orofacial Clefts and the Influence of Consanguinity

2014 ◽  
Vol 38 (3) ◽  
pp. 241-246 ◽  
Author(s):  
NM Alamoudi ◽  
H J Sabbagh ◽  
NPT Innes ◽  
D El Derwi ◽  
AZ Hanno ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Orofacial Cleft ◽  
Prospective Surveillance ◽  
Orofacial Clefts ◽  
Birth Prevalence ◽  
Live Births ◽  
Jeddah City ◽  
The Relationship

The Objective of this study was to identify the prevalence and describe the characteristics of non-syndromic orofacial cleft (NSOFC) in Jeddah, Saudi Arabia and examine the influence of consanguinity. Study Design: Six hospitals were selected to represent Jeddah's five municipal districts. New born infants with NSOFC born between 1st of January 2010 to 31st of December 2011 were clinically examined and their number compared to the total number of infants born in these hospitals to calculate the prevalence of NSOFC types and sub-phenotypes. Referred Infants were included for the purpose of studying NSOFC characteristics and their relationship to consanguinity. Information on NSOFC infants was gathered through parents’ interviews, infants’ files and patient examinations. Results: Prospective surveillance of births resulted in identifying 37 NSOFC infants born between 1st of January 2010 to 31st of December 2011 giving a birth prevalence of 0.80/1000 living births. The total infants seen, including referred cases, were 79 children. Consanguinity among parents of cleft palate (CP) cases was statistically higher than that among cleft lip with or without cleft palate (CL/P) patients (P=0.039). Although there appears to be a trend in the relationship between consanguinity and severity of CL/P sub-phenotype, it was not statistically significant (P= 0.248). Conclusions: Birth prevalence of NSOFC in Jeddah City was 0.8/1000 live births with CL/P: 0.68/1000 and CP: 0.13/1000. Both figures were low compared to the global birth prevalence (NSOFC: 1.25/1000, CL/P: 0.94/1000 and CP: 0.31/1000 live births). Consanguineous parents were statistically higher among CP cases than among other NSOFC phenotypes.

Infant TGF-Alpha Genotype, Orofacial Clefts, and Maternal Periconceptional Multivitamin Use

1998 ◽  
Vol 35 (4) ◽  
pp. 366-370 ◽  
Author(s):  
Gary M. Shaw ◽  
Cathy R. Wasserman ◽  
Jeffrey C. Murray ◽  
Edward J. Lammer
Keyword(s):  
Cigarette Smoking ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Transforming Growth Factor ◽  
Strong Association ◽  
Preliminary Evidence ◽  
Serum Folate ◽  
Orofacial Cleft ◽  
Orofacial Clefts ◽  
Multivitamin Use

Objective We previously demonstrated a strong association between periconceptional maternal cigarette smoking, infant transforming growth factor–alpha (TGFa) genotype, and risk of orofacial clefts. Because serum folate may be decreased by cigarette smoking and because maternal periconceptional use of multivitamins containing folic acid has been associated with a reduced risk of clefting, we explored whether a potential relation existed between infant TGFa genotype, maternal multivitamin use, and risk of orofacial cleft phenotypes. Design Data were derived from a population-based case–control study of fetuses and live-born infants among a cohort of 1987 to 1989 California births (n = 548,844). Information concerning periconceptional multivitamin use was obtained via telephone interviews with mothers of 731 (84.7% of eligible) orofacial cleft case infants, and of 734 (78.2%) nonmalformed control infants. DNA was obtained from newborn screening bloodspots and genotyped for the Taq1 polymorphism of TGFa. Among infants of interviewed mothers, genotypes were available for 571 (78.1%) case infants and 640 (87.2%) control infants. Setting The study encompassed all hospitals in selected California counties. Main Outcome Measure The main outcome measures were the risks of specific cleft phenotypes among infants with uncommon TGFa genotypes and whose mothers did not use multivitamins periconceptionally. Results Compared with infants homozygous for the common TGFa genotype and whose mothers used multivitamins, increased clefting risks were observed for infants with the A2 genotype (homozygous or heterozygous) and whose mothers did not use multivitamins. Risk estimates were 3.0 (1.4–6.6 [95% confidence interval]) for isolated cleft lip with or without cleft palate (CLP), 2.4 (0.69–11.6) for multiple CLP, 2.6 (0.97–7.7) for isolated cleft palate (CP), 4.2 (1.3–16.2) for multiple CP, and 8.1 (2.6–27.7) for “known-syndrome” clefts. Clefting risks for infants with the A2 genotype and whose mothers used multivitamins were substantially smaller, as were the risks for infants with the A1 genotype whose mothers did not use multivitamins. Conclusion These data provide preliminary evidence for a gene–nutrient interaction in risk of clefting.

scholarly journals Maternal multivitamin intake and orofacial clefts in offspring: Japan Environment and Children's Study (JECS) cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e035817
Author(s):  
Satomi Yoshida ◽  
Masato Takeuchi ◽  
Chihiro Kawakami ◽  
Koji Kawakami ◽  
Shuichi Ito
Keyword(s):  
Cohort Study ◽  
Cleft Lip ◽  
Maternal Nutrition ◽  
Cleft Lip And Palate ◽  
Multinomial Logistic Regression ◽  
First Trimester ◽  
Secondary Outcome ◽  
Orofacial Cleft ◽  
Orofacial Clefts ◽  
Multivitamin Supplementation

ObjectivesOrofacial clefts are common birth defects with a lack of strong evidence regarding their association with maternal nutrition. We aimed to determine whether a relationship exists between maternal nutrient or multivitamin intake and orofacial clefts.DesignThis is a prospective, population-based nationwide cohort study.SettingThe study was conducted in 15 regional centres, consisting of local administrative units and study areas.ParticipantsA total of 98 787 eligible mother–child pairs of the Japan Environment and Children’s Study were included.InterventionExposures were maternal nutrition and the use of supplemental multivitamins in mothers.Primary and secondary outcome measuresOutcomes were the occurrence of any orofacial cleft at birth. Multinomial logistic regression analyses were used to evaluate the association between maternal multivitamin intake and the incidence of orofacial clefts.ResultsOf the 98 787 children, 69 (0.07%) were diagnosed with cleft lip alone, 113 (0.11%) were diagnosed with cleft lip and palate, and 52 (0.05%) were diagnosed with cleft palate within 1 month after birth. Regarding the total orofacial cleft outcome, statistically significant point estimates of relative risk ratios (RR) were determined for multivitamin intake before pregnancy (RR=1.71; 95% CI 1.06 to 2.77) and during the first trimester (RR=2.00; 95% CI 1.18 to 3.37), but the association was not significant for multivitamin intake after the first trimester (RR=1.34; 95% CI 0.59 to 3.01). Maternal micronutrient intake via food was not associated with the incidence of orofacial clefts in offspring.ConclusionsIntake of multivitamin supplements shortly before conception or during the first trimester of pregnancy was found to be associated with an increased incidence of orofacial clefts at birth. Pregnant women and those intending to become pregnant should be advised of the potential risks of multivitamin supplementation.

scholarly journals Study of Cleft Lip and Palate in Kathmandu Model Hospital, Nepal

2019 ◽  
Vol 9 (1) ◽  
pp. 6-10
Author(s):  
Sanzida Khatun
Keyword(s):  
Cleft Palate ◽  
Congenital Anomalies ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Positive Family History ◽  
First Trimester ◽  
Associated Anomalies ◽  
Cross Sectional ◽  
History Of ◽  
First Trimester Of Pregnancy

Introduction: Cleft lip and/or palate is a congenitally persistent space affecting orofacial region. It is generally divided into cleft lip (CL), cleft palate (CP) and cleft lip with cleft palate (CLP). The objective of the study was to evaluate distribution of patterns of orofacial clefts according to sex and laterality; predisposing factors and other congenital anomalies associated with cleft lip and/or palate. Materials & Method: A cross-sectional descriptive type of study was carried out using in 268 patients having cleft lip and/or palate. Types of clefts, predominance of sex and laterality, familial history, associated anomalies and drug and disease history of mother were recorded. Result: The results revealed 23.51% CL, 54.85% CLP and 21.64% CP. There were 58.21% males and 41.79% females. Positive family history of cleft was present in 28.0% and associated anomalies were observed in 3.7% of the cleft subjects. Mothers of 6.0% of the total patients were exposed to teratogenic agents during first trimester of pregnancy. Conclusion: It was concluded that among the three types of cleft (CL, CP and CLP), CLP is the most common type. The males are affected more with cleft lip and/or palate than the females. Clefts also have risks of associated congenital anomalies. Exposure to teratogenic agents in first trimester of pregnancy is also associated with orofacial cleft.

A Closer Look at Delayed Primary Cleft Surgery and Unrepaired Cleft Lip and/or Palate in 5 UK Cleft Centers

2021 ◽  
pp. 105566562110217
Author(s):  
Sophie Butterworth ◽  
Clare Rivers ◽  
Marnie Fullarton ◽  
Colm Murphy ◽  
Victoria Beale ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Medical Problems ◽  
Primary Surgery ◽  
The United Kingdom ◽  
Number Of Patients ◽  
Primary Palate ◽  
Palate Repair ◽  
Cleft Surgery

Background: There may be many reasons for delays to primary cleft surgery. Our aim was to investigate the age of children undergoing primary cleft lip or primary cleft palate repair in 5 cleft centers within the United Kingdom. Identify the reasons for delayed primary cleft lip repair (beyond 6 months) and delayed primary palate repair (beyond 13 months). Identify children who had a cleft lip and/or palate (CL±P) that was intentionally unrepaired and the reasons for this. Methods: A retrospective, multicenter review of patients born with a CL±P between December 1, 2012, and December 31, 2016. Three regional cleft centers, comprising of 5 cleft administrative units in the United Kingdom participated. Results: In all, 1826 patients with CL±P were identified. Of them, 120 patients had delayed lip repair, outside the expected standard of 183 days. And, 178 patients in total had delayed palate repair, outside the expected standard of 396 days. Twenty (1%) patients had an unrepaired cleft palate. Conclusions: This large retrospective review highlights variations between centers regarding the timing of lip and palate surgery and details the reasons stated for delayed primary surgery. A small number of patients with an unrepaired cleft palate were identified. All had complex medical problems or comorbidities listed as a reason for the decision not to operate and 50% had a syndromic diagnosis. The number of patients receiving delayed surgery due to comorbidities, being underweight or prematurity, highlights the importance of the cleft specialist nurse and pediatrician within the cleft multidisciplinary team.

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