Influence of season on prevalence of cleft lip and palate

Seasonal Variation of Nonsyndromic Orofacial Clefts in Northern Chinese Population

BACKGROUND

Nonsyndromic orofacial clefts (NSOC) comprise a range of disorders affecting the lips and oral cavity. Various authors evaluated seasonal influence on the occurrence of NSOC differently. The aim of present study was to investigate seasonal variation in birth of individuals with orofacial cleft in northern China.

METHODS

A retrospective study comprised 499 cases and 452 controls were conducted. Children with NSOC operated in The First Affiliated Hospital of Harbin Medical University from 2009 to 2015 were investigated. Controls were children patients with trauma and bone fracture from the same hospital during the same period. Data on sex, birth time, area of residence was retrospectively collected from patients' records. Chi-squared test was used for comparisons. P values less than or equal to 0.05 were considered to be significant.

RESULTS

Seasonal distribution was significantly different between cases and controls (P < 0.05). Birth time peaks of cases, especially males, occurred in winter. Furthermore, compared with controls, more cases with cleft lip/palate were born in winter (P < 0.05). There was no significant seasonal difference between female cases and controls (P > 0.05), and no statistical difference was found between cases with cleft palate and controls (P > 0.05).

CONCLUSIONS

Our study revealed the presence of seasonal variation in individuals with orofacial cleft in northern Chinese population. We found a peak incidence of birth time for NSOC during winter.

Seasonal Influence on the Numbers of Gender-Related Orofacial Cleft Conceptions in the Netherlands

BACKGROUND

In the multifactorial etiology of orofacial clefts (OFCs), environmental factors play an important role. To trace the influence of these factors, the timing of the cell biological mechanisms that occur during embryological development of the primary and secondary palates must be taken into account. That is, the fusion process of the facial and palatal processes, respectively, followed by their differentiation into bone and musculature, which take place during the first trimester of pregnancy. During this period, harmful seasonal influences such as viral infections and vitamin deficiencies could induce OFC in the embryo.

AIMS

The aim of this study is to find out whether a seasonal conception period with an increased risk of OFC development exists, particularly gender related.

METHODS

This was a retrospective cross-sectional study on children with OFC born in the Netherlands from 2006 to 2016. Total conception rates of live births in the Netherlands were used as a control group. χ² tests were performed to analyze monthly and seasonal differences. Males and females, positive and negative family history and subphenotype groups based on fusion and/or differentiation (F- and/or D-) defects, and their timing in embryogenesis were analyzed separately.

RESULTS

In total, 1653 children with OFC, 1041 males and 612 females, were analyzed. Only males with FD-defects showed a significant seasonal variation with an increase in conceptions during spring, most often in May.

CONCLUSIONS

Males with FD-defects showed a significant seasonal variation with an increase in conceptions during spring. No other seasonal trends could be demonstrated.

Prevalence and Clinical Case Series of Syndromic and Nonsyndromic Cleft Lip and Palate in a Saudi Arabian Neonatal Population

OBJECTIVE

To report clinical case series of cleft lip with or without palate (CL/P) and to estimate the prevalence of infants with CL/P who were syndromic or nonsyndromic.

DESIGN

This is a clinical case series study of CL/P among live births in the maternity hospital.

SETTING

The study was carried out in Maternity and Children Hospital, Najran between January 2013 and December 2016.

MATERIALS AND METHODS

Sex and clinical presentation of CL/P were collected from the medical records of live births. Clinical presentations were identified by type of CL/P and stratified according to laterality of occurrence. The data were analyzed using (SPSS) program, version 20. Results were presented in simple descriptive statistics.

MAIN OUTCOME

Prevalence of CL/P in the Najran region of Saudi Arabia was 0.65 per 1000 live births (95% CI: 0.650 [0.389-1.092]). Cleft lip and palate was the commonest clinical presentation.

RESULT

Of 24 367 live birth, 16 were classified as having CL/P. The overall frequency of CL/P was 0.65/1000 live births (95% CI: 0.650 [0.389-1.092]). There were 10 males and 5 females. Infant sex cannot be established in 1 case. Two (12.5%) patients had cleft lip, 4 (25%) had isolated cleft palate, and 10 (62.5%) had combined CL/P. Nine (56.25%) neonates were cases of nonsyndromic CL/P, while 7 (43.75%) were cases of syndromic CL/P.

CONCLUSIONS

Prevalence rate of 0.65 per 1000 live births over 4-year period was observed at (95% CI: 0.650 [0.389-1.092]). Cleft lip with or without palate was the commonest clinical presentation.

Analysis of the Prevalence and Incidence of Cleft Lip and Palate in Colombia

OBJECTIVE

To analyze the population prevalence and birth prevalence of oral clefts in Colombia from 2009 to 2017.

METHODS

A cross-sectional study using information from the National Administrative Records of Colombia. The data came from 2 types of administrative records (Surveillance System and the Individual Registry of Service Provision) and the oral health national survey. Population prevalence and birth prevalence by type of cleft lip and/or cleft (CL/P) ratios were calculated using Poisson distribution for count data and to assess stationary tests on time series (Dickey-Fuller) and (Phillips-Perron) was used.

RESULTS

Population prevalence in Colombia was 3.27 per 10 000 inhabitants (95% confidence interval [CI], 3.21-3.32) and birth prevalence was 6.0 per 10 000 live births (95% CI, 5.67-6.35). Bogotá have the highest population prevalence with CL/P. In the analysis of trends for the prevalence proportion by type of clefts in newborn babies with cleft, it was observed that the highest proportion was for babies with CLP. Cleft lip (CL) has increased from 17.4% in 2014 to 34.2% in 2017, cleft palate (CP) has decreased from 32.9% to 20.2%; and CLP changed from 49.6% to 45.5% in the same period.

CONCLUSIONS

The population prevalence was 3.27 per 10 000 inhabitants. Births prevalence was 6.0 per 10 000 live births, and Orinoquia and Amazonia have higher rates than the national average. The administrative registers are adequate systems to know the behavior of oral clefts. The CL/P had a nonstationary trend during the period 2014 to 2017.

Long-term significant seasonal differences in the numbers of new-borns with an orofacial cleft in the Czech Republic - a retrospective study

BACKGROUND

Choosing the optimal season for conception is a part of family planning since it can positively influence the pregnancy outcome. Changes in the monthly number of infants born with a birth defect can signal prenatal damage - death or malformation - related to a harmful seasonal factor. The aim of our paper was to search for possible seasonal differences in the numbers of new-borns with an orofacial cleft and thus for a period of conception that can increase the risk of orofacial cleft development.

METHODS

Mean monthly numbers of live births in the Bohemia region of the Czech Republic during the years 1964-2000 were compared within a group of 5619 new-borns with various types of orofacial clefts and the control group derived from natality data on 3,080,891 new-borns.

RESULTS

The control group exhibited regular seasonal variation in the monthly numbers of new-borns: significantly more babies born during March-May and fewer babies born during October-December. Similar natural seasonal variation was also found in the group of babies with an orofacial cleft. However, after subdividing the cleft group according to gender and cleft type, in comparison to controls, significant differences appeared in the number of new-born girls with cleft lip during January-March and in the number of boys born with cleft palate in April - May.

CONCLUSIONS

We found significant differences from controls in the number of new-born girls with CL and boys with CP, whose dates of birth correspond to conception from April to August and to the estimated prenatal critical period for cleft formation from May to October. The latter period includes the warm season, when various injurious physical, chemical and biological factors may act on a pregnant woman. This finding should be considered in pregnancy planning. Future studies are necessary to investigate the putative injurious factors during the warm season that can influence pregnancy outcome.

A review of seasonality of cleft births - The Brazil experience

AIMS

Evaluate the seasonal influence in nonsyndromic cleft lip and/or palate (NSCL/P) in Brazilian patients.

METHODS

A case-control study, with 361 unrelated patients with NSCL/P and 481 healthy individuals, was done on a reference service for craniofacial deformities in Minas Gerais State, Brazil. Information was collected from clinical records considering gender, month of birth, as well as with the seasons.

RESULTS

Nonparametric tests did not show a seasonal variation in month of birth and in seasons of year of NSCL/P compared to a control group (p = 0.902 and p = 0.679, respectively). A difference in births between the groups was identified only in January, however, was not significant. Moreover, among the control group there were more births in the months of February and August, and for the cleft group, more in July and August. The males were more affected by cleft lip with or without palate (CLP) and the females by isolated cleft palate (CP) manifestation. The ratio of CL:CLP:CP indicated that CLP was predominant when compared with CL and CP, CLP was more frequent in male patients, and CP predominance was seen in females.

CONCLUSION

This study did not show seasonal differences in births on NSCL/P in a Brazilian group, emphasizing that environmental factors may be related to oral clefts. These results provide a basis for further epidemiological studies of orofacial clefts in Brazil.

A case-control study of environmental exposures for nonsyndromic cleft of the lip and/or palate in eastern Guangdong, China

OBJECTIVE

To study the relationship between environmental factors and nonsyndromic cleft of the lip and/or palate (NSCLP) in eastern Guangdong for the prevention of NSCLP.

METHODS

A 1:1 retrospective case-control study was carried out. Data from 479 children with NSCLP who accepted comprehensive care in our center were recruited as cases from April 2010 to April 2013. An equal number of controls were recruited from pediatrics during the same period. Then we conducted face-to-face interviews with both parents using a structural questionnaire to identify the relationship between NSCLP and environmental risk factors.

RESULTS

Univariate Chi-square analysis identified 23 factors (P<0.05) as being significantly related to NSCLP. Stepwise multiple logistic regression analyses demonstrated that there were 16 factors significantly associated with this disease. Being male (OR=0.609), parental childbearing age of 25-29 years (ORfather=0.633; ORmother=0.469), higher parental education level (high school or greater) and folic acid supplementation (OR=0.360) were protective factors against NSCLP. However, positive family history of NSCLP (OR=54.132), positive maternal abortion history (OR=3.698), high or low parental age at time of childbirth, poor maternal education level (primary school) (OR=2.258), maternal common cold during pregnancy (OR=1.464), and drug use during pregnancy (OR=3.364) were significant risk factors for NSCLP.

CONCLUSION

The findings are beneficial for researchers to understand the etiology of NSCLP and to lay a solid foundation for the prevention of NSCLP in eastern Guangdong through educational programs to teach parents about the benefits of folic acid supplementation, adequate parental age at childbirth (25-29 years), higher parental education level (high school or higher), and the dangers of common cold and drug use during the first trimester of pregnancy, positive family history and maternal abortion history.

Seasonal variation in birth months of patients with oral-facial clefts

BACKGROUND

Seasonality of the incidence of congenital anomalies has provided useful clues in etiological research. However, seasonality of oral-facial clefts is inconsistent in many countries, including native China. The aim of this study was to determine whether births of patients with oral-facial clefts follow a seasonal pattern in a native Chinese population.

METHODS

Patients with oral-facial clefts treated at the Plastic Surgery Hospital between January 2002 and December 2011 were retrospectively investigated. The controls comprised all living births from the obstetric department of the Third Affiliated Hospital of Peking University from January 2002 to December 2011. Seasonal variations in birth months were analyzed using the χ test.

RESULTS

A total of 6193 patients with oral-facial clefts and 13,254 healthy living newborns were included in this study. Birth time peaks of the patients occurred in autumn and winter, especially in October and January, compared with the nadir in the summer (P < 0.05). The birth time peaks of male patients occurred in autumn and winter, especially in October, February, and January. The birth time peaks of female patients occurred in autumn and winter, especially in January, October, and November. There was a statistical difference in birth distribution among the different months (P < 0.05) and 4 seasons (P < 0.05) in female patients. No statistical difference was found in male patients (P > 0.05).

CONCLUSIONS

There is a possible seasonality in birth months and a difference between sexes of patients with oral-facial clefts in this native Chinese population. This approach could be useful to study the etiology and pathogenesis of oral-facial clefts.

Seasonal and yearly trends in cleft lip and palate in northeast Iran, 1989-2011

Cleft lip and palate are the most common craniofacial congenital anomalies. The aim of this study was to detect the trend of seasonal and yearly fluctuations in the prevalence of cleft lip and palate birth in the northeast of Iran.

MATERIALS AND METHODS

Data were obtained from 348 patients referred to the Cleft Lip and Palate Research Center of Mashhad Dental School during a 22-year period. Children with syndromes or patients from other areas of Iran were not included in this investigation. Recorded data included sex, type of cleft, date of birth, place of birth, and area of residence. Chi-squared test was used for comparisons.

RESULTS

Without sex difference, the prevalence of all cleft types was more in winter and spring; however, there was no significant seasonal difference in birth dates of children with clefts (P = 0.777). This study showed that there was no significant difference in cleft types in both sexes(P = 0.113). Moreover, there appeared to be a reduction over time in the prevalence of all types of clefts, but there were fluctuations between years.

CONCLUSIONS

This article suggests the influence of genetic and environmental factors other than season on the prevalence of orofacial clefts.

Is there Seasonality in the Incidence of Oral-Facial Clefts?

Abstract Objective: To determine if seasonal variation in the incidence of oral-facial clefts exists in the Hong Kong Chinese population. Methods: Cases of non-syndromal oral-facial clefts identified from the Prenatal Diagnostic Clinic database from 2002-2009, and total births from our departmental statistics during this period, were used to calculate the averaged month-of-conception incidence for overall cases and individual categories of clefts, including cleft lip (CL), cleft palate (CP), cleft lip with/without cleft palate (CL+/-CP), and cleft lip with cleft palate (CLP). Results: There were 59 eligible cases (1.21/1000 births), including 25 CL, 12 CP and 22 CLP cases. The peak incidence was in February (1.96/1000 births) and the lowest in September (0.67/1000 births). There was significant inverse correlation with the months from winter (December) to autumn (November) for all categories except for CP. When analysed by seasons, significant inverse correlation from winter to autumn was observed for all categories, and significant differences in incidence was demonstrated for CL+/-CP and CL. Conclusions: The seasonality in the incidence of oral-facial clefts found in this study suggested that environmental factors are probably involved, which would have accounted for the reported seasonal variations and geographical and racial differences in the incidence in the literature.

L-alanyl-glutamine pretreatment attenuates acute inflammatory response in children submitted to palatoplasty

PURPOSE: To evaluate the effects of L-alanyl-glutamine (L-Ala-Gln) pretreatment on oxidative stress, glycemic control and inflammatory response in children submitted to palatoplasty. METHODS: Thirty male children scheduled for routine palatoplasty, age range 2-10 years, were randomly assigned to 2 groups (n=15): Group A (saline, control) and Group B (L-Ala-Gln). Group A received normal saline 100 ml, delivered intravenously by infusion pump over 3 hours preceding surgical procedure. Group B was treated with L-Ala-Gln, 20% solution (0.5g/Kg), adding saline to complete 100ml. Peripheral venous blood samples were collected at 5 different time-points: T1- at the beginning of the study, 3 h prior to the surgical procedure; T2- at the end of the infusion (before the surgical procedure), T3- at the end of the surgical procedure, T4- 6 h postoperative and T5- 12 h postoperative. Parameters analyzed included glutathione (GSH), thiobarbituric acid reactive substances (TBARS), glucose, insulin, C-reactive protein (CRP) and interleukin-6 (IL-6). RESULTS: No statistically significant differences were found between groups comparing glucose, insulin, TBARS, GSH and IL-6 levels. However, glucose levels increased (P <0.001) in T4 and T5 as compared to baseline (T1) in control group as opposed to L-Ala-Gln group. IL-6 increased in both groups during the postoperative period, indicating an increased inflammatory response. L-Ala-Gln pretreatment did not suppress the increase of IL-6, but reduced the increase of postoperative CRP levels (T5, p <0.01). CONCLUSION: Pretreatment with L-Ala-Gln in children submitted to palatoplasty attenuates the inflammatory response in early post-operative period and promoted a better glycemic control.

Maternal fever during early pregnancy and the risk of oral clefts

An increased risk of birth defects after hyperthermic exposures has been confirmed in animal studies, but population studies have yielded inconsistent results. Oral clefts are a common birth defect and have been associated with these exposures in some of these studies. In this study, data from the National Birth Defects Prevention Study was used to evaluate the association of maternal report of febrile illness in early pregnancy and the risk of oral clefts. All oral cleft cases born between 1997 and 2004 were compared with nonmalformed controls born in the same geographical region during the same time period. Mothers reporting febrile illness during pregnancy were stratified by fever grade and antipyretic use. Logistic regression models were used to generate crude and adjusted odds ratios for exposure to fever and association with each oral cleft phenotype. The dataset included 5821 controls, 1567 cases of cleft lip with or without cleft palate (CL+/-P) and 835 cases of cleft palate only. A modestly increased risk was observed for isolated CL+/-P (odds ratio, 1.28; 95% confidence interval, 1.01-1.63). Stratification by fever grade (body temperature <101.5 degrees or > or =101.5 degrees F) did not yield significant differences in risk. Risk estimates were higher among women who reported a fever, but did not take antipyretics to control their fever, particularly for nonisolated compared with isolated oral clefts. This finding suggests that adequate control of fever may diminish the deleterious effects of fever in cases of oral cleft.

Ambient air pollution and birth defects in brisbane, australia

Background

Birth defects are a major public health concern as they are the leading cause of neonatal and infant mortality. Observational studies have linked environmental pollution to adverse birth outcomes, including congenital anomalies. This study examined potential associations between ambient air pollution and congenital heart defects and cleft lip or palate among births in Brisbane, Australia (1998–2004).

Methods

Ambient air pollution levels were averaged over weeks 3–8 of pregnancy among 150,308 births. Using a case–control design, we used conditional logistic regression and matched cases to 5 controls. Analyses were conducted using all births, and then births where the mother resided within 6 and 12 kilometers of an ambient air quality monitor.

Findings

When analyzing all births there was no indication that ambient air pollution in Brisbane was associated with a higher risk of cardiac defects. Among births where the mother resided within 6 kilometers of an ambient air quality monitor, a 5 ppb increase in O₃ was associated with an increased risk of pulmonary artery and valve defects (OR 2.96, 95% CI: 1.34, 7.52) while a 0.6 ppb increase in SO₂ was associated with an increased risk of aortic artery and valve defects (OR 10.76, 95% CI: 1.50, 179.8). For oral cleft defects among all births, the only adverse association was between SO₂ and cleft lip with or without cleft palate (OR 1.27, 95% CI: 1.01, 1.62). However, various significant inverse associations were also found between air pollutants and birth defects.

Conclusions

This study found mixed results and it is difficult to conclude whether ambient air pollution in Brisbane has an adverse association with the birth defects examined. Studies using more detailed estimates of air pollution exposure are needed.

Seasonal Variation and Regional Distribution of Cleft Lip and Palate in Zambia

Objective:

To assess variations in seasonality and regional distribution of orofacial clefts in babies born in Zambia.

Design:

A retrospective chart review was done using records of all cleft procedures performed by the only plastic surgeon in Zambia (G.J.). Delivery data from the University Teaching Hospital (UTH) were also examined to estimate the birth prevalence of orofacial clefts (55,108 live births between 2001 and 2005).

Patients:

All cleft patients operated in Zambia from 2000 to 2006 (413 patients).

Results:

A low birth prevalence of clefts (1/4239 live births) was found using UTH delivery data. Surgical data showed no difference for the frequency of one gender over another overall (M:F ratio is 1.04; p  =  .70). More bilateral clefts occurred in cleft lip and palate (CLP) patients than in cleft lip (CL) patients (p < .01), and more unilateral left-sided clefts occurred in CL than in CLP patients (p  =  .03). The data reflected seasonal variation in month of birth of cleft lip with or without cleft palate (CL±P) patients (p < .01), with a peak in April and May and more births in March through August (57.2%) than in September through February (42.8%). There was regional variation in cleft births among the nine Zambian provinces (p < .01).

Conclusions:

This study shows seasonal variation in clefts that may be explained, at least in part, by environmental factors affecting the development of CL±P. Access to treatment is likely the major determinant of regional disparity in clefts. These results provide a basis for further epidemiological studies of orofacial clefts in Zambia.