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Santoro M, Mezzasalma L, Coi A, Pierini A. Orofacial Clefts and Maternal Risk Factors: A Population-Based Case-Control Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:819. [PMID: 39062268 PMCID: PMC11274858 DOI: 10.3390/children11070819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND/OBJECTIVES Orofacial clefts (OFCs) are some of the most common congenital anomalies worldwide. The aim of this case-control study was to evaluate the association of OFCs with selected maternal characteristics. METHODS Data on isolated non-syndromic cases of OFCs were extracted from the population-based registry of congenital anomalies of Tuscany. A sample of live-born infants without any congenital anomaly was used as the control group. We investigated the association with sex and some maternal characteristics: age, body mass index, smoking, and education. Adjusted odds ratios (OR) were calculated using a logistic regression model. Analyses were performed for the total OFCs and separately for cleft lip (CL) and cleft palate (CP). RESULTS Data on 219 cases and 37,988 controls were analyzed. A higher proportion of males (57.9%) was observed, particularly for CL. A decreasing trend among the maternal age classes was observed (OR:0.81 (95%CI 0.70-0.94)). Underweight mothers had a higher prevalence of OFCs, in particular for CL (OR:1.88 (95%CI 1.08-3.26)). CONCLUSIONS We found an association of OFCs with lower maternal age. The association with maternal age remains controversial and further epidemiological evidence is needed through multicenter studies. We observed that CL was more common in underweight mothers, suggesting actions of primary prevention.
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Affiliation(s)
- Michele Santoro
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
| | - Lorena Mezzasalma
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
| | - Alessio Coi
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
| | - Anna Pierini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
- Foundation Gabriele Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
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Pereira MCDM, Silva CM, Queiroz TBD, Neves LTD. Oral Cleft and Maternal History of Spontaneous Abortion: A Case-Control Study. Cleft Palate Craniofac J 2023:10556656231213726. [PMID: 37964519 DOI: 10.1177/10556656231213726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
To investigate and compare the occurrence of previous spontaneous abortion among mothers of children with nonsyndromic oral clefts (NSOC) and mothers of children without NSOC; to understand if previous spontaneous abortion could be a risk factor for the occurrence of NSOC in subsequent pregnancies. Case-control study. Nonsyndromic oral clefts is an important public health problem. In the context of investigating risk factors for the occurrence of this malformation, previous spontaneous abortion have been considered in the etiology at NSOC. There were 1004 participants. In the case group 502 mothers of children with NSOC, and in the control group 502 mothers of children without NSOC or any other malformation or syndrome. A standardized questionnaire was utilized to interview the maternal history of spontaneous abortion. The data were evaluated using descriptive statistics, and comparisons were performed using the Chi-square test, adopting a significance level of 5%. The prevalence of maternal history of spontaneous abortion was 16.3% in the case group and 15.9% in the control group. Comparing the groups there was no statistical difference (p-value = 0.93). Analyzing the occurrence of previous spontaneous abortion, separating the case group according to the type of cleft in the child, no statistical differences were observed when comparing these groups between them. Maternal history of spontaneous abortion was not associated with NSOC, not representing an independent risk factor for NSOC in the Brazilian population.
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Affiliation(s)
- Maria Carolina de Moraes Pereira
- Department of Post-Graduation in Rehabilitation Sciences, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Bauru, Sao Paulo, 17012-900, Brazil
| | - Carolina Maia Silva
- Department of Post-Graduation in Rehabilitation Sciences, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Bauru, Sao Paulo, 17012-900, Brazil
| | - Thaís Bernardes de Queiroz
- Department of Post-Graduation in Rehabilitation Sciences, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Bauru, Sao Paulo, 17012-900, Brazil
| | - Lucimara Teixeira das Neves
- Department of Post-Graduation in Rehabilitation Sciences, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Bauru, Sao Paulo, 17012-900, Brazil
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, (FOB/USP), Bauru, Sao Paulo, 17012-901, Brazil
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Cheng X, Du F, Long X, Huang J. Genetic Inheritance Models of Non-Syndromic Cleft Lip with or without Palate: From Monogenic to Polygenic. Genes (Basel) 2023; 14:1859. [PMID: 37895208 PMCID: PMC10606748 DOI: 10.3390/genes14101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Non-syndromic cleft lip with or without palate (NSCL/P) is a prevalent birth defect that affects 1/500-1/1400 live births globally. The genetic basis of NSCL/P is intricate and involves both genetic and environmental factors. In the past few years, various genetic inheritance models have been proposed to elucidate the underlying mechanisms of NSCL/P. These models range from simple monogenic inheritance to more complex polygenic inheritance. Here, we present a comprehensive overview of the genetic inheritance model of NSCL/P exemplified by representative genes and regions from both monogenic and polygenic perspectives. We also summarize existing association studies and corresponding loci of NSCL/P within the Chinese population and highlight the potential of utilizing polygenic risk scores for risk stratification of NSCL/P. The potential application of polygenic models offers promising avenues for improved risk assessment and personalized approaches in the prevention and management of NSCL/P individuals.
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Affiliation(s)
- Xi Cheng
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (X.C.); (F.D.); (X.L.)
| | - Fengzhou Du
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (X.C.); (F.D.); (X.L.)
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Xiao Long
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (X.C.); (F.D.); (X.L.)
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Jiuzuo Huang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (X.C.); (F.D.); (X.L.)
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
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Farshidfar N, Ajami S, Sahmeddini S, Goli A, Foroutan HR. Epidemiological and Spatiotemporal Descriptive Analysis of Patients with Nonsyndromic Cleft Lip and/or Palate: A 12-Year Retrospective Study in Southern Iran. BIOMED RESEARCH INTERNATIONAL 2023; 2023:7624875. [PMID: 37124932 PMCID: PMC10132907 DOI: 10.1155/2023/7624875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/20/2023] [Accepted: 03/21/2023] [Indexed: 05/02/2023]
Abstract
Objectives The current study is aimed at evaluating epidemiological characteristics and spatiotemporal distribution of cleft lip and/or palate (CL/P) in the south of Iran. Methods Data were extracted from the 1840 medical records of patients who were referred to the Cleft Lip and Palate Center of Shiraz University of Medical Sciences, from January 1, 2011, to September 1, 2022. The collected variables included demographic data (gender, birth date and season, place, birth order, and weight), cleft types and the subtypes, parental information (health status, education level, marital status, and age during the pregnancy), and other basic parameters. The chi-square test at a significance level of 0.05 was used to analyze collected data. The geographic information system (GIS) analysis was also used for analyzing the spatial distribution of CL/P patients. Results Based on our inclusion criteria, 1281 nonsyndromic patients were included in this study. The most common type was cleft lip and palate (CLP) with 48.32%, whereas cleft palate (CP) and cleft lip (CL) accounted for 40.75% and 10.93% of the patients, respectively. There was a progressive increase in the frequency of all types of clefts, and most of them were male (P ≤ 0.001). The urban population outnumbered the rural ones in all provinces. Parents were mostly healthy (>80%) with low educational status (47.5%). Most born CL/P patients were from consanguineous marriages (58.9%), especially between first-degree relatives. A majority of CL/P patients (73.1%) were born in the first two gestations with a birth weight of 2500-4000 g (77.4%). Most infants with CL/P (84.3%) were born from mothers who had at least one of the predisposing factors. Conclusion In this study, the frequency of cleft types and subtypes was similar to the existing literature. However, high rate of consanguineous marriage, especially between first-degree relatives, was the most notable feature of this population.
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Affiliation(s)
- Nima Farshidfar
- Orthodontic Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shabnam Ajami
- Orthodontic Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sarina Sahmeddini
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Goli
- Department of Sociology & Social Planning, Shiraz University, Shiraz, Iran
| | - Hamid Reza Foroutan
- Department of Surgery, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Shi FP, Huang YY, Dai QQ, Chen YL, Jiang HY, Liang SY. Maternal Common Cold or Fever During Pregnancy and the Risk of Orofacial Clefts in the Offspring: A Systematic Review and Meta-analysis. Cleft Palate Craniofac J 2023; 60:446-453. [PMID: 34918551 DOI: 10.1177/10556656211067695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The common cold and/or an associated fever during pregnancy have/has been suspected to harm the developing fetus. We sought possible correlations between a maternal common cold or fever during pregnancy and the risk of orofacial clefts in the offspring. We systematically searched PubMed and Embase using appropriate keywords, and we checked the reference lists of retrieved articles. We used random-effects models to estimate overall relative risks. Incidence of orofacial clefts. We included 13 case-control studies. Modest but statistically significant associations were found between a maternal common cold and cleft lip with or without a cleft palate (CL/CP) (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.66-2.83) and a cleft palate only (CPO) (OR 3.08; 95% CI 1.5-6.34). Furthermore, maternal fever was also associated with an increased risk of CL/CP (OR 1.91, 95% CI 1.3-2.8) and CPO (OR 1.48, 95% CI 0.83-2.63) in the offspring. Further analyses of maternal influenza (alone) yielded similar results. Although evidence of heterogeneity should be carefully evaluated, our findings suggest that maternal common cold or fever during pregnancy may be associated with a greater risk of CL/CP or CPO in the offspring. Future cohort studies using valid assessments of maternal common cold exposure during pregnancy that consider the severity of fever are needed to clarify the contribution of maternal common cold or fever status to the risk of orofacial clefts in children.
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Affiliation(s)
- Fang-Ping Shi
- Ningbo Urology and Nephrology Hospital, Ningbo, Zhejiang, China
| | - Ying-Ying Huang
- Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiao-Qun Dai
- Ningbo Urology and Nephrology Hospital, Ningbo, Zhejiang, China
| | - Yu-Lu Chen
- Ningbo Urology and Nephrology Hospital, Ningbo, Zhejiang, China
| | - Hai-Yin Jiang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, 12377Zhejiang University, Hangzhou, Zhejiang, China
| | - Si-Yuan Liang
- Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Association of gestational hypertension and preeclampsia with nonsyndromic orofacial clefts in China: a large prospective cohort study. J Hypertens 2022; 40:1352-1358. [PMID: 35762476 DOI: 10.1097/hjh.0000000000003150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The associations between hypertensive disorders of pregnancy and nonsyndromic orofacial clefts (NSOFCs) are not consistent or based on case-control study design. We hypothesize that OFCs and NSOFCs are associated with hypertensive disease in pregnancy. METHODS Data were collected from the Project for Neural Tube Defects Prevention (1993-1996), a large population-based cohort study conducted in two southern provinces of China. We used a system to record all births after 20 complete gestational weeks, including live births and stillbirths, and all structural congenital anomalies regardless of gestational week. A total of 200 215 singleton live births without other external birth defects were finally included. RESULTS The incidence of NSOFCs was 20.2 per 10 000 for the whole population, and 20.5 and 39.2 per 10 000 for women with gestational hypertension and preeclampsia, respectively. Compared with the nonpreeclampsia group, preeclampsia was associated with an increased risk of NSOFCs [adjusted risk ratio (RR) = 2.02, 95% confidence interval (CI): 1.27-3.20], cleft lip with or without cleft palate (CL/P) [adjusted RR = 2.24, 95% CI 1.37-3.65], and cleft lip and palate (CLP) [adjusted RR = 2.60, 95% CI 1.45-4.67] but not cleft lip only (CLO) [adjusted RR = 1.66, 95% CI 0.68-4.07] or cleft palate only (CPO) [adjusted RR = 1.09, 95% CI 0.27-4.45]. No associations were observed between gestational hypertension and any types of NSOFCs. CONCLUSION Our study supported that among hypertensive disorders of pregnancy, only preeclampsia increased the risk of NSOFCs and its subtypes (CL/P and CLP).
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Inostroza V, Salamanca C, Recabarren AS, Pantoja R, Leiva N, Pardo R, Suazo J. Maternal genotypes of folate/one-carbon metabolism gene variants and nonsyndromic cleft lip with or without cleft palate risk in Chile. Eur J Oral Sci 2021; 129:e12813. [PMID: 34289180 DOI: 10.1111/eos.12813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 12/27/2022]
Abstract
The aim of this study was to evaluate, in a case-control design, the association between maternal genotypes for variants in 23 genes involved in folate/one-carbon metabolism and nonsyndromic cleft lip with or without cleft palate (NSCL/P) in a Chilean population. After applying several filters to an Illumina array, we extracted 175 single nucleotide polymorphisms (SNPs) from 150 mothers of NSCL/P cases and 150 control women. Association was evaluated using computed odds ratio (OR) with a 95% confidence interval (95% CI) in additive, recessive, and dominant models. After multiple comparison correction, only SNP rs4451422 (A>C), located 237 bp downstream of the gene encoding the human folylpolyglutamate synthetase (FPGS), maintained a significant association with NSCL/P in the offspring (OR 3.03; 95% CI 1.69-5.26). The variant rs4451422 is associated with a decrease in FPGS expression according to database annotation. Our results lead to a new hypothesis that a lower activity of FPGS enzyme reduces intracellular folate levels and increases the risk of an offspring having NSCL/P.
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Affiliation(s)
- Verónica Inostroza
- Department of Anatomy, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Salamanca
- Institute for Research in Dental Sciences, School of Dentistry, Universidad de Chile, Santiago, Chile.,Research Center in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile.,Universidad Adventista de Chile, Chillán, Chile
| | - Andrea S Recabarren
- Institute for Research in Dental Sciences, School of Dentistry, Universidad de Chile, Santiago, Chile
| | - Roberto Pantoja
- Unit of Oral and Maxillofacial Surgery, Hospital Clínico San Borja-Arriaran, Santiago, Chile.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidad de Chile, Santiago, Chile
| | - Noemí Leiva
- Unit of Maxillofacial Malformations, School of Dentistry, Universidad de Chile, Santiago, Chile
| | - Rosa Pardo
- Section of Genetics, Hospital Clínico Universidad de Chile, Santiago, Chile.,Unit of Neonatology, Hospital Clínico Universidad de Chile, Santiago, Chile.,Unit of Genetics, Hospital Dr. Sótero del Río, Santiago, Chile
| | - José Suazo
- Institute for Research in Dental Sciences, School of Dentistry, Universidad de Chile, Santiago, Chile
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Silva CM, Pereira MCDM, Queiroz TBD, Neves LTD. Family history in non-syndromic orofacial clefts: Is there a pattern? Oral Dis 2021; 28:2194-2203. [PMID: 34146367 DOI: 10.1111/odi.13942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/11/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To survey the frequency and pattern of family history for non-syndromic orofacial clefts (NSOFC). Initial hypothesis: more complex forms have a higher frequency of positive family history. MATERIALS AND METHODS A retrospective study was carried with 2,668 subjects with three different types of clefts (CL Group (cleft lip), CLP Group (cleft lip and palate), and CP group (cleft palate)); family history information was collected. The Chi-square (X2 ) and Z-test were used. RESULTS A positive family history was found in 31% of the sample. The CLP Group had highest percentage and highest proportion of affected relatives, being these factors statistically significant when compared to the CP Group. Comparisons between the CLP Male and CL Male with CP Male were statistically significant. First-degree kinship was the most frequently found. CONCLUSIONS The initial hypothesis was confirmed, subjects with CLP had the highest percentage of positive family history, the highest proportion of affected relatives and had more affected relatives in comparison with CP. It is more common to find affected relatives in the CLP Male and CL Male groups when compared with CP Male. CLP and CP groups present a pattern of occurrence of the type of cleft in the family.
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Affiliation(s)
- Carolina Maia Silva
- Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo (Post-Graduation Program in Rehabilitation Sciences-HRAC/USP), Bauru, Brazil
| | - Maria Carolina de Moraes Pereira
- Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo (Post-Graduation Program in Rehabilitation Sciences-HRAC/USP), Bauru, Brazil
| | - Thaís Bernardes de Queiroz
- Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo (Post-Graduation Program in Rehabilitation Sciences-HRAC/USP), Bauru, Brazil
| | - Lucimara Teixeira das Neves
- Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo (Post-Graduation Program in Rehabilitation Sciences-HRAC/USP), Bauru, Brazil.,Bauru School of Dentistry, University of Sao Paulo, (Department of Biological Science - FOB/USP), Bauru, Brazil
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Xu W, Yi L, Deng C, Zhao Z, Ran L, Ren Z, Zhao S, Zhou T, Zhang G, Liu H, Dai L. Maternal periconceptional folic acid supplementation reduced risks of non-syndromic oral clefts in offspring. Sci Rep 2021; 11:12316. [PMID: 34112890 PMCID: PMC8192944 DOI: 10.1038/s41598-021-91825-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/01/2021] [Indexed: 11/15/2022] Open
Abstract
Maternal periconceptional folic acid supplementation (FAS) has been documented to be associated with decreased risk of nonsyndromic oral clefts (NsOC). However, the results remain inconclusive. In this population-based case–control study of 807 singletons affected by NsOC and 8070 healthy neonates who were born between October 2010 and September 2015 in Chengdu, China, we examined the association of maternal FAS with the risk of nonsyndromic cleft lip with or without cleft palate (NsCL/P), and cleft palate (NsCP). Unconditional logistic regression analysis was used to estimate the crude and adjusted odds ratios (ORs) and 95% confidential intervals (CI). Significant associations were found between maternal periconceptional FAS and decreased risk of NsCL/P (aOR = 0.41, 95% CI 0.33–0.51). This protective effect was also detected for NsCL (aOR = 0.42, 95% CI 0.30–0.58) and NsCLP (aOR = 0.41, 95% CI 0.31–0.54). Both maternal FAS started before and after the last menstrual period (LMP) were inversely associated with NsCL/P (before LMP, aOR = 0.43, 95% CI 0.33–0.56; after LMP, aOR = 0.41, 95% CI 0.33–0.51). The association between NsCP and maternal FAS initiating before LMP was also found (aOR = 0.52, 95% CI 0.30–0.90). The findings suggest that maternal periconceptional FAS can reduce the risk of each subtype of NsCL/P in offspring, while the potential effect on NsCP needs further investigations.
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Affiliation(s)
- Wenli Xu
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China
| | - Ling Yi
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China
| | - Changfei Deng
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China
| | - Ziling Zhao
- Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Longrong Ran
- Chengdu Women's & Children's Central Hospital, Chengdu, Sichuan, China
| | - Zhihong Ren
- Chengdu Women's & Children's Central Hospital, Chengdu, Sichuan, China
| | - Shunxia Zhao
- Chengdu Women's & Children's Central Hospital, Chengdu, Sichuan, China
| | - Tianjin Zhou
- Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Gang Zhang
- Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Hanmin Liu
- Pediatric Department, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China. .,Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China.
| | - Li Dai
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China. .,Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China.
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Abstract
OBJECTIVES The main objective of this study was to report the prevalence and other relative risk factors of oral clefts among newborn infants. METHODS In this study, we reviewed the data regarding 234 infants with cleft anomalies as collected in questionnaires from 2004 to 2019 and demographic parameters were assessed. RESULTS Cleft lip and palate was the most common anomaly (66.7%), followed by isolated cleft palate (28.2%), isolated cleft lip (3.8%), and cleft lip and alveolus (1.3%). The study also showed that 54.3% of all cleft patients were boys and 45.7% were girls (with a rate of 1.18) and the difference between both sexes was significant (P-value = 0.010). In addition, cleft lip and palate was more common in males and isolated cleft palate was seen more in girls (P-value = 0.002, P-value = 0.001, respectively). The parents (56.4%) had consanguinity and 20% of them had a history of cleft in their family. CONCLUSION Cleft lip and palate in boys and cleft palate in girls was more common. Parents' consanguinity and history of cleft in their family are also important factors to consider. Further studies on cleft anomalies along with or without genetic factors are required.
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11
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Rios Moura J, Eufrázio do Nascimento Andrade AP, Lima da Silva CA, De Andrade Santos PP, Souza Freitas V, Costa das Mercês E. [Clinical-epidemiological profile of orofacial fissures in a reference center from northeast Brazil]. Rev Salud Publica (Bogota) 2019; 21:209-216. [PMID: 33027331 DOI: 10.15446/rsap.v21n2.74065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 02/19/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To describe the clinical-epidemiological profile of patients with orofacial fissures treated at a reference center from northeast Brazil. MATERIALS AND METHODS Descriptive study, based on secondary data obtained from medical records. Sociodemographic information of patients and their mothers, use of medication during pregnancy, clinical and surgical aspects related to fissures, family history of malformation, and consanguinity among the parents were investigated. Data were analyzed descriptively using the SPSS (Statistical Package for Social Sciences) statistical program to obtain frequency, mean and standard deviation measures. RESULTS 51.1% of the patients with orofacial fissures were female, 46.2% were under one year of age and 54.4% lived in urban areas. The majority of mothers were between the ages of 16 and 25 during the gestational period, and 59.2% reported the use of medication. Cleft lip and palate were the most prevalent types of fissures (34.4%). On admission to the Craniofacial Anomaly Rehabilitation Center, 90.5% of the individuals had not yet undergone surgical treatment. Family history of fissure was found in 29.8% of the cases studied, but inbreeding among parents was reported in only 7.1% of them. CONCLUSION Socioeconomic and genetic factors can influence the development of orofacial fissures; this requires greater governmental attention as well as new studies for better investigation.
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Affiliation(s)
- Jamille Rios Moura
- JR: Cirurgiã dentista, M. Sc. Saúde Coletiva, Universidade Estadual de Feira de Santana, Bahia, Brasil.
| | | | | | - Pedro Paulo De Andrade Santos
- PDA: Cirurgião dentista. Ph. D. Patologia Oral, Universidade Federal do Rio Grande do Norte, Rio Grande do Norte, Brasil.
| | - Valéria Souza Freitas
- VS: Cirurgia dentista. Ph. D. Patologia Oral, Universidade Estadual de Feira de Santana, Programa de Pós-graduação em Saúde Coletiva, Bahia, Brasil.
| | - Eduardo Costa das Mercês
- EC: Cirurgião dentista. Universidade Estadual de Feira de Santana, Feira de Santana, Bahia, Brasil.
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Common polymorphism in the glycine N-methyltransferase gene as a novel risk factor for cleft lip with or without cleft palate. Int J Oral Maxillofac Surg 2018; 47:1381-1388. [DOI: 10.1016/j.ijom.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/25/2018] [Accepted: 06/06/2018] [Indexed: 12/15/2022]
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Jin H, Yingqiu C, Zequn L, Yanjun H, Yunyan Z, Shufan Z, Yiyang C, Ru L, Li Z, Yongling Z, Hongtao W, Can L. Chromosomal microarray analysis in the prenatal diagnosis of orofacial clefts: Experience from a single medical center in mainland China. Medicine (Baltimore) 2018; 97:e12057. [PMID: 30142861 PMCID: PMC6112896 DOI: 10.1097/md.0000000000012057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The aim of this study was to investigate the value of chromosomal microarray analysis (CMA) for the prenatal diagnosis of orofacial clefts.A total of 143 fetuses with oral clefts were detected by ultrasound during prenatal exam between 2012 and 2017 in our center. We categorized the cases into 4 groups: isolated cleft lip (CL) (CL only), isolated cleft palate (CP only), isolated cleft lip and palate (CLP) (CLP only), and syndromic CLP (combined with other malformations). The CMA was performed in all cases, while 139 fetuses were referred for G-banded chromosome analysis.There were 42 male and 10 female fetuses were born, with a sex ratio of 4.2:1. The isolated CLP group accounted for 74.1% (106/143) of cases, while the isolated CL, isolated CP, and syndromic CP groups accounted for 13.9% (20/143), 2% (3/143), and 10% (14/143), respectively. A total of 11 fetuses had pathogenic copy number variants (CNVs, 7.7%), including isolated CP (1/143, 0.7%), isolated CLP (5/143, 3.5%), and syndromic CLP (5/143, 3.5%). Compared with the CMA results, 5 fetuses were found to have an abnormal karyotype (5/139, 3.6%). However, no abnormalities were found in either karyotype analysis or CMA in the isolated CL group.CMA is a valuable tool for identifying submicroscopic chromosomal abnormalities in the prenatal diagnosis of oral clefts. An excellent outcome can be expected for fetuses with isolated CL that are negative for chromosomal abnormalities.
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Affiliation(s)
- Han Jin
- Department of Prenatal Diagnostic Center
| | - Cui Yingqiu
- Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Liu Zequn
- Department of Prenatal Diagnostic Center
| | | | - Zhang Yunyan
- Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhao Shufan
- Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chen Yiyang
- Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Li Ru
- Department of Prenatal Diagnostic Center
| | - Zhen Li
- Department of Prenatal Diagnostic Center
| | | | - Wang Hongtao
- Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Liao Can
- Department of Prenatal Diagnostic Center
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Raut JR, Simeone RM, Tinker SC, Canfield MA, Day RS, Agopian AJ. Proportion of Orofacial Clefts Attributable to Recognized Risk Factors. Cleft Palate Craniofac J 2018; 56:151-158. [PMID: 29727221 DOI: 10.1177/1055665618774019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Estimate the population attributable fraction (PAF) for a set of recognized risk factors for orofacial clefts. DESIGN We used data from the National Birth Defects Prevention Study. For recognized risk factors for which data were available, we estimated crude population attributable fractions (cPAFs) to account for potential confounding, average-adjusted population attributable fractions (aaPAFs). We assessed 11 modifiable and 3 nonmodifiable parental/maternal risk factors. The aaPAF for individual risk factors and the total aaPAF for the set of risk factors were calculated using a method described by Eide and Geffler. SETTING Population-based case-control study in 10 US states. PARTICIPANTS Two thousand seven hundred seventy-nine cases with isolated cleft lip with or without cleft palate (CL±P), 1310 cases with isolated cleft palate (CP), and 11 692 controls with estimated dates of delivery between October 1, 1997, and December 31, 2011. MAIN OUTCOME MEASURES Crude population attributable fraction and aaPAF. RESULTS The proportion of CL±P and CP cases attributable to the full set of examined risk factors was 50% and 43%, respectively. The modifiable factor with the largest aaPAF was smoking during the month before pregnancy or the first month of pregnancy (4.0% for CL±P and 3.4% for CP). Among nonmodifiable factors, the factor with the largest aaPAF for CL±P was male sex (27%) and for CP it was female sex (16%). CONCLUSIONS Our results may inform research and prevention efforts. A large proportion of orofacial cleft risk is attributable to nonmodifiable factors; it is important to better understand the mechanisms involved for these factors.
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Affiliation(s)
- Janhavi R Raut
- 1 Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA
| | - Regina M Simeone
- 2 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah C Tinker
- 2 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark A Canfield
- 3 Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA
| | - R Sue Day
- 1 Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA
| | - A J Agopian
- 1 Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA
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Yang Y, Liu H, Ma R, Jin L. Prevalence of Cleft Lip/Palate in the Fangshan District of Beijing, 2006-2012. Cleft Palate Craniofac J 2018; 55:1296-1301. [PMID: 29601215 DOI: 10.1177/1055665618767115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To estimate the cleft lip with or without cleft palate (CL/P) prevalence among births between 2006 and 2012 in Fangshan district of Beijing, China. DESIGN Surveillance data analysis. SETTING All hospitals that provide obstetric services in the district. PATIENTS The CL/P cases presented for this report were from 13 weeks' gestation to 7 days postpartum. MAIN OUTCOME MEASURES The CL/P prevalence was defined as the number of cases per 10 000 births, including live births and stillbirths at 28 weeks' gestation or beyond. RESULTS The overall CL/P prevalence was 18.9 (95% confidence interval [CI]: 15.1-22.7) per 10 000 births. From 2006 to 2012, the CL/P prevalence was 19.3, 20.2, 10.9, 16.1, 17.5, 25.4, and 22.3 per 10 000 births; annually, no significant change was noted ( Pfor trend = .311). The prevalence of cleft palate, cleft lip, and cleft lip and palate were 3.4 (95% CI: 2.0-5.4), 6.2 (95% CI: 4.2-8.8), and 9.4 (95% CI: 6.9-12.4) per 10 000 births, respectively. The CL/P prevalence among the nonpermanent residents (31.4 per 10 000 births) was 2.31 times that of permanent residents (13.6 per 10 000 births). Among nonpermanent residents, the CL/P prevalence showed an upward trend over the study period ( Pfor trend = .036), that increased from 38.8 (95% CI: 16.5-76.6) per 10 000 births in 2006 to 54.6 (95% CI: 25.7-100.4) per 10 000 births in 2012. CONCLUSIONS The overall CL/P prevalence was stable in the Fangshan district. However, the CL/P prevalence of the nonpermanent residents increased significantly.
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Affiliation(s)
- Yanfen Yang
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Hui Liu
- 2 Maternal and Child Health Hospital, Fangshan District, Beijing, China
| | - Ruixin Ma
- 2 Maternal and Child Health Hospital, Fangshan District, Beijing, China
| | - Lei Jin
- 3 Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health, Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Prevalence and Parental Risk Factors for Speech Disability Associated with Cleft Palate in Chinese Children-A National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111168. [PMID: 27886104 PMCID: PMC5129378 DOI: 10.3390/ijerph13111168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/11/2016] [Accepted: 11/11/2016] [Indexed: 12/02/2022]
Abstract
Although the prevalence of oral clefts in China is among the highest worldwide, little is known about the prevalence of speech disability associated with cleft palate in Chinese children. The data for this study were collected from the Second China National Sample Survey on Disability, and identification of speech disability associated with cleft palate was based on consensus manuals. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). A weighted number of 112,070 disabled children affected by cleft palate were identified, yielding a prevalence of 3.45 per 10,000 children (95% CI: 3.19–3.71). A history of speech disability in the mother (OR = 20.266, 95% CI 5.788–70.959, p < 0.0001), older paternal child-bearing age (OR = 1.061, 95% CI 1.017–1.108, p = 0.0065, per year increase in age), and lower parental education (maternal: OR = 3.424, 95% CI 1.082–10.837, p = 0.0363; paternal: OR = 2.923, 95% CI 1.245–6.866, p = 0.0138) were strongly associated with risk of speech disability associated with cleft palate in the offspring. Our results showed that maternal speech disability, older paternal child-bearing age, and lower levels of parental education were independent risk factors for speech disability associated with cleft palate for children in China. These findings may have important implications for health disparities and prevention.
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Chi C, Wang S, Wojnarowska F, Kirtschig G, Davies E, Bennett C. Safety of topical corticosteroids in pregnancy. Cochrane Database Syst Rev 2015; 2015:CD007346. [PMID: 26497573 PMCID: PMC8558096 DOI: 10.1002/14651858.cd007346.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Topical corticosteroids are the most frequently prescribed dermatological treatment and are often used by pregnant women with skin conditions. However, little is known about their safety in pregnancy. OBJECTIVES To assess the effects of topical corticosteroids on pregnancy outcomes in pregnant women. SEARCH METHODS This is an update of a review previously published in 2009. We updated our searches of the following databases to July 2015: the Cochrane Skin Group Specialised Register, the Cochrane Pregnancy and Childbirth Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 6), MEDLINE, EMBASE, and LILACS. We also searched five trials registers and checked the reference lists of included studies, published reviews, articles that had cited the included studies, and one author's literature collection, for further references to relevant RCTs. SELECTION CRITERIA Randomised controlled trials and cohort studies of topical corticosteroids in pregnant women, as well as case-control studies comparing maternal exposure to topical corticosteroids between cases and controls when studies reported pre-specified outcomes. The primary outcomes included mode of delivery, major congenital abnormality, birth weight, and preterm delivery (delivery before 37 completed weeks gestation); the secondary outcomes included foetal death, minor congenital abnormality, and low Apgar score (less than seven at 5 min). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two authors independently applied selection criteria, extracted data, and assessed the quality of the included studies. A third author was available for resolving differences of opinion. A further author independently extracted data from included studies that were conducted by authors of this systematic review. MAIN RESULTS We included 7 new observational studies in this update, bringing the total number to 14, including 5 cohort and 9 case-control studies, with 1,601,515 study subjects.Most studies found no causal associations between maternal exposure to topical corticosteroids of any potency and pregnancy outcomes when compared with no exposure. These outcomes included: mode of delivery (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.95 to 1.15, 1 cohort study, n = 9904, low quality evidence); congenital abnormalities, including orofacial cleft or cleft palate and hypospadias (where the urethral opening is on the underside of the penis) (RR 0.82, 95% CI 0.34 to 1.96, 2 cohort studies, n = 9512, low quality evidence; and odds ratio (OR) 1.07, 95% CI 0.71 to 1.60, 1 case-control study, n = 56,557); low birth weight (RR 1.08, 95% CI 0.86 to 1.36; n = 59,419, 4 cohort studies; very low quality evidence); preterm delivery (RR 0.93, 95% CI 0.81 to 1.08, 4 cohort studies, n = 59,419, low quality evidence); foetal death (RR 1.02, 95% CI 0.60 to 1.73, 4 cohort studies, n = 63,885, very low quality evidence); and low Apgar score (RR 0.84, 95% CI 0.54 to 1.31, 1 cohort study, n = 9220, low quality evidence).We conducted stratified analyses of mild or moderate potency, and potent or very potent topical corticosteroids, but we found no causal associations between maternal exposure to topical corticosteroid of any potency and congenital abnormality, orofacial clefts, preterm delivery, or low Apgar score. For low birth weight, although the meta-analysis based on study-level data was not significant for either mild to moderate corticosteroids (pooled RR 0.90, 95% CI 0.74 to 1.09, 3 cohort studies, n > 55,713) or potent to very potent corticosteroids (pooled RR 1.58, 95% CI 0.96 to 2.58, 4 cohort studies, n > 47,651), there were significant differences between the two subgroups (P = 0.04). The results from three of the individual studies in the meta-analysis indicated an increased risk of low birth weight in women who received potent to very potent topical corticosteroids. Maternal use of mild to moderate potency topical steroids was associated with a decreased risk of foetal death (pooled RR 0.70, 95% CI 0.64 to 0.77, 2 studies, n = 48,749; low quality evidence), but we did not observe this effect when potent to very potent topical corticosteroids were given during pregnancy (pooled RR 1.14, 95% CI 0.69 to 1.88, 3 studies, n = 37,086, low quality evidence).We used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group approach to rate the overall quality of the evidence. Data from observational studies started at low quality. We further downgraded the evidence because of imprecision in low birth weight and inconsistency in foetal death. Lower quality evidence resulted in lower confidence in the estimate of effect for those outcomes. AUTHORS' CONCLUSIONS This update adds more evidence showing no causal associations between maternal exposure to topical corticosteroids of all potencies and pregnancy outcomes including mode of delivery, congenital abnormalities, preterm delivery, foetal death, and low Apgar score, which is consistent with the previous version of this review. This update provides stratified analyses based on steroid potency; we found no association between maternal use of topical corticosteroids of any potency and an increase in adverse pregnancy outcomes, including mode of delivery, congenital abnormality, preterm delivery, foetal death, and low Apgar score. Similar to the previous version of the review, this update identified a probable association between low birth weight and maternal use of potent to very potent topical corticosteroids, especially when the cumulative dosage of topical corticosteroids throughout the pregnancy is very large, which warrants further investigation. The finding of a possible protective effect of mild to moderate topical corticosteroids on foetal death could also be examined.
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Affiliation(s)
- Ching‐Chi Chi
- Chang Gung Memorial HospitalDepartment of Dermatology and Centre for Evidence‐Based Medicine6, Sec West, Chia‐Pu RoadPuzihChiayiTaiwan61363
- Chang Gung UniversityCollege of MedicineTaoyuanTaiwan
| | - Shu‐Hui Wang
- Far Eastern Memorial HospitalDepartment of Dermatology21, Sec 2, Nanya S RdBanciao DistrictNew Taipei CityTaiwan220
| | | | - Gudula Kirtschig
- University of TübingenInstitute of General Medicine and Interprofessional CareTübingenGermany
| | - Emily Davies
- Amersham Hospital, Buckinghamshire Healthcare NHS TrustDepartment of Dermatology100 Gilbert Scott CourtWhielden StreetAmershamBuckinghamshireUKHP7 0JD
| | - Cathy Bennett
- Coventry UniversityCentre for Technology Enabled Health Research (CTEHR)Priory StreetCoventryUKCV1 5FB
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Figueiredo JC, Ly S, Magee KS, Ihenacho U, Baurley JW, Sanchez-Lara PA, Brindopke F, Nguyen THD, Nguyen V, Tangco MI, Giron M, Abrahams T, Jang G, Vu A, Zolfaghari E, Yao CA, Foong A, DeClerk YA, Samet JM, Magee W. Parental risk factors for oral clefts among Central Africans, Southeast Asians, and Central Americans. ACTA ACUST UNITED AC 2015; 103:863-79. [PMID: 26466527 PMCID: PMC5049483 DOI: 10.1002/bdra.23417] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 07/11/2015] [Accepted: 07/15/2015] [Indexed: 12/20/2022]
Abstract
Background Several lifestyle and environmental exposures have been suspected as risk factors for oral clefts, although few have been convincingly demonstrated. Studies across global diverse populations could offer additional insight given varying types and levels of exposures. Methods We performed an international case–control study in the Democratic Republic of the Congo (133 cases, 301 controls), Vietnam (75 cases, 158 controls), the Philippines (102 cases, 152 controls), and Honduras (120 cases, 143 controls). Mothers were recruited from hospitals and their exposures were collected from interviewer‐administered questionnaires. We used logistic regression modeling to estimate odds ratios (OR) and 95% confidence intervals (CI). Results Family history of clefts was strongly associated with increased risk (maternal: OR = 4.7; 95% CI, 3.0–7.2; paternal: OR = 10.5; 95% CI, 5.9–18.8; siblings: OR = 5.3; 95% CI, 1.4–19.9). Advanced maternal age (5 year OR = 1.2; 95% CI, 1.0–1.3), pregestational hypertension (OR = 2.6; 95% CI, 1.3–5.1), and gestational seizures (OR = 2.9; 95% CI, 1.1–7.4) were statistically significant risk factors. Lower maternal (secondary school OR = 1.6; 95% CI, 1.2–2.2; primary school OR = 2.4, 95% CI, 1.6–2.8) and paternal education (OR = 1.9; 95% CI, 1.4–2.5; and OR = 1.8; 95% CI, 1.1–2.9, respectively) and paternal tobacco smoking (OR = 1.5, 95% CI, 1.1–1.9) were associated with an increased risk. No other significant associations between maternal and paternal factors were found; some environmental factors including rural residency, indoor cooking with wood, chemicals and water source appeared to be associated with an increased risk in adjusted models. Conclusion Our study represents one of the first international studies investigating risk factors for clefts among multiethnic underserved populations. Our findings suggest a multifactorial etiology including both maternal and paternal factors. Birth Defects Research (Part A) 103:863–879, 2015. © 2015 The Authors Birth Defects Research Part A: Clinical and Molecular Teratology Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Jane C Figueiredo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Stephanie Ly
- Division of Plastic & Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California.,Department of Community Health Sciences and California Center for Population Research, UCLA Fielding School of Public Health, Los Angeles, California
| | | | - Ugonna Ihenacho
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - James W Baurley
- BioRealm LLC, Los Angeles, California.,Bioinformatics and Data Science Research Center, Bina Nusantara University, Jakarta, Indonesia
| | - Pedro A Sanchez-Lara
- Departments of Pediatrics and Pathology & Laboratory Medicine, Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, California
| | - Frederick Brindopke
- Division of Plastic & Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | | | | | - Maria Irene Tangco
- Operation Smile Philippines, Manila, Philippines.,Department of Surgery, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | | | | | - Grace Jang
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Annie Vu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Emily Zolfaghari
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Caroline A Yao
- Division of Plastic & Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Athena Foong
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Yves A DeClerk
- Departments of Pediatrics and Biochemistry and Molecular Biology, Keck School of Medicine, University of Southern California and Children's Hospital Los Angeles, Los Angeles, California
| | - Jonathan M Samet
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - William Magee
- Division of Plastic & Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
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