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Kulesa-Mrowiecka M, Lipowicz A, Marszałek-Kruk BA, Kania D, Wolański W, Myśliwiec A, Dowgierd K. Characteristics of Factors Influencing the Occurrence of Cleft Lip and/or Palate: A Case Analysis and Literature Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:399. [PMID: 38671616 PMCID: PMC11049449 DOI: 10.3390/children11040399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/02/2024] [Accepted: 03/15/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Cleft lip with or without cleft palate (CL/P) stands as the most common congenital facial anomaly, stemming from multifactorial causes. OBJECTIVE Our study aimed to ascertain the prevalence and characteristics of cleft palates, identify associated risk factors to inform prevention and prenatal detection for early intervention, and assess postoperative rehabilitation protocols for cleft palates. DESIGN This study employs a retrospective descriptive and clinical approach. PATIENTS The study includes 103 children with cleft palates treated at the Department of Head and Neck Surgery Clinic for Children and Young Adults, Department of Clinical Pediatrics, University of Warmia and Mazury. METHODS We conducted a thorough evaluation of records, considering variables such as sex, cleft type, maternal occupation, parental education, and family history of clefts. Data analysis was carried out using R software version GPL-3 and ordinal logistic regression analyses. RESULTS Notably, children born to mothers who experienced significant stress during pregnancy exhibited a 9.4-fold increase in the odds of having bilateral cleft palates. Conversely, no substantial evidence was found to support the influence of the child's sex, birth order, body mass, maternal exposure to workplace toxins, infections, or drug toxicity on the dependent variable. CONCLUSIONS Our findings suggest that children with parents who have a history of clefts and those with less educated mothers are more likely to develop bilateral cleft palates. Additionally, children born to mothers experiencing stress during pregnancy face an increased risk of bilateral cleft palates. It is important to note that there is a paucity of literature on rehabilitation following various cleft palate surgical techniques in children.
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Affiliation(s)
- Małgorzata Kulesa-Mrowiecka
- Department of Rehabilitation in Internal Diseases, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Krakow, Poland;
| | - Anna Lipowicz
- Department of Anthropology, Institute of Environmental Biology, Wroclaw University of Environmental and Life Sciences, 50-375 Wroclaw, Poland;
| | | | - Damian Kania
- Laboratory of Physiotherapy and Physioprevention, Institute of Physiotherapy and Health Sciences, Academy of Physical Education, 40-065 Katowice, Poland; (D.K.); (A.M.)
| | - Wojciech Wolański
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland;
| | - Andrzej Myśliwiec
- Laboratory of Physiotherapy and Physioprevention, Institute of Physiotherapy and Health Sciences, Academy of Physical Education, 40-065 Katowice, Poland; (D.K.); (A.M.)
| | - Krzysztof Dowgierd
- Head and Neck Surgery Clinic for Children and Young Adults, Department of Clinical Pediatrics, University of Warmia and Mazury, 10-561 Olsztyn, Poland
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Rafisa A, Sarilita E, Delage B, Munger RG, Mossey PA. Situational analysis of nutritional status among 1899 children presenting with cleft lip and/or palate in Indonesia. J Glob Health 2023; 13:04127. [PMID: 37856736 PMCID: PMC10586796 DOI: 10.7189/jogh.13.04127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Background Given the increased risk of malnutrition in children with cleft lip and/or palate (CLP), determining their nutritional status is critical for preventing adverse surgical risks. However, no such disaggregated, national-level data are available in Indonesia. We aimed to determine the nutritional status of patients with clefts in Indonesia and to identify problems and solutions for malnutrition cases within the population. Methods In this cross-sectional study, we considered records of individuals who underwent primary surgery for CLP in Smile Train-sponsored facilities in Indonesia between 1 January 2016 and 31 December 2021 (n = 18 480). We only included children under the age of five with an evaluation date prior to admission date and excluded subjects with invalid data values. We classified their nutritional status by z-scores according to the World Health Organization Child Growth Standard (2006). Malnutrition cases cover four indicators - stunting, wasting, underweight, and overweight. We compared the prevalence for malnutrition cases in children under the age of five using national health survey data. Results We included 1899 records following data validation. The national prevalence of stunting (24.4%), wasting (12.5%), and overweight cases (12.9%) was high, while underweight cases (6.8%) were comparatively low. Statistical analyses showed significant differences in nutritional status based on length/height-for-age between girls and boys aged 0-5 months (P = 0.008) and 48-60 months (P = 0.001), and based on body mass index-for-age (P = 0.000) between girls and boys aged 0-5 months. Girls in different age groups exhibited a statistically significant difference in nutritional status based on length/height-for-age (P = 0.002) and weight-for-age (P = 0.017). Concurrent stunting and overweight were the most common forms of concurrent malnutrition (8.7%). We found a significant difference in the prevalence of underweight (P = 0.001) and overweight (P = 0.000) cases between children with CLP and those without CLP. Conclusions Our findings highlight the importance of nutritional interventions for children with orofacial clefts in Indonesia, and the importance of age and gender in their design and implementation. Further investigation is necessary to explore the risks of overweight and concurrent malnutrition among this population.
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Affiliation(s)
- Anggun Rafisa
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Jatinangor, West Java, Indonesia
| | - Erli Sarilita
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Jatinangor, West Java, Indonesia
| | | | - Ronald G Munger
- Centre for Epidemiologic Studies, Utah State University, Logan, Utah, USA
| | - Peter A Mossey
- Division of Oral Health Sciences and WHO Collaborating Centre for Oral Health & Craniofacial Anomalies, University of Dundee, Dundee, Scotland, UK
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Charoenvicha C, Wongkawinwoot K, Sirikul W, Khwanngern K, Sirimaharaj W. Predisposing factors of non-syndromic cleft lip and cleft palate in the northern Thai population: A 10-year retrospective case-control study. Congenit Anom (Kyoto) 2023; 63:147-153. [PMID: 37515453 DOI: 10.1111/cga.12529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/01/2023] [Accepted: 06/04/2023] [Indexed: 07/30/2023]
Abstract
The most common congenital anomaly is orofacial cleft, which is categorized into two main types: cleft lip with or without cleft palate (CL/P) and cleft palate only (CPO). One of the most accepted etiologies is multifactorial (gene-environment). This study aimed to identify the amendable risk factors of an orofacial cleft in Northern Thailand. A retrospective case-control study in Maharaj Nakorn Chiang Mai Hospital was conducted from 2011 to 2020. One hundred and seventeen cases of CL/P and CPO were included. Forty-nine normal children were enrolled in a time-matched control group. Exploratory survey data on maternal exposures were collected. Multivariate logistic regression was used to estimate the adjusted association between maternal exposures and CL/P, and CPO occurrence. Multivariate analysis identified three predisposing factors that increased the risk of CL/P and CPO. The first factor was caffeine consumption with a total amount of 560 mg/week (adjusted OR: 7.59; 95% CI: 2.48-23.23; p < 0.001). The second factor was any smoker or passive smoking (adjusted OR: 8.47; 95% CI: 1.63-43.92; p = 0.011). The third factor was a low socioeconomic status (income of lower than 270 USD/month; adjusted OR: 4.05; 95% CI: 1.07-15.27; p = 0.039). From the 10-year study in Northern Thailand: caffeine consumption, exposure to cigarette smoke, and low socioeconomic status were identified as associated negative factors for orofacial clefts. We propose that preconceptional counseling for risk reduction should be emphasized in reducing the mother's exposure to these factors. Future investigations in large multicenter populations are suggested.
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Affiliation(s)
- Chirakan Charoenvicha
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
- Clinical Research Center, Chiangmai University, Chiang Mai, Thailand
- Princess Sirindhorn IT Foundation Craniofacial Center, Chiang Mai University, Chiang Mai, Thailand
| | - Karn Wongkawinwoot
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Wachiranun Sirikul
- Faculty of Medicine, Department of Community Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Krit Khwanngern
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
- Clinical Research Center, Chiangmai University, Chiang Mai, Thailand
- Princess Sirindhorn IT Foundation Craniofacial Center, Chiang Mai University, Chiang Mai, Thailand
| | - Wimon Sirimaharaj
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
- Clinical Research Center, Chiangmai University, Chiang Mai, Thailand
- Princess Sirindhorn IT Foundation Craniofacial Center, Chiang Mai University, Chiang Mai, Thailand
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Chai C, Cheng L, Jiao J, Dang J, Jin S. A Comprehensive Investigation on Potential Risk Factors for NSCL/P in a Rural District of Hebei Province, China. Cleft Palate Craniofac J 2023; 60:211-218. [PMID: 34787503 DOI: 10.1177/10556656211058833] [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] [Indexed: 01/18/2023] Open
Abstract
Non syndromic cleft lip with or without palate (NSCL/P), one of the most common birth defects, is closely related to various risk factors. However, information regarding risk factors for NSCL/P in rural districts in China is very limited thus far. The objective of this study was designed to identify the potential risk factors for NSCL/P in rural districts. A comprehensive retrospective investigation including 435 NSCL/P patients and 402 healthy children was carried out in Hebei Province, China. Multiple logistic regression analysis and transmission disequilibrium test (TDT) were respectively used to identify non-genetic and genetic risk factors for NSCL/P, and then PLINK was used to explore the relationship between non-genetic and genetic risk factors. The results showed that maternal periconceptional exposure to pesticides and herbicides, as well as low parental education level were involved in the increased risk of NSCL/P, whereas maternal folic acid and multivitamin supplementation use during preconception period were associated with the reduced risk of NSCL/P. TDT analysis identified 2 single nucleotide polymorphisms (SNPs) (rs7078160 and rs4752028) in VAX1 and one SNP (rs17563) in BMP4 as the genetic risk factors for NSCL/P. Further analysis showed that the genetic risk factors were closely related with the negative non-genetic risk factors. Our study identified the potential risk factors for NSCL/P in rural districts, thus providing a theoretical basis for the prevention of NSCL/P occurrence.
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Affiliation(s)
- Congna Chai
- 595156Department of Stomatology, Handan Central Hospital, Handan, China
| | - Lei Cheng
- 595156Department of Stomatology, Handan Central Hospital, Handan, China
| | - Jianjun Jiao
- 595156Department of Stomatology, Handan Central Hospital, Handan, China
| | - Juan Dang
- Department of Orthodontics, Handan Stomatological Hospital, Handan, China
| | - Shubin Jin
- 595156Department of Stomatology, Handan Central Hospital, Handan, China
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Modifiable Risk Factors of Non-Syndromic Orofacial Clefts: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121846. [PMID: 36553290 PMCID: PMC9777067 DOI: 10.3390/children9121846] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
OFCs (orofacial clefts) are among the most frequent congenital defects, but their etiology has yet to be clarified. OFCs affect different structures and functions with social, psychological and economic implications in children and their families. Identifying modifiable risk factors is mandatory to prevent the occurrence of non-syndromic OFCs (NSOFCs). PubMed, Cochrane Library, Scopus and Web of Science were searched from 1 January 2012 to 25 May 2022 and a total of 7668 publications were identified. Studies focusing on the risk factors of NSOFCs were selected, leading to 62 case-control and randomized clinical trials. Risk factors were categorized into non-modifiable and modifiable. The first group includes genetic polymorphisms, gender of the newborn, ethnicity, and familiarity. Within the second group, risk factors that can only be modified before conception (consanguinity, parental age at conception, socio-economical and educational level, area of residency and climate), and risk factors modifiable before and after conception (weight, nutritional state, acute and chronic diseases, psychophysical stress, licit and illicit drugs, alcohol, smoke, pollutants and contaminants) have been distinguished. This study provides a wide overview of the risk factors of NSOFCs, focusing on modifiable ones, to suggest new perspectives in education, prevention, medical interventions and clinical research.
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Fuangtharnthip P, Chonnapasatid W, Thiradilok S, Manopatanakul S, Jaruratanasirikul S. Registry-Based Study of Prevalence of Cleft Lip/Palate in Thailand from 2012 to 2015. Cleft Palate Craniofac J 2021; 58:1430-1437. [PMID: 33486980 DOI: 10.1177/1055665620987677] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Two main objectives were established. First objective was to determine the prevalence of the cleft lip and/or cleft palate (CL/P) in Thailand from 2012 to 2015 using the orofacial clefts (OFCs) registry and civil registration. Second objective was to conduct a quality control of this OFC registry especially for the Birth Defects Registration (BDR). DESIGN Registry-based survey. SETTING Analyzing data from the Thailand National Health Security Office. PARTICIPANTS Registered patients with CL/P in Thailand from 2012 to 2015. INTERVENTION None. MAIN OUTCOME MEASURE Duplicated records were verified using National Identity Number (Thai ID#) and date of birth. The prevalence of CL/P and specific phenotypes was then calculated. From this prevalence estimate method, quality assurance of the OFCs registry was possible. RESULTS For the main outcome, the population-weighted pool prevalence of CL/P was 2.14 per 1000 live births (95% confidence interval of 2.08-2.20). Thai ID# and expense reimbursement systems were the main factors driving this cases capturing. However, this OFCs registration still requires active case finding with clinical verification, improvement of staff training and databases networking. CONCLUSIONS This study reported a very high CL/P prevalence of Thailand. Strengths and limitations of these OFCs registry and BDR were described.
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Affiliation(s)
- Pornpoj Fuangtharnthip
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Wannapong Chonnapasatid
- Master of Science in Advanced General Dentistry, Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Thailand
| | - Sasipa Thiradilok
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Somchai Manopatanakul
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Hong Y, Xu X, Lian F, Chen R. Environmental Risk Factors for Nonsyndromic Cleft Lip and/or Cleft Palate in Xinjiang Province, China: A Multiethnic Study. Cleft Palate Craniofac J 2020; 58:489-496. [PMID: 32924548 DOI: 10.1177/1055665620956869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the risk factors of the occurrence of nonsyndromic cleft lip and/or cleft palate (NSCL/P) in Xinjiang Province, China. DESIGN The study included 359 patients of NSCL/P and 310 controls. Information about sociodemographic characteristics, lifestyle behaviors, negative life events, possible environmental hazards exposures, and use of supplementations were collected from cases and controls. Both t test and χ2 tests were used for group comparisons. Multivariable logistic regression was used to estimate the independent associations between environmental risk factors and the presence of NSCL/P. The receiver operating characteristic curve was used to establish the predictive variables for the occurrence of NSCL/P. RESULTS The results showed that maternal pesticide exposure (odds ratio [OR] = 11.40, 95%CI: 5.40-24.10), antibiotic drugs use (OR = 1.32, 95%CI: 1.14-1.53), paternal smoking (OR = 3.30, 95%CI: 1.87-5.83), threatened abortion (OR = 12.2, 95%CI: 3.29-45.25) were associated with increased risk of NSCL/P in offspring. In contrast, maternal moderate (OR = 0.43, 95%CI: 0.20-0.92) and middle physical workload (OR = 0.48, 95%CI: 0.0.23-0.97), vitamin-B complex supplementations (OR = 0.11, 95%CI: 0.03-0.41), calcium and iron (OR = 0.27, 95%CI: 0.08-0.90) supplementations were associated with reduced risk of NSCL/P in offspring. These variables together explain nearly 60% of the variation of occurrence of NSCL/P. CONCLUSION These findings from our study may help to develop primary prevention strategies for NSCL/P in Xinjiang.
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Affiliation(s)
- Yu Hong
- Department of Preventive Medicine, 469983School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Xianrong Xu
- Department of Preventive Medicine, 469983School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Fuzhi Lian
- Department of Preventive Medicine, 469983School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Rong Chen
- Department of Preventive Medicine, 469983School of Medicine, Hangzhou Normal University, Hangzhou, China
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Chowchuen B, Surakunprapha P, Winaikosol K, Punyavong P, Kiatchoosakun P, Pradubwong S. Birth Prevalence and Risk Factors Associated With CL/P in Thailand. Cleft Palate Craniofac J 2020; 58:557-566. [PMID: 32911976 DOI: 10.1177/1055665620956896] [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] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The objectives of this study were to obtain the birth prevalence of cleft lips and/or cleft palates (CL±P) and to identify potential associated risk factors in the population of the Northeast (NE) region of Thailand. METHODS The data were collected from October 1, 2012, to September 30, 2013, for infant deliveries with nonsyndromic CL±P in all hospitals of 4 provinces in the region. Workshops were conducted to establish diagnostic criteria, treatment guidelines, referral systems, data collection, and data reporting. All patients included in this study, including a case (the child born with cleft lip and palate [CLP]) and 2 control cases (2 following children born without CLP in the same hospital), completed a questionnaire regarding demographics, cleft characteristics, and factors of interest such as alcohol intake, smoking, vitamin use, and medication. Unadjusted and adjusted odds ratio were presented for the magnitude of associations between proposed risk factors and CL±P along with 95% CIs. RESULTS The overall birth prevalence of CL±P was 1.93 per 1000 live births. There was a significant difference in percentages of infants with low birth weights (P = .03), family history of CL±P (P = .01) in cases than controls. Mothers who took self-medication or a menstrual regulation supplement were more likely to have the child with CL±P (P = .01 adjusted). CONCLUSIONS The prevalence of CL±P in the NE Thailand was high. Low infant birth weight, family history of CL±P, and the use of self-medication or menstrual regulation herbal supplement was significant factors.
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Affiliation(s)
- Bowornsilp Chowchuen
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, 26684Khon Kaen University, Khon Kaen, Thailand
| | - Palakorn Surakunprapha
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, 26684Khon Kaen University, Khon Kaen, Thailand
| | - Kengkart Winaikosol
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, 26684Khon Kaen University, Khon Kaen, Thailand
| | - Pattama Punyavong
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, 26684Khon Kaen University, Khon Kaen, Thailand
| | - Pakaphan Kiatchoosakun
- Department of Pediatrics, Faculty of Medicine, 26684Khon Kaen University, Khon Kaen, Thailand
| | - Suteera Pradubwong
- Nursing Division, Srinagarind Hospital, Faculty of Medicine, 26684Khon Kaen University, Khon Kaen, Thailand
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Mendonca VJ. Maternal Folic Acid Intake and Risk of Nonsyndromic Orofacial Clefts: A Hospital-Based Case–Control Study in Bangalore, India. Cleft Palate Craniofac J 2019; 57:678-686. [DOI: 10.1177/1055665619893214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Orofacial clefts are the most common congenital anomaly worldwide. Cleft etiology appears to be multifactorial, with genetic and environmental components. Although periconceptional folic acid supplementation has been shown to be protective for neural tube defects, current evidence for its role in cleft prevention is mixed with few studies from low- and middle-income countries. Aim: To investigate the association between periconceptional folic acid intake and incidence of nonsyndromic orofacial clefts among infants in Bangalore, India. Methods: A hospital-based case–control study (106 cases, 212 controls) utilizing a questionnaire to collect data on prenatal supplements, dietary folate, and potentially confounding factors. Multivariate logistic regression analysis was used to assess relationships between folic acid supplementation and all nonsyndromic clefts, and in separate analyses for cleft lip and/or palate (CL/P) and cleft palate (CP), adjusting for statistically significant variables. Results: A statistically significant protective association was found for separate folic acid supplements (not combined with iron or multivitamins) taken in the periconceptional period and all clefts combined (adjusted odds ratio [OR]: 0.62, 95% confidence interval [CI], 0.45-0.86) and CL/P (adjusted OR: 0.57; 95% CI, 0.38-0.86). Higher levels of dietary folate were found to be associated with a reduced risk for all clefts (adjusted OR: 0.98, 95% CI, 0.96-0.99), CL/P (adjusted OR: 0.98, 95% CI, 0.96-0.99), and CP (adjusted OR: 0.96, 95% CI, 0.93-0.99). Conclusion: This study provides limited evidence for a protective association of periconceptional folic acid supplementation with nonsyndromic orofacial clefts. The low proportion of mothers taking folic acid supplements in the periconceptional period highlights the need for increased education and awareness regarding prenatal nutrition.
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Wei Y, Jin L, Li Z, Liu J, Wang L, Pi X, Yin S, Wang C, Ren A. Levels of uranium and thorium in maternal scalp hair and risk of orofacial clefts in offspring. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2019; 204:125-131. [PMID: 31029986 DOI: 10.1016/j.jenvrad.2019.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 06/09/2023]
Abstract
Uranium and thorium are common radioactive elements that exist in the environment. However, few environmental epidemiological studies have focused on their possible effects on congenital malformations. Here, we explored the association between uranium and thorium concentrations in maternal scalp hair grown from 3 months before to 3 months after conception, namely during the periconceptional period and the risk of orofacial clefts (OFCs) in offspring. Our study included 153 women whose pregnancies were affected by OFCs (cases) and 601 women who delivered infants without birth defects (controls) from four provinces in China. Face-to-face interviews were used to collect sociodemographic characteristics with a structured questionnaire. Concentrations of uranium and thorium in maternal scalp hair grown during the periconceptional period were detected using inductively coupled plasma-mass spectrometry. The risk of OFCs in association with higher concentrations of the two radioactive elements was estimated using odds ratios (ORs) and 95% confidence intervals (CIs) while adjusting for potential confounding factors. The levels of uranium and thorium in maternal hair were in agreement with the published literature. After adjusting for several confounders, the ORs of thorium in the highest, upper, and lower quartile versus the lowest quartile were 2.63 (95% CI, 1.41-4.92), 1.98 (95% CI, 1.03-3.79), and 2.73 (95% CI, 1.46-5.12), respectively. No association was found between levels of uranium and the risk of OFCs. Maternal periconceptional exposure to thorium may be a risk factor for OFCs in offspring.
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Affiliation(s)
- Yihui Wei
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Lei Jin
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Zhiwen Li
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Jufen Liu
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Linlin Wang
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Xin Pi
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Shengju Yin
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Chengrong Wang
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China
| | - Aiguo Ren
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing 100191, PR China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, PR China.
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Abstract
INTRODUCTION There is controversial evidence from the literature regarding the protective effect of folic acid supplementation during pregnancy against orofacial clefts. The authors undertook this meta-analysis to assess whether folate supplementation during pregnancy can reduce the risk of nonsyndromic cleft lip with or without cleft palate (CL/P) and cleft palate only (CPO) in infants. METHODS Eligible articles were identified by searching databases, including PubMed, Medline, Scopus, ISI (Web of Knowledge) to September 2017. A meta-analysis was performed to evaluate the effects of maternal supplementation on oral clefts. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using Stata software. Publication bias was assessed by the Begg and Egger test. (Registration ID: CRD42018083922) RESULTS:: Out of the 1630 articles found in the authors' initial literature searches, 6 cohort studies, and 31 case-control studies were included in the authors' final meta-analysis. The results of the main analysis revealed that maternal folate supplementation was associated with a modest but statically significant decreased risk of all cleft subtypes (OR = 0.69, 95% CI: 0.60, 0.78). Folic acid intake alone was inversely associated with CL/P (OR = 0.73, 95% CI: 0.62-0.85,) but to a lesser extent than CPO (OR = 0.75, 95% CI = 053-1.04). Multivitamin intake had a significant protective effect for CL/P (OR = 0.65 95% CI = 0.55-0.80) as well as CPO (OR = 0.69, 95% CI = 0.53-0.90). CONCLUSIONS Our results indicate that maternal supplementation in early pregnancy reduces the risk of nonsyndromic CL/P and CPO in infants. These data can serve to reassure women planning a pregnancy to consume multivitamins during the periconception period to protect against oral clefts.
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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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13
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Mbuyi-musanzayi S, Kayembe TJ, Kashal MK, Lukusa PT, Kalenga PM, Tshilombo FK, Devriendt K, Reychler H. Non-syndromic cleft lip and/or cleft palate: Epidemiology and risk factors in Lubumbashi (DR Congo), a case-control study. J Craniomaxillofac Surg 2018; 46:1051-1058. [DOI: 10.1016/j.jcms.2018.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 04/10/2018] [Accepted: 05/02/2018] [Indexed: 11/16/2022] Open
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Wu N, Lu Y, Liu K, Li Z, Liu Q, Lu L. Associations of ABCA4 and MAFB with Nonsyndromic Cleft Lip with or without Cleft Palate in a Northeastern Chinese Population. J HARD TISSUE BIOL 2018. [DOI: 10.2485/jhtb.27.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nan Wu
- Department of Oral and Maxillofacial Surgery, China Medical University School of Stomatology
| | - Yongping Lu
- Key Laboratory of Reproductive Health, Liaoning Province Research Institute of Family Planning
| | - Kun Liu
- Department of Oral and Maxillofacial Surgery, Jinan Stomatological Hospital
| | - Zengjian Li
- Department of Oral and Maxillofacial Surgery, China Medical University School of Stomatology
| | - Qiang Liu
- Department of Oral and Maxillofacial Surgery, China Medical University School of Stomatology
| | - Li Lu
- Department of Oral and Maxillofacial Surgery, China Medical University School of Stomatology
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15
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Silva HPVD, Arruda TTS, Souza KSCD, Bezerra JF, Leite GCP, Brito MEFD, Lima VMGDM, Luchessi AD, Bortolin RH, Ururahy MAG, Rezende AAD. Risk factors and comorbidities in Brazilian patients with orofacial clefts. Braz Oral Res 2018; 32:e24. [PMID: 29641641 DOI: 10.1590/1807-3107bor-2018.vol32.0024] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 02/19/2018] [Indexed: 02/17/2024] Open
Abstract
Considering that environmental risk factors substantially contribute to the etiology of orofacial clefts and that knowledge about the characteristics and comorbidities associated with oral clefts is fundamental to promoting better quality of life, this study aimed to describe the risk factors, main characteristics, and comorbidities of a group of patients with cleft lip and/or cleft palate (CL/P) from Rio Grande do Norte (RN), Brazil. Data were obtained from 173 patients with CL/P using a form from the Brazilian database on Orofacial Clefts. Most patients were male with cleft lip and palate and had a normal size and weight at birth; presented few neonatal intercurrent events; and had anemia and respiratory and cardiovascular diseases as main associated comorbidities. They also required timely surgical rehabilitation and multidisciplinary care to stimulate their neuropsychomotor development. In addition, a high frequency of familial recurrence and of parental consanguinity was evidenced in the studied population, especially for the cleft lip and cleft palate type. Other relevant findings were the considerable maternal exposure to alcohol, infections, smoking, and hypertension, as well as low supplementation with vitamins and minerals and deliberate consumption of analgesics, antibiotics, and antihypertensives during pregnancy. Characterization of the CL/P patient profile is essential for the planning of health services and integration among the health professionals involved in the diagnosis and treatment of these malformations. Our results reinforce the need for additional research to confirm the association between environmental factors and the development of orofacial clefts.
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Affiliation(s)
| | - Thaynnan Thómaz Silva Arruda
- Department of Clinical and Toxicological Analyses, Universidade Federal do Rio Grande do Norte - UFRN, Natal, RN, Brazil
| | - Karla Simone Costa de Souza
- Department of Clinical and Toxicological Analyses, Universidade Federal do Rio Grande do Norte - UFRN, Natal, RN, Brazil
| | - João Felipe Bezerra
- Department of Clinical and Toxicological Analyses, Universidade Federal do Rio Grande do Norte - UFRN, Natal, RN, Brazil
| | | | | | | | - André Ducati Luchessi
- Department of Clinical and Toxicological Analyses, Universidade Federal do Rio Grande do Norte - UFRN, Natal, RN, Brazil
| | - Raul Hernandes Bortolin
- Department of Clinical and Toxicological Analyses, Universidade Federal do Rio Grande do Norte - UFRN, Natal, RN, Brazil
| | - Marcela Abbott Galvão Ururahy
- Department of Clinical and Toxicological Analyses, Universidade Federal do Rio Grande do Norte - UFRN, Natal, RN, Brazil
| | - Adriana Augusto de Rezende
- Department of Clinical and Toxicological Analyses, Universidade Federal do Rio Grande do Norte - UFRN, Natal, RN, Brazil
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16
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Dien VHA, McKinney CM, Pisek A, Pitiphat W. Maternal exposures and risk of oral clefts in South Vietnam. Birth Defects Res 2018; 110:527-537. [PMID: 29322637 DOI: 10.1002/bdr2.1192] [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] [Received: 10/12/2017] [Revised: 12/06/2017] [Accepted: 12/15/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Oral clefts are among the most common congenital anomalies. Most studies on risk factors of oral clefts have been carried out in developed countries. We investigated the associations between maternal exposures in the first trimester and oral clefts in South Vietnam. METHODS We conducted a hospital-based case-control study during October 2014-November 2015. Cases included 170 patients with nonsyndromic cleft lip with or without cleft palate and those with cleft palate only. Controls were 170 children without oral clefts, matched to each case by age and gender. Mothers were interviewed using structured questionnaire. We performed conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Passive smoking was associated with increased risk of oral clefts in univariate analysis, but not in multivariable analysis (adjusted OR [aOR] = 1.68; 95% CI, 0.53-5.37). No association was observed between liver intake and oral clefts. Compared with nondrinkers, mothers who reported consumption of caffeine-containing beverages were more likely to have an infant with oral cleft (aOR = 5.89; 95% CI, 1.08-32.00). Periconceptional use of folic acid and multivitamins supplementation was associated with reduced risk of oral clefts (aOR = 0.01; 95% CI, 0.00-0.09 and aOR = 0.03; 95% CI, 0.01-0.13, respectively). CONCLUSIONS The results suggest no associations of maternal passive smoking or liver intake with oral clefts. Periconceptional use of folic acid or multivitamins may protect against oral clefts. Further studies are warranted to examine the roles of caffeine consumption in pregnant mothers on occurrence of oral clefts in offspring.
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Affiliation(s)
- Vu H A Dien
- Department of Community Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Christy M McKinney
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, USA
| | - Araya Pisek
- Department of Community Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Waranuch Pitiphat
- Department of Community Dentistry, Faculty of Dentistry, and Chronic Inflammatory and Systemic Diseases Associated with Oral Health Research Group, Khon Kaen University, Khon Kaen, Thailand
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Sarmiento K, Valencia S, Gracia G, Hurtado-Villa P, Zarante I. Clinical and Epidemiologic Description of Orofacial Clefts in Bogota and Cali, Colombia, 2001-2015. Cleft Palate Craniofac J 2017; 55:517-520. [PMID: 29554446 DOI: 10.1177/1055665617741062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Among congenital craniofacial anomalies, orofacial clefts (OFCs) are the most common. Global prevalence is 2 in 1000 and in Colombia, 1 in 700. Our goal was to describe cleft palate (CP) prevalence and cleft lip with or without cleft palate (CL±P) from 2001 to 2015 in Bogota and Cali, Colombia. METHOD Using the ECLAMC case-control design method, information was obtained from the Congenital Anomalies Monitoring and Surveillance Programs in Bogota and Cali. We describe the prevalence of cases classified into the following groups: isolated, polymalformed, and syndromic. The proportion of cases and controls was 1:4. Data were analyzed using frequency distribution and Student t test to compare means and 95% confidence intervals (CIs). RESULTS We identified 529 OFC cases and 2116 controls from 448,930 births: a rate of 11.8 per 10,000 (CI = 10.80-12.83). From the total cases, 73% were identified with CL/CP compared to 27% with CP. Males had higher CL±P (59%) prevalence, whereas the highest neonatal mortality was observed among polymalformed cases (7%). The most common anomaly identified among our cases was cleft lip without isolated cleft palate (58%). We found that OFCs are linked to birthweight, size, and gestational age and higher parity with statistically significant differences in all variables compared to controls. CONCLUSIONS OFC is a highly prevalent anomaly in Colombia, with a range of maternal and infant differences across case subgroups. The identification of important OFC subgroups that follow certain patterns of prevalence may prove useful to primary and tertiary care facilities with the goal of reducing further disability.
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Affiliation(s)
- K Sarmiento
- 1 Department of Physiological Sciences, School of Medicine, Pontifical Xaverian University, Bogota, Colombia
| | - S Valencia
- 2 City of Bogota Health Department, Bogota, Colombia
| | - G Gracia
- 2 City of Bogota Health Department, Bogota, Colombia
| | - P Hurtado-Villa
- 3 Department of Basic Sciences, School of Health, Pontifical Xaverian University, Cali, Colombia
| | - I Zarante
- 4 Institute of Human Genetics, Pontifical Xaverian University, Bogota, Colombia
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McKinney CM, Pisek A, Chowchuen B, DeRouen T, Muktabhant B, Pradubwong S, Yeung C, Pitiphat W. Case-control study of nutritional and environmental factors and the risk of oral clefts in Thailand. ACTA ACUST UNITED AC 2016; 106:624-32. [PMID: 27097933 DOI: 10.1002/bdra.23505] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/22/2016] [Accepted: 03/07/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND One infant in 700 is born with an oral cleft. Prior studies suggest low micronutrient status is associated with an increased risk of oral clefts. Environmental factors such as passive smoke exposure or supplement use may also affect oral cleft risk. We examined nutrition and environmental related risk factors for oral clefts. METHODS We conducted a case-control study in Northeast Thailand in 2012 to 2013. We enrolled 95 cases and 95 controls. We recruited cases with a nonsyndromic cleft lip with or without a cleft palate (CL±P) less than 24 months old. Cases were matched to controls on age and place of conception. We collected survey data, a food frequency questionnaire, and measured zinc concentrations in toenail trimmings. We calculated descriptive statistics by case and control status. We used conditional logistic regression to estimate unadjusted and adjusted associations, 95% confidence intervals (CIs), and p-values. RESULTS Any liver intake (adjusted OR [aOR] for ≥1/week versus none), 10.58; 95%CI, 1.74-64.37, overall p = 0.02) and the presence of food insecurity (aOR, 9.62; 95% CI, 1.52-61.05; p = 0.02) in the periconceptional period increased CL±P risk. Passive smoke exposure increased the risk of CL±P (aOR, 6.52; 95% CI, 1.98-21.44; p < 0.01). Toenail zinc concentrations were not associated with CL±P risk. CONCLUSION Our findings add to a growing body of knowledge of environmental risk factors for oral clefts from low- and middle-income countries. Our findings on liver are contradictory to prior results. Large multisite studies are needed to identify environmental and genetic risk factors for oral clefts. Birth Defects Research (Part A) 106:624-632, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Christy M McKinney
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington
| | - Araya Pisek
- Department of Community Dentistry, Faculty of Dentistry, Khon Kaen University, Thailand
| | - Bowornsilp Chowchuen
- Division of Plastic Surgery, Faculty of Medicine, Khon Kaen University, Thailand
| | - Timothy DeRouen
- Departments of Oral Health Sciences, Biostatistics, and Global Health, Schools of Dentistry and Public Health, USA
| | - Benja Muktabhant
- Department of Nutrition, Faculty of Public Health, Khon Kaen University, Thailand
| | - Suteera Pradubwong
- Nursing Division, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand
| | - Cathy Yeung
- Departments of Pharmacy and Pharmaceutics, School of Pharmacy, University of Washington, Seattle, Washington
| | - Waranuch Pitiphat
- Department of Community Dentistry, Faculty of Dentistry, and Chronic Inflammatory and Systemic Diseases Associated with Oral Health Research Group, Khon Kaen University, Thailand
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A Multisite Study of Oral Clefts and Associated Abnormalities in Thailand: The Epidemiologic Data. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 3:e583. [PMID: 26894008 PMCID: PMC4727692 DOI: 10.1097/gox.0000000000000570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 11/03/2015] [Indexed: 11/25/2022]
Abstract
Background: This study aimed to obtain epidemiological data of birth incidences of cleft lips and/or cleft palates (CLP) in the Thai population with associated risk factors. Methods: The data were collected for a period of 12 months between 2003 and 2004 for infants’ deliveries with CLP and associated risk factors in all hospitals of 6 provinces from 4 regions of Thailand. The birth incidence, related factors with cleft birth, and linkage with geographical area were analyzed by the geographic information system. Results: Phitsanulok, Saraburi, and Khon Kaen had higher birth incidences for CLP of 2.01, 1.69, and 1.66 per 1000 live births, respectively, and the overall birth incidence was 1.51 per 1000 live births. There were a total of 112 cleft births (61 males and 51 females) with 43 cleft lips, 18 cleft palates, and 51 cleft lips + cleft palates. The northeast region had infants with different gestational ages at birth and mothers with higher intakes of vitamins and a use of vitamin A supplement or retinoic acid than others. A use of folic acid supplement was low in all 4 regions. Conclusions: The varied incidence of CLP may reflect the incomplete accuracy of case ascertainment. A number of challenges were addressed. The geographic information system was helpful for more background investigation and planning of cleft care management. Our study enables future studies of etiological factors and future birth registries.
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