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Vathulya M, Singh N, Naithani M, Kessler P. An intercontinental comparison of the influence of smoking on the occurrence of nonsyndromic cleft lip and palate: a meta-analysis and systematic review. Arch Craniofac Surg 2024; 25:51-61. [PMID: 38742331 PMCID: PMC11098758 DOI: 10.7181/acfs.2023.00437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/11/2023] [Accepted: 11/06/2023] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The influence of smoking on nonsyndromic clefts has been a topic of research for many years. However, few studies have investigated the effect of smoking on causing clefts in different gene pools. METHODS A meta-analysis was conducted of case-control studies related to smoking. Keywords such as "clefts," "cleft lip," "cleft palate," "orofacial cleft," and "smoking" were used to search the MEDLINE, Embase, and Cochrane databases. RESULTS In total, 51 articles were reviewed. The RevMan software was utilized for the analysis, and the Mantel-Haenszel method was employed to pool the odds ratios (ORs) and 95% confidence intervals. Although the overall OR, a measure of the association between exposure and outcome, was higher for smokers than for non-smokers, this association was significantly stronger in individuals from Asia and South America (1.73), and lowest in Europe (1.31). Among active and passive smokers in Asia, the OR was approximately 0.93, indicating an equivalent impact from both types of smoking. CONCLUSION This analysis indirectly suggests that restriction measures targeting both active and passive smoking are crucial in Asia.
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Affiliation(s)
- Madhubari Vathulya
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Neetu Singh
- Department of Biochemistry, King George’s Medical University, Lucknow, India
| | - Manisha Naithani
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, India
| | - Peter Kessler
- Department of Cranio-Maxillofacial Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Sanchez MLN, Swartz MD, Langlois PH, Canfield MA, Agopian A. Epidemiology of Nonsyndromic, Orofacial Clefts in Texas: Differences by Cleft Type and Presence of Additional Defects. Cleft Palate Craniofac J 2023; 60:789-803. [PMID: 35225696 PMCID: PMC11104489 DOI: 10.1177/10556656221080932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To describe the current epidemiology of nonsyndromic cleft palate alone (CP) and cleft lip with or without cleft palate (CL ± P) in Texas and examine differences in the characteristics of infants with CP and CL ± P based on the presence/absence of additional defects. We used data from the Texas Birth Defects Registry, a statewide active birth defect surveillance system, from 1815 cases with CP and 5066 with CL ± P, without a syndrome diagnosis (1999-2014 deliveries). All live births in Texas were used for comparison. Poisson regression was used to calculate crude and adjusted prevalence ratios (aPR) for each characteristic, separately for each cleft subphenotype. The prevalence of CL ± P and CP in our study was estimated as 8.3 and 3.0 per 10 000 live births, respectively. After adjusting for several characteristics, several factors were associated with CL ± P, CP, or both, including infant sex and maternal race/ethnicity, age, smoking, and diabetes. There were several differences between infants with isolated versus nonisolated clefts. For example, maternal prepregnancy diabetes was associated with an increased prevalence of CL ± P (aPR 7.91, 95% confidence interval [CI]: 5.53, 11.30) and CP (aPR 3.24, 95% CI: 1.43, 7.36), but only when additional defects were present. Findings from this study provide a contemporary description of the distribution of orofacial clefts in Texas accounting for differences between isolated and nonisolated clefts. They may contribute to increasing our understanding of the etiology of CP and CL ± P.
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Affiliation(s)
- Maria Luisa Navarro Sanchez
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, TX, USA
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX, USA
| | - Peter H. Langlois
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA
| | - Mark A. Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA
| | - A.J. Agopian
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, TX, USA
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Sabbagh HJ, Baghlaf KK, Jamalellail HMH, Bakhuraybah AS, AlGhamdi SM, Alharbi OA, AlHarbi KM, Hassan MHA. Environmental tobacco smoke exposure and non-syndromic orofacial cleft: Systematic review and meta-analysis. Tob Induc Dis 2023; 21:76. [PMID: 37313116 PMCID: PMC10258680 DOI: 10.18332/tid/163177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/26/2023] [Accepted: 04/11/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Environmental tobacco smoke (ETS) is associated with several congenital anomalies, including non-syndromic orofacial clefts (NSOFCs). This systematic review aimed to update the literature on the association between ETS and NSOFCs. METHODS Four databases were searched up to March 2022, and studies that evaluated the association between ETS and NSOFCs were selected. Two authors selected the studies, extracted the data, and evaluated the risk of bias. Comparing the association of maternal exposure to ETS and active parental smoking with NSOFCs allowed for the creation of pooled effect estimates for the included studies. RESULTS Twenty-six studies were deemed eligible for this review, of which 14 were reported in a previous systematic review. Twenty five were case-control studies, and one was a cohort study. In total, these studies included 2142 NSOFC cases compared to 118129 controls. All meta-analyses showed an association between ETS and the risk of having a child with NSOFC, based on the cleft phenotype, risk of bias, and year of publication, with a pooled increased odds ratio of 1.80 (95% CI: 1.51-2.15). These studies had a marked heterogeneity, which decreased upon subgrouping based on the recent year of publication and the risk of bias. CONCLUSIONS ETS exposure was associated with more than a 1.5-fold increase in the risk of having a child with NSOFC, showing a higher odds ratio than paternal and maternal active smoking. TRIAL REGISTRATION The study is registered on the International Prospective Register of Systematic Reviews database # CRD42021272909.
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Affiliation(s)
- Heba J. Sabbagh
- Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khlood K. Baghlaf
- Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hattan M. H. Jamalellail
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
- Primary Health Care, Jizan Department, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | | | - Salem M. AlGhamdi
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar A. Alharbi
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalid M. AlHarbi
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mona H. A. Hassan
- Department of Biostatistics, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Yang L, Wang H, Yang L, Zhao M, Guo Y, Bovet P, Xi B. Maternal cigarette smoking before or during pregnancy increases the risk of birth congenital anomalies: a population-based retrospective cohort study of 12 million mother-infant pairs. BMC Med 2022; 20:4. [PMID: 35012532 PMCID: PMC8750764 DOI: 10.1186/s12916-021-02196-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/22/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The associations of maternal cigarette smoking with congenital anomalies in offspring have been inconsistent. This study aimed to clarify the associations of the timing and intensity of maternal cigarette smoking with 12 subtypes of birth congenital anomalies based on a nationwide large birth cohort in the USA. METHODS We used nationwide birth certificate data from the US National Vital Statistics System during 2016-2019. Women reported the average daily number of cigarettes they consumed 3 months before pregnancy and in each subsequent trimester during pregnancy. Twelve subtypes of congenital anomalies were identified in medical records. Poisson regression analysis was used to estimate the risk ratios (RRs) with 95% confidence intervals (CIs) for 12 subtypes of congenital anomalies associated with the timing (i.e., before pregnancy, and during three different trimesters of pregnancy) and intensity (i.e., number of cigarettes consumed per day) of maternal cigarette smoking. RESULTS Among the 12,144,972 women included, 9.3% smoked before pregnancy and 7.0%, 6.0%, and 5.7% in the first, second, and third trimester, respectively. Maternal smoking before or during pregnancy significantly increased the risk of six subtypes of birth congenital anomalies (i.e., congenital diaphragmatic hernia, gastroschisis, limb reduction defect, cleft lip with or without cleft palate, cleft palate alone, and hypospadias), even as low as 1-5 cigarettes per day. The adjusted RRs (95% CIs) for overall birth congenital anomalies (defined as having any one of the congenital malformations above significantly associated with maternal cigarette smoking) among women who smoked 1-5, 6-10, and ≥ 11 cigarettes per day before pregnancy were 1.31 (1.22-1.41), 1.25 (1.17-1.33), and 1.35 (1.28-1.43), respectively. Corresponding values were 1.23 (1.14-1.33), 1.33 (1.24-1.42), 1.33 (1.23-1.43), respectively, for women who smoked cigarettes in the first trimester; 1.32 (1.21-1.44), 1.36 (1.26-1.47), and 1.38 (1.23-1.54), respectively, for women who smoked cigarettes in the second trimester; and 1.33 (1.22-1.44), 1.35 (1.24-1.47), and 1.35 (1.19-1.52), respectively, for women who smoked cigarettes in the third trimester. Compared with women who kept smoking before and throughout pregnancy, women who never smoked had significantly lower risk of congenital anomalies (RR 0.77, 95% CI 0.73-0.81), but women who smoked before pregnancy and quitted during each trimester of pregnancy had no reduced risk (all P > 0.05). CONCLUSIONS Maternal smoking before or during pregnancy increased the risk of several birth congenital anomalies, even as low as 1-5 cigarettes per day. Maternal smokers who stopped smoking in the subsequent trimesters of pregnancy were still at an increased risk of birth congenital anomalies. Our findings highlighted that smoking cessation interventions should be implemented before pregnancy.
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Affiliation(s)
| | | | - Liu Yang
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yajun Guo
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - Pascal Bovet
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Jaisani M, Dongol A, Acharya P, Yadav A, Sagtani A, Pradhan L, Jaisani P, Laverick S. Oro-facial clefts at a tertiary level hospital of eastern Nepal: A retrospective insight. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2022. [DOI: 10.4103/jclpca.jclpca_29_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Fell M, Dack K, Chummun S, Sandy J, Wren Y, Lewis S. Maternal Cigarette Smoking and Cleft Lip and Palate: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2021; 59:1185-1200. [PMID: 34569861 PMCID: PMC9411693 DOI: 10.1177/10556656211040015] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives
A systematic review and meta-analysis to determine the association between active maternal smoking and cleft lip and palate etiology.
Data sources
Medline, Embase, Web of Science and the Cochrane Library from inception to November, 2020.
Study selection
Observational studies of cigarette smoking habits in pregnant women. Outcomes included cleft lip and/or palate, cleft lip ± palate and cleft palate only.
Data analysis
Publication bias analyses were performed and the Newcastle Ottawa scales were used to assess study quality. Fixed or random effect models were used in the meta-analysis, dependent on risk of statistical heterogeneity.
Results
Forty-five studies were eligible for inclusion of which 11 were cohort and 34 were case–control studies. Sixteen studies were of sufficient standard for inclusion in the meta-analysis. The summary odds ratio for the association between smoking and cleft lip and/or palate was 1.42 (95%CI 1.27-1.59) with a population attributable fraction of 4% (95%CI 3%-5%). There was limited evidence to show a dose–response effect of smoking.
Conclusions
This review reports a moderate association between maternal smoking and orofacial cleft but the overall quality of the conventional observational studies included was poor. There is a need for high quality and novel research strategies to further define the role of smoking in the etiology of cleft lip and palate.
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Affiliation(s)
| | - Kyle Dack
- 1980University of Bristol, Bristol, UK
| | - Shaheel Chummun
- 2394University Hospitals Bristol and Weston NHS Trust, Bristol, UK
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Mekonnen D, MollaTaye, Worku W. Congenital anomalies among newborn babies in Felege-Hiwot Comprehensive Specialized Referral Hospital, Bahir Dar, Ethiopia. Sci Rep 2021; 11:11027. [PMID: 34040058 PMCID: PMC8154920 DOI: 10.1038/s41598-021-90387-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 05/06/2021] [Indexed: 11/09/2022] Open
Abstract
Congenital anomaly is a structural or functional defect which could occur in any organ system. The aim of this study was to determine the prevalence and associated factors of congenital anomalies among newborn babies delivered at Felege-Hiwot Comprehensive Specialized Referral Hospital, Bahir Dar, Ethiopia. A cross-sectional study design was used to review medical records/charts of 11,177 new born babies born at the delivery ward of Felege-Hiwot Comprehensive Specialized Referral Hospital, Ethiopia. The data were collected using an abstraction form. A bivariate analysis was done to assess factors associated with congenital anomalies. Variables whose p-value < 0.2 were included in the multivariable analysis to identify the effects of confounders. P-values < 0.05 were considered statistically significant. A total of 11,177 newborn babies and their mothers were included in the study and the proportion of congenital anomalies was found to be 0.62%. The most (46.4%) prevalent congenital anomaly was neural tube defects. Newborn birth weight < 1.25 kg [AOR, 32.6, 95% CI 11.9-89.0], and newborn weight < 2.5 kg [AOR, 2.67, 95% CI 1.54-4.65], antenatal visits [AOR, 4.0, 95% CI 2.39-6.69] and urban residence [AOR, 2.1, 95% CI 1.28-3.55] were statistically significant factors. In conclusion, neural tube defects were anomalies prevalent in this study. Antenatal visits, birth weight and residence were factors associated with congenital anomalies.
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Affiliation(s)
- Daniel Mekonnen
- Department of Public Health, Haramaya University, Dire Dawa, Ethiopia
| | - MollaTaye
- Department of Anatomy, School of Medicine, College of Medicine and Health Sciences, The University of Gondar, Central Gondar, Ethiopia.
| | - Walelegn Worku
- Department of Occupational and Environmental Health, Institute of Public Health, College of Medicine and Health Sciences, The University of Gondar, Central Gondar, Ethiopia
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Abebe S, Gebru G, Amenu D, Mekonnen Z, Dube L. Risk factors associated with congenital anomalies among newborns in southwestern Ethiopia: A case-control study. PLoS One 2021; 16:e0245915. [PMID: 33508017 PMCID: PMC7843017 DOI: 10.1371/journal.pone.0245915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/08/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Human embryo is well protected in the uterus by the embryonic membrane, although teratogens may cause developmental disruptions after maternal exposure to them during early pregnancy. Most of the risk factors contributing to the development of congenital anomalies are uncertain; however, genetic factors, environmental factors and multifactorial inheritance are found to be risk factors. Regardless of their clinical importance, there are little/no studies conducted directly related to predisposing risk factors in southwestern Ethiopia. OBJECTIVE The study aimed to determine the associated risk factors with congenital anomalies among newborns in southwestern Ethiopia. METHODS Case-control study was conducted on newborns and their mothers in six purposively selected hospitals in southwestern Ethiopia from May 2016 to May 2018. Data was collected after evaluation of the neonates for the presence of congenital anomalies using the standard pretested checklist. The data was analyzed using SPSS version 25.0. P <0.01 was set as statistically significant. RESULTS Risk factors such as unidentified medicinal usage in the first three months of pregnancy (AOR = 3.435; 99% CI: 2.012-5.863), exposure to pesticide (AOR = 3.926; 99% CI: 1.266-12.176), passive smoking (AOR = 4.104; 99% CI: 1.892-8.901), surface water as sources of drinking (AOR = 2.073; 99% CI: 1.221-3.519), folic acid supplementation during the early pregnancy (AOR = 0.428; 99% CI: 0.247-0.740) were significantly associated with the congenital anomalies. CONCLUSIONS In this study, risk factors such as passive smoking, exposure to pesticides, chemicals and use of surface water as a source of drinking during early pregnancy had a significant association with congenital anomalies. There is a need to continuously provide health information for the community on how to prevent and control predisposing risk factors.
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Affiliation(s)
- Soressa Abebe
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmai Gebru
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Demisew Amenu
- Department of Gynecology and Obstetrics, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Lemessa Dube
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
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Lynn JV, Ranganathan K, Bageris MH, Luby AO, Tursak HR, Hart-Johnson T, Blackwood RA, Buchman SR. Sociodemographic Predictors of Patient Age at Time of Cleft Lip and Palate Repair. Cleft Palate Craniofac J 2020; 57:1402-1409. [DOI: 10.1177/1055665620949119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To identify the impact of sociodemographic and health variables on the age at which patients undergo cleft lip repair, cleft palate repair, and primary speech evaluation. Design: A retrospective, noninterventional quality assessment, and quality improvement study was designed. Setting: This institutional study was performed at Michigan Medicine in Ann Arbor, MI. Patients: All patients born between 2011 and 2014 who received surgical cleft repair, excluded those who were adopted (n = 165). Main Outcome Measure: The age at which patients undergo cleft lip repair, cleft palate repair, and primary speech evaluation. Results: Cleft lip repair was performed significantly later for patients identifying as Asian (18 weeks, P = .01), patients with Child Protective Services contact (19 weeks, P = .01), patients with a significant comorbidity (14 weeks, P = .02), and patients who underwent preliminary lip adhesion surgery (19 weeks, P < .01). Cleft palate repair was performed significantly later for patients identifying racially as Asian (19 weeks, P = .03) and other (22 weeks, P = .03). Preliminary speech and language evaluation were performed significantly later for patients identifying as black (55 weeks, P = .03) and patients diagnosed with an isolated cleft lip (71 weeks, P < .01). Conclusions: Timing of cleft lip, cleft palate repair, and primary speech and language evaluation are subject to variation which may be predicted by clinically accessible factors. By identifying race, Child Protective Services contact, and care variables as significant predictors of increased patient age at time of intervention, multidisciplinary cleft care teams can proactively allocate patient support resources.
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Affiliation(s)
- Jeremy V. Lynn
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA
- Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, MI, USA
| | - Kavitha Ranganathan
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Matthew H. Bageris
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA
- Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, MI, USA
| | - Alexandra O. Luby
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Hailey R. Tursak
- Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, MI, USA
| | - Tami Hart-Johnson
- Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, MI, USA
| | - R. Alexander Blackwood
- Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, MI, USA
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Steven R. Buchman
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA
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Six2 regulates Pax9 expression, palatogenesis and craniofacial bone formation. Dev Biol 2019; 458:246-256. [PMID: 31765609 DOI: 10.1016/j.ydbio.2019.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/30/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022]
Abstract
In this study, we investigated the role of the transcription factor Six2 in palate development. Six2 was selected using the SysFACE tool to predict genes from the 2p21 locus, a region associated with clefting in humans by GWAS, that are likely to be involved in palatogenesis. We functionally validated the predicted role of Six2 in palatogenesis by showing that 22% of Six2 null embryos develop cleft palate. Six2 contributes to palatogenesis by promoting mesenchymal cell proliferation and regulating bone formation. The clefting phenotype in Six2-/- embryos is similar to Pax9 null embryos, so we examined the functional relationship of these two genes. Mechanistically, SIX2 binds to a PAX9 5' upstream regulatory element and activates PAX9 expression. In addition, we identified a human SIX2 coding variant (p.Gly264Glu) in a proband with cleft palate. We show this missense mutation affects the stability of the SIX2 protein and leads to decreased PAX9 expression. The low penetrance of clefting in the Six2 null mouse combined with the mutation in one patient with cleft palate underscores the potential combinatorial interactions of other genes in clefting. Our study demonstrates that Six2 interacts with the developmental gene regulatory network in the developing palate.
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Perry MF, Mulcahy H, DeFranco EA. Influence of periconception smoking behavior on birth defect risk. Am J Obstet Gynecol 2019; 220:588.e1-588.e7. [PMID: 30790570 DOI: 10.1016/j.ajog.2019.02.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/06/2019] [Accepted: 02/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Smoking is one of the most important modifiable risk factors for adverse maternal and neonatal outcomes. Smoking during pregnancy has been associated with fetal growth restriction, adverse pregnancy outcomes, and chronic adult diseases. Existing research has evaluated the risk of smoking on congenital defects. However, no studies have evaluated how periconception smoking affects birth defects. OBJECTIVE The purpose of this study was to assess the association of maternal smoking and the timing of periconception exposure with congenital birth defects. STUDY DESIGN This study was a population-based retrospective cohort of live births in Ohio from 2006-2015 with the use of data from birth certificates. Rates of cardiovascular, musculoskeletal, gastrointestinal, and neural tube birth defects were compared between a referent group of women who did not smoke and a group of women who smoked (1) during the preconception period of 3 months before conception only and not in the first trimester and (2) in the preconception period plus throughout the first trimester of pregnancy. Multivariate logistic regression was used to quantify the relationship between periconception smoking and the rate of birth defects after adjustment for maternal race, age, pregestational diabetes mellitus, and socioeconomic factors. RESULTS Of the 1,436,036 live births in the study period, 75% of mothers did not smoke during the preconception period or during pregnancy. There were 334,156 women (23.3%) who smoked during pregnancy; 6.0% of the population smoked preconception only, and 17.3% of the population smoked both during the preconception period and through the first trimester. Smoking during the preconception period only, even without first trimester exposure, was associated with a 40% increased risk of gastroschisis. Smoking that was limited to preconception only was not associated with any other individual birth defects. However, smoking through the first trimester was associated with a statistically significant increased risk of several defects that included gastroschisis and limb reduction and a composite outcome of any defect, even after adjustment for coexisting factors. CONCLUSION Smoking during the period of fetal organogenesis (during the first trimester of pregnancy) is associated with increased risk of some birth defects. In this study, we provide novel data that smoking during the few months before conception, even with cessation in the first trimester, may also pose a risk for fetal malformation such as gastroschisis. These findings highlight the importance of preconception women's public health education efforts and warrant further investigation.
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Zheng Z, Xie G, Yang T, Qin J. Congenital malformations are associated with secondhand smoke among nonsmoking women: A meta-analysis. Birth 2019; 46:222-233. [PMID: 30284325 DOI: 10.1111/birt.12401] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The association between active maternal smoking and congenital malformations is well established, but little is known about the association between secondhand smoke and congenital malformations. Moreover, studies regarding the association between congenital malformations and secondhand smoke have not yielded consistent results. METHODS In July 2018, we searched PubMed, EMBASE, and China Biology Medicine databases for observational studies characterizing the relationship between secondhand smoke and congenital malformations of offspring in nonsmoking women. Two reviewers independently decided on whether a study should be included, did data extraction, and assessed study quality. Pooled risks with 95% confidence intervals were calculated using either the fixed-effects models or random-effects models. Further subgroup analyses and sensitivity analyses were performed to explore the potential source of heterogeneity and to examine the robustness of risk estimates. RESULTS Thirty-three studies with a total of 31 944 cases and 32 335 controls were included. Secondhand smoke exposure was associated with an increased risk of congenital malformations (odds ratio = 1.92; 95% confidence interval 1.61-2.30). Secondhand smoke was correlated with significantly increased risk for digestive system (1.17 [1.05-1.32]), nervous system (1.74 [1.33-2.29]), and cardiovascular system (2.10 [1.32-3.35]) malformations and for oral clefts (1.87 [1.47-2.39]). CONCLUSIONS Secondhand smoke exposure increases the risk for overall and several organ-system malformations. These findings highlight the necessity of improving community awareness to prevent secondhand smoke exposure during the preconception and conception periods.
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Affiliation(s)
- Zan Zheng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - GuoHong Xie
- Medical College of Hunan Normal University, Changsha, China
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
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Increased Risk for Neurodevelopmental Disorders in Children With Orofacial Clefts. J Am Acad Child Adolesc Psychiatry 2018; 57:876-883. [PMID: 30392629 DOI: 10.1016/j.jaac.2018.06.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/31/2018] [Accepted: 06/22/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Children with orofacial clefts (OFC) may have an increased risk of poor mental health. This study aimed to investigate the risk of psychiatric diagnoses in individuals with OFC, stratified by cleft type. METHOD A nationwide register-based cohort of all individuals born with nonsyndromic OFC in Sweden between 1973 and 2012 (n = 7,842) was compared to a matched cohort (n = 78,409) as well as to their unaffected siblings (n = 9,637). The risk of psychiatric diagnoses, suicide attempts, and suicides was examined by crude and adjusted Cox regression models. Effect modification by sex was investigated with interaction terms in the models. RESULTS Children with cleft lip (CL) had a significantly higher risk of any psychiatric disorder, intellectual disability, and language disorders; children with cleft lip and palate (CLP) had, in addition, an increased risk of autism spectrum disorder (ASD). Children with cleft palate only (CPO) had risk increases for the same diagnoses as children with CL and CLP, but with higher hazard ratios, and also for psychotic disorders, attention-deficit/hyperactivity disorder (ADHD), and other behavioral or emotional disorders in childhood. Sex stratification indicated higher risk increases among females in CL and CLP but not in CPO. Siblings without OFC were less likely to be diagnosed with any psychiatric disorder, intellectual disability, language disorder, ASD, or ADHD compared to their siblings with OFC. CONCLUSION Children with nonsyndromic clefts had a significantly higher risk of neurodevelopmental disorders. This risk is unlikely to be explained by familial influences such as inherited genetic or shared environmental factors.
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Taye M, Afework M, Fantaye W, Diro E, Worku A. Factors associated with congenital anomalies in Addis Ababa and the Amhara Region, Ethiopia: a case-control study. BMC Pediatr 2018; 18:142. [PMID: 29699508 PMCID: PMC5921791 DOI: 10.1186/s12887-018-1096-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/20/2018] [Indexed: 12/02/2022] Open
Abstract
Background The early stage of embryo development is extremely vulnerable to various teratogenic factors, leading to congenital anomalies. In Ethiopia, a significant number of babies are born with congenital anomalies, but the risk factors for the anomalies have never been studied. Understanding the specific risk factors for congenital anomalies is very essential to provide health education that aims at creating awareness and establishing preventive strategic plan/s. The main objective of this study was to assess the risk factors associated with congenital anomalies in Addis Ababa and the Amhara Region, Ethiopia. Methods A case-control study was conducted from January 1- June 30, 2015. The participants were recruited at the purposively selected hospitals in Addis Ababa and the Amhara Region. A total of 207 cases and 207 controls were included in the study. Cases were neonates, infants, and children 0-11 months of age with external and internal major congenital anomalies diagnosed by pediatricians. Controls were neonates, infants, and children 0-11 months of age without external and internal anomalies. Data on sociodemographic characteristics, exposure to risk factors, and reproductive history were collected by face to face interviews with children’s mothers/caregivers using a structured questionnaire. Binary logistic regression was employed to explore risk factors associated with the occurrence of the problems. Results About 87.4% of the children were below 6 months, and 12.6% were between 6 and 11 months. The majority (59.9%) of the children were male, with the M: F sex ratio of 1.49. The mean age of the mothers was 26 years (16-45 years). Unidentified medication use during early pregnancy (AOR = 4.595; 95% CI: 1.868-11.301, P-value = 0.001), maternal alcohol drinking (AOR = 2.394; 95% CI: 1.212-4.726, P-value = 0.012), and exposure to chemicals (AOR = 9.964; 95% CI = 1.238-80.193, P-value = 0.031) were significantly associated with the occurrence of congenital anomalies. Iron folate use (AOR = 0.051; 95% CI: 0.010-0.260, P-value = < 0.001) before and during early pregnancy had a protective effect on congenital anomaly. Conclusion Unidentified medication use, alcohol drinking during early pregnancy, and exposure to chemicals had a significant association with the occurrence of congenital anomalies, whereas iron folate use before and during early pregnancy had a protective effect from congenital anomalies.
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Affiliation(s)
- Molla Taye
- Department of Anatomy, School of Medicine, College of Medicine and Health Sciences, the University of Gondar, Gondar, Ethiopia.
| | - Mekbeb Afework
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondwossen Fantaye
- School of Dentistry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ermias Diro
- School of Medicine, College of Medicine and Health Sciences, the University of Gondar, Gondar, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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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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Abstract
Data sourcesCochrane, PubMed and Ovid Medline. A search timeline of January 1966 to May 2015 was used and language was restricted to English.Study selectionCase-control and cohort studies relating to oral clefts, with information on maternal active smoking, before and after conception, excluding paternal smoking and exposure to environmental tobacco smoke.Data extraction and synthesisTwo authors extracted data independently. Both Begg's and Egger's funnel plots were used to assess publication bias. Sensitivity analysis was performed to assess impact of the different study types and chi-squared and P values were determined by SPSS software. Studies with missing data were excluded from the meta-analysis.ResultsA statistically significant association was found between maternal active smoking and CL +/- P (odds ratio [OR] 1.368; 95% confidence interval [CI] 1.259-1.486) as well as CP (OR 1.241; 95% CI 1.117-1.378). Half the studies showed positive dose-response effect for each subgroup (test for linear trend, P < .05).ConclusionsWomen who smoke during pregnancy have a moderate risk of having a child with a CL +/- P or CP. A dose-response effect between maternal smoking and clefts was not established.
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17
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Bell K, Corbacho B, Ronaldson S, Richardson G, Torgerson D, Robling M. The impact of pre and perinatal lifestyle factors on child long term health and social outcomes: a systematic review. HEALTH ECONOMICS REVIEW 2018; 8:2. [PMID: 29368151 PMCID: PMC5783983 DOI: 10.1186/s13561-018-0186-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 01/11/2018] [Indexed: 05/22/2023]
Abstract
To understand the full extent of the impact of a trial, it is important to consider the long-term consequences of outcomes beyond the trial follow-up period, especially for early year's interventions. A systematic review of the literature associated with the long-term consequences of four key outcomes from the Building Blocks trial, specifically, low birth weight, smoking during pregnancy, interval to subsequent pregnancy and A&E attendance or inpatient admission was conducted. These factors were guided by the funders, the Department of Health, as being of particular interest in the UK context. Relevant studies were identified from a number of sources including large databases, reference checking and citation searching. The search yielded 3665 papers, 43 of which were considered appropriate for inclusion. Of these, 29 were relating to smoking during pregnancy, 13 to low birth weight, 0 to A&E attendances during early childhood and 1 to short (< 2 years) interval to subsequent pregnancy. Consistent associations were found between maternal smoking during pregnancy and the effects this has on children's health, educational attainment and likelihood of engaging in problem behaviour and criminal activity in later life. Low birth weight was also found to impact on children's long-term health and cognitive development. Subsequent pregnancies within two years of the previous birth were linked with increased likelihood of pre-term birth and neonatal death. Only minimal evidence was identified regarding the consequences of a short interval to second pregnancy and of child A&E and outpatient attendances. Given that these outcomes have been identified by the UK Department of Health as of particular interest for UK benefit, investment of research in these areas is recommended to establish a clearer picture of both short and long-term consequences.
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Affiliation(s)
- Kerry Bell
- York Trials Unit, Department of Health Sciences, University of York, ARRC Building, York, YO10 5DD UK
| | - Belen Corbacho
- York Trials Unit, Department of Health Sciences, University of York, ARRC Building, York, YO10 5DD UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, ARRC Building, York, YO10 5DD UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, York, YO10 5DD UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, ARRC Building, York, YO10 5DD UK
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS Wales
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18
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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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Durning P, Chestnutt IG, Morgan MZ, Lester NJ. The Relationship between Orofacial Clefts and Material Deprivation in Wales. Cleft Palate Craniofac J 2017; 44:203-7. [PMID: 17328647 DOI: 10.1597/06-004.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: This study investigated the relationship between material deprivation and the incidence of orofacial clefts (OFC) in South, West, and Central Wales, U.K. Design and Setting: The South, West, and Central Wales Orofacial-Cleft Register served as the primary data source for the study. Data on all children born with an orofacial cleft between 1982 and 2003 were geocoded to one of 844 geographic wards. National census data, similarly geocoded, served as the population denominator. Townsend's index of material deprivation was used to assign wards to one of seven levels of deprivation. This permitted investigation of the association of orofacial clefts with material deprivation. Results: Between 1982 and 2003, there were 831 babies born with an orofacial cleft, equating to 109 clefts per 100,000 live births. The incidence of orofacial clefts ranged from 82 per 100,000 (95% confidence interval [C.I.] 64 to 102 per 100,000) in babies born to mothers residing in the least deprived areas to 127 per 100,000 (95% C.I., 112 to 144 per 100,000) in those living in the most deprived areas, a significant linear trend being apparent (p < .001). A statistically significant risk of 1.55 (95% C.I., 1.18 to 2.04) for orofacial clefts was apparent between most and least deprived septiles of deprivation. Conclusions: This study provides further evidence of an association between material deprivation and orofacial clefts. Further work is required to elicit the degree to which potential risk factors contribute to this association and to determine how deprivation predisposes to orofacial clefts.
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Affiliation(s)
- P Durning
- Cardiff and Vale National Health Service Trust, Cardiff, UK
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20
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Fetterman JL, Sammy MJ, Ballinger SW. Mitochondrial toxicity of tobacco smoke and air pollution. Toxicology 2017; 391:18-33. [PMID: 28838641 PMCID: PMC5681398 DOI: 10.1016/j.tox.2017.08.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Jessica L Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, United States
| | - Melissa J Sammy
- Department of Pathology, Division of Molecular and Cellular Pathology, University of Alabama, Birmingham, AL, United States
| | - Scott W Ballinger
- Department of Pathology, Division of Molecular and Cellular Pathology, University of Alabama, Birmingham, AL, United States.
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21
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B Hasmun NN, Drummond BK, Milne T, Cullinan MP, Meldrum AM, Coates D. Effects of environmental tobacco smoke on the oral health of preschool children. Eur Arch Paediatr Dent 2017; 18:393-398. [PMID: 29090450 DOI: 10.1007/s40368-017-0308-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/18/2017] [Indexed: 11/26/2022]
Abstract
AIMS This study investigated the association between the prevalence of oral health problems (caries, gingivitis, mucosal pigmentation and enamel defects in one to 5 year-old children exposed and not exposed to environmental tobacco smoke before and/or after birth. Exposure to environmental tobacco smoke (ETS) in childhood may have significant health effects. METHODS A structured questionnaire was used to collect data on a child's current and previous illnesses, oral health behaviours, dietary habits, parental smoking behaviours and parents' dental history. The intraoral examination recorded dental caries (dmfs), enamel defects, gingival health, melanin pigmentation and soft tissue health. Stimulated saliva was collected. Total sIgA levels were quantified using indirect competitive ELISA with a SalimetricsTM kit. RESULTS The 44 children (aged 15-69 months) recruited were divided into two groups: ETS and non-ETS (control). There were 22 children in each: 16 who were exposed to ETS during and after gestation were identified as the ETSB subgroup. Participants exposed to ETS were more likely to have had upper respiratory tract and middle ear infections during the neonatal period and had higher mean dmft, mean dmfs, mean percent of surfaces with demarcated opacities and mean GI than the non-ETS participants. The children exposed to ETS before and after birth had the highest occurrence of enamel opacities showed a higher risk for dental caries even though more children in this group used the recommended fluoride toothpaste (1000 ppm fluoride). Mothers who smoked either never breastfed their children or breastfed their children for less than the recommended period of 6 months. Children exposed to ETS were shown to have higher mean total sIgA (μg/ml) than the children in the control group. CONCLUSIONS Associations between ETS exposure before and after gestation and oral health, including salivary changes in young children were shown in the present study. Dental health professionals should include a question about household smoking in children's dental histories, which would allow opportunities to discuss the impact of smoking on child oral health. Longitudinal oral health studies should include a history of maternal smoking during pregnancy and afterwards.
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Affiliation(s)
- N N B Hasmun
- Faculty of Dentistry, Centre of Studies for Paediatric Dentistry and Orthodontics, Universiti Teknologi Mara, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor Darul Ehsan, Malaysia
| | - B K Drummond
- Department of Oral Sciences, Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - T Milne
- Department of Oral Sciences, Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - M P Cullinan
- Department of Oral Sciences, Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - A M Meldrum
- Department of Oral Sciences, Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - D Coates
- Department of Oral Sciences, Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
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22
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Eshete MA, Liu H, Li M, Adeyemo WL, Gowans LJJ, Mossey PA, Busch T, Deressa W, Donkor P, Olaitan PB, Aregbesola BS, Braimah RO, Oseni GO, Oginni F, Audu R, Onwuamah C, James O, Augustine-Akpan E, Rahman LA, Ogunlewe MO, Arthur FKN, Bello SA, Agbenorku P, Twumasi P, Abate F, Hailu T, Demissie Y, Hailu A, Plange-Rhule G, Obiri-Yeboah S, Dunnwald MM, Gravem PE, Marazita ML, Adeyemo AA, Murray JC, Cornell RA, Butali A. Loss-of-Function GRHL3 Variants Detected in African Patients with Isolated Cleft Palate. J Dent Res 2017; 97:41-48. [PMID: 28886269 DOI: 10.1177/0022034517729819] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In contrast to the progress that has been made toward understanding the genetic etiology of cleft lip with or without cleft palate, relatively little is known about the genetic etiology for cleft palate only (CPO). A common coding variant of grainyhead like transcription factor 3 ( GRHL3) was recently shown to be associated with risk for CPO in Europeans. Mutations in this gene were also reported in families with Van der Woude syndrome. To identify rare mutations in GRHL3 that might explain the missing heritability for CPO, we sequenced GRHL3 in cases of CPO from Africa. We recruited participants from Ghana, Ethiopia, and Nigeria. This cohort included case-parent trios, cases and other family members, as well as controls. We sequenced exons of this gene in DNA from a total of 134 nonsyndromic cases. When possible, we sequenced them in parents to identify de novo mutations. Five novel mutations were identified: 2 missense (c.497C>A; p.Pro166His and c.1229A>G; p.Asp410Gly), 1 splice site (c.1282A>C p.Ser428Arg), 1 frameshift (c.470delC; p.Gly158Alafster55), and 1 nonsense (c.1677C>A; p.Tyr559Ter). These mutations were absent from 270 sequenced controls and from all public exome and whole genome databases, including the 1000 Genomes database (which includes data from Africa). However, 4 of the 5 mutations were present in unaffected mothers, indicating that their penetrance is incomplete. Interestingly, 1 mutation damaged a predicted sumoylation site, and another disrupted a predicted CK1 phosphorylation site. Overexpression assays in zebrafish and reporter assays in vitro indicated that 4 variants were functionally null or hypomorphic, while 1 was dominant negative. This study provides evidence that, as in Caucasian populations, mutations in GRHL3 contribute to the risk of nonsyndromic CPO in the African population.
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Affiliation(s)
- M A Eshete
- 1 School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.,2 Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.,3 Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - H Liu
- 4 Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA, USA.,5 State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory for Oral Biomedicine of Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - M Li
- 6 Department of Oral Pathology, Radiology and Medicine, University of Iowa, Iowa City, IA, USA
| | - W L Adeyemo
- 7 Department of Oral and Maxillofacial Surgery, University of Lagos, Lagos, Nigeria
| | - L J J Gowans
- 8 Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - P A Mossey
- 9 Department of Orthodontics, University of Dundee, Dundee, UK
| | - T Busch
- 6 Department of Oral Pathology, Radiology and Medicine, University of Iowa, Iowa City, IA, USA
| | - W Deressa
- 1 School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - P Donkor
- 8 Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - P B Olaitan
- 10 Department of Plastic Surgery, Ladoke Akintola University of Science and Technology, Osogbo, Nigeria
| | - B S Aregbesola
- 11 Department of Oral and Maxillofacial Surgery, Obafemi Awolowo University, Ile Ife, Nigeria
| | - R O Braimah
- 12 Department of Oral and Maxillofacial Surgery, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - G O Oseni
- 10 Department of Plastic Surgery, Ladoke Akintola University of Science and Technology, Osogbo, Nigeria
| | - F Oginni
- 11 Department of Oral and Maxillofacial Surgery, Obafemi Awolowo University, Ile Ife, Nigeria
| | - R Audu
- 13 Department of Virology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - C Onwuamah
- 13 Department of Virology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - O James
- 7 Department of Oral and Maxillofacial Surgery, University of Lagos, Lagos, Nigeria
| | - E Augustine-Akpan
- 6 Department of Oral Pathology, Radiology and Medicine, University of Iowa, Iowa City, IA, USA
| | - L A Rahman
- 14 Division of Pediatric Surgery, Department of Surgery, University of Ilorin, Ilorin, Nigeria
| | - M O Ogunlewe
- 7 Department of Oral and Maxillofacial Surgery, University of Lagos, Lagos, Nigeria
| | - F K N Arthur
- 8 Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - S A Bello
- 15 State House Clinic, Abuja, Nigeria
| | - P Agbenorku
- 8 Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - P Twumasi
- 8 Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - F Abate
- 2 Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - T Hailu
- 2 Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Y Demissie
- 2 Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.,3 Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - A Hailu
- 2 Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.,3 Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - G Plange-Rhule
- 8 Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - S Obiri-Yeboah
- 8 Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - M M Dunnwald
- 4 Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA, USA
| | - P E Gravem
- 16 Plastic and Reconstructive Surgery Department, Haukeland University Hospital, Bergen, Norway
| | - M L Marazita
- 17 Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - A A Adeyemo
- 18 National Human Genomic Research Institute, Bethesda, MD, USA
| | - J C Murray
- 19 Department of Pediatrics University of Iowa, Iowa City, IA, USA
| | - R A Cornell
- 4 Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA, USA
| | - A Butali
- 6 Department of Oral Pathology, Radiology and Medicine, University of Iowa, Iowa City, IA, USA
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23
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Eke CB, Uche EO, Chinawa JM, Obi IE, Obu HA, Ibekwe RC. Epidemiology of congenital anomalies of the central nervous system in children in Enugu, Nigeria: A retrospective study. Ann Afr Med 2017; 15:126-32. [PMID: 27549417 PMCID: PMC5402814 DOI: 10.4103/1596-3519.188892] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Congenital anomalies, including those of the central nervous system (CNS), are among the leading causes of morbidity, mortality, and fetal loss. Objective: To determine the prevalence and associated factors of CNS congenital anomalies in children. Methods: A cross-sectional retrospective study of children managed with CNS anomalies was undertaken. Relevant clinical data of identified cases based on standard case definitions were retrieved from their case record files. Data were analyzed using SPSS 20.0 while the level of statistical significance was set at P < 0.05. Results: Seventy-two cases of CNS anomalies were identified over the period under review; out of 7329 total pediatric admissions giving a prevalence of 0.98%. Spina bifida cystica, 49 (68.0%) was the most common of the five anomalies seen followed by congenital hydrocephalus 11 (15.3%). Fifty-seven (79.2%) of the mothers did not take periconceptional folic acid supplementation (P < 0.05) whereas 25 (34.7%), 6 (8.3%), and 1 (1.4%) reported history of febrile illness in the first trimester of pregnancy, alcohol use, and diabetes mellitus in pregnancy, respectively. Majority of the cases of spina bifida cystica (30 [61.2%]) seen had corrective surgeries while the overall case fatality rate was 1 (1.4%). Conclusions: Spina bifida cystica was the most common anomaly of the CNS seen in this study and majority of the mothers of affected children did not take periconceptional folic acid supplementation (P < 0.05). Efforts should be made to create awareness and apply adequate preventive health education models including the use of periconceptional folic acid supplementation as well as the provision of access to standard prenatal care to at risk mothers.
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Affiliation(s)
- Christopher Bismarck Eke
- Department of Paediatrics, University of Nigeria/University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Enoch Ogbonnaya Uche
- Department of Surgery, Neurosurgical Unit, University of Nigeria/University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Ikechukwu Emmanuel Obi
- Department of Community Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Herbert Anayo Obu
- Department of Paediatrics, University of Nigeria/University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Roland Chidi Ibekwe
- Department of Paediatrics, University of Nigeria/University of Nigeria Teaching Hospital, Enugu, Nigeria
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Liu Y, Wang B, Li Z, Zhang L, Liu J, Ren A. Indoor air pollution and the risk of orofacial clefts in a rural population in Shanxi province, China. ACTA ACUST UNITED AC 2016; 106:708-15. [PMID: 27227359 DOI: 10.1002/bdra.23522] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/19/2016] [Accepted: 04/19/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Shanxi Province is a region in China with a high incidence of orofacial clefts (OFCs). Our objective is to investigate the effect of maternal exposure to indoor air pollution (IAP) from coal combustion and tobacco smoke on the risk of an infant being born with orofacial clefts. METHODS Data were derived from an ongoing population-based case-control study of major external structural birth defects in Shanxi Province. Subjects included 213 cases with OFCs and 1319 healthy babies born between November 2002 and December 2014 in four rural counties. Exposure information was collected by face-to-face interview with mothers within 1 week of delivery or pregnancy termination. The authors derived an exposure index by integrating a series of IAP-related characteristics concerning dwelling and lifestyle. RESULTS Increased odds of OFC were associated with IAP exposure from heating (adjusted odds ratio [aOR] = 2.4; 95% confidence interval [CI], 1.2-4.5) and from smoking (aOR = 1.8; 95% CI: 1.3, 2.5), but not with exposure from cooking (aOR = 0.9; 95% CI, 0.6-1.4). Compared with women without IAP exposure, the aORs of OFC for children of women with exposure indices of 1, 2, 3 and ≥ 4 were 1.1 (95% CI, 0.6-1.8), 1.4 (95% CI, 0.8-2.4), 1.8 (95% CI, 1.0-3.2), and 3.4 (95% CI, 1.6-7.4), respectively, demonstrating a clear dose-response trend (p < 0.001). CONCLUSION Periconceptional exposure to IAP from coal combustion and tobacco smoking may increase the risk of OFCs in offsprings of women in Shanxi Province. Birth Defects Research (Part A) 106:708-715, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Yingying Liu
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, China
| | - Bin Wang
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, China
| | - Zhiwen Li
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, China
| | - Le Zhang
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, China
| | - Jufen Liu
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, China
| | - Aiguo Ren
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, China
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Nicoletti D, Appel LD, Siedersberger Neto P, Guimarães GW, Zhang L. Maternal smoking during pregnancy and birth defects in children: a systematic review with meta-analysis. CAD SAUDE PUBLICA 2016; 30:2491-529. [PMID: 26247979 DOI: 10.1590/0102-311x00115813] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 08/18/2014] [Indexed: 11/22/2022] Open
Abstract
This systematic review aimed to investigate the association between maternal smoking during pregnancy and birth defects in children. We performed an electronic search of observational studies in the databases ovid MEDLINE (1950 to April 2010), LILACS and SciELO. We included 188 studies with a total of 13,564,914 participants (192,655 cases). Significant positive associations were found between maternal smoking and birth defects in the following body systems: cardiovascular (OR: 1.11; 95%CI: 1.03-1.19), digestive (OR: 1.18; 95%CI: 1.07-1.30), musculoskeletal (OR: 1.27; 95%CI: 1.16-1.39) and face and neck (OR: 1.28; 95%CI: 1.19-1.37). The strength of association between maternal smoking and birth defects measured by the OR (95%CI) is significantly related to the amount of cigarettes smoked daily (χ2 = 12.1; df = 2; p = 0.002). In conclusion, maternal smoking during pregnancy is associated with congenital malformations in children and this association is dose-dependent.
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Affiliation(s)
- Dilvania Nicoletti
- Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, Brazil
| | | | | | | | - Linjie Zhang
- Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, Brazil
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Taib BG, Taib AG, Swift AC, van Eeden S. Cleft lip and palate: diagnosis and management. Br J Hosp Med (Lond) 2015; 76:584-5, 588-91. [PMID: 26457939 DOI: 10.12968/hmed.2015.76.10.584] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cleft lip and palate is the most common congenital facial anomaly in children, which can affect appearance, speech, hearing, growth, psychosocial wellbeing and social integration. This article provides an overview of the condition for the benefit of all health-care professionals.
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Affiliation(s)
- Bilal G Taib
- Academic Foundation Year 2 Doctor in the Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool L7 8XP
| | - Adnan G Taib
- Academic Foundation Year 1 Doctor in the Department of Cardiology, Royal Derby Hospital, Derby
| | - Andrew C Swift
- Consultant Ear, Nose and Throat Surgeon and Rhinologist in the Department of Otorhinolaryngology, Head & Neck Surgery and Thyroid, Aintree University Hospital, Liverpool
| | - Simon van Eeden
- Consultant Cleft and Maxillofacial Surgeon in the Department of Cleft and Maxillofacial Surgery, Alder Hey Children's Hospital Foundation Trust, Liverpool
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Ghazali N, Rahman NA, Kannan TP, Jaafar S. Screening of Transforming Growth Factor Beta 3 and Jagged2 Genes in the Malay Population with Nonsyndromic Cleft Lip with or without Cleft Palate. Cleft Palate Craniofac J 2015; 52:e88-94. [DOI: 10.1597/14-024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To determine the prevalence of mutations in transforming growth factor beta 3 (TGFβ3) and Jagged2 genes and their association with nonsyndromic cleft lip with or without cleft palate (CL±P) patients. Design Cross-sectional study on nonsyndromic CL±P and noncleft patients. Setting Reconstructive clinic and outpatient dental clinic, Hospital Universiti Sains Malaysia. Patients Blood samples of 96 nonsyndromic CL±P and 96 noncleft subjects. Main Outcome Measure Prevalence and association of mutations in TGFβ3 and Jagged2 genes with nonsyndromic CL±P. Results Most of the nonsyndromic CL±P patients (53.1%) had left unilateral CLP. There were slightly more females (56.6%) compared with males. The prevalence of the mutations in the TGFβ3 gene was 17.7% (95% confidence interval [CI]: 9.5, 24.5) and in the Jagged2 gene was 12.5% (95% CI: 5.5, 18.5), which was higher compared with the noncleft group. For the TGFβ3 gene, there was no mutation in the coding region in either of the groups. All variants were single nucleotide polymorphisms located within the intronic flanking region. Two variants were identified (g.15812T>G and g.15966A>G) in both nonsyndromic CL±P and noncleft patients. However, the association was not significant ( P > .05). Three variants (g.19779C>T, g.19547G>A, and g.19712C>T) were identified in the Jagged2 gene among nonsyndromic CL±P and noncleft patients. Only g.19712C>T showed a significant association with nonsyndromic CL±P patients ( P = .039). Conclusion g.19712C>T might play a crucial role in the development of cleft lip and palate. To the best of our knowledge, this is the first report of the mutation found within intron 13 of the Jagged2 gene among nonsyndromic CL±P Malay patients.
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Affiliation(s)
- Norliana Ghazali
- Dental Public Health Unit, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | | | - Saidi Jaafar
- Molecular Biology Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
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Pedersen MS, Wehby GL, Pedersen DA, Christensen K. Long-term effects of oral clefts on health care utilization: a sibling comparison. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2015; 16:603-612. [PMID: 24908286 DOI: 10.1007/s10198-014-0612-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 05/12/2014] [Indexed: 06/03/2023]
Abstract
Oral clefts are among the most common birth defects affecting thousands of newborns each year, but little is known about their potential long-term consequences. In this paper, we explore the impact of oral clefts on health care utilization over most of the lifespan. To account for time-invariant unobservable parental characteristics, we compare affected individuals with their own unaffected siblings. The analysis is based on unique data comprising the entire cohort of individuals born with oral clefts in Denmark tracked until adulthood in administrative register data. We find that children with oral clefts use more health services than their unaffected siblings. Additional results show that the effects are driven primarily by congenital malformation-related hospitalizations and intake of anti-infectives. Although the absolute differences in most health care utilization diminish over time, affected individuals have slightly higher utilization of some health care services in adulthood (particularly for diseases of the nervous and respiratory system). These results have important implications for affected individuals, their families, and their health professionals.
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Affiliation(s)
- Morten Saaby Pedersen
- Department of Business and Economics, Centre of Health Economics Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark,
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Abstract
The aim of this study was to analyze the association of potential risk factors such as positive family cleft history, smoking, use of drugs during pregnancy, and parental age with oral clefts in offspring within the Kosovo population. We conducted a population-based case-control study of live births in Kosovo from 1996 to 2005. Using a logistic regression model, 244 oral cleft cases were compared with 488 controls. We have excluded all syndromic clefts. Heredity increases the risk of clefts in newborns [odds ratio (OR) = 8.25, 95% confidence interval (CI) 3.12-23.52]. Clefts were also associated with smoking (OR = 1.87, 95% CI 0.75-4.08), use of drugs during pregnancy (OR = 2.25, 95% CI 0.82-5.12), increasing maternal age (OR = 1.83, 95% CI 1.42-2.49), and increasing paternal age (OR = 1.3, 95% CI 1.2- 1.4). We found heredity to be the most important factor for cleft occurrence in Kosovar newborns. Another significant potential risk factor for occurrence of clefts is the parental age. We found the use of drugs and smoking during pregnancy to be less significant.
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Lamy S, Laqueille X, Thibaut F. Conséquences potentielles de la consommation de tabac, de cannabis et de cocaïne par la femme enceinte sur la grossesse, le nouveau-né et l’enfant : revue de littérature. Encephale 2015; 41 Suppl 1:S13-20. [DOI: 10.1016/j.encep.2014.08.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 01/30/2014] [Indexed: 12/17/2022]
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Sabbagh HJ, Hassan MHA, Innes NPT, Elkodary HM, Little J, Mossey PA. Passive smoking in the etiology of non-syndromic orofacial clefts: a systematic review and meta-analysis. PLoS One 2015; 10:e0116963. [PMID: 25760440 PMCID: PMC4356514 DOI: 10.1371/journal.pone.0116963] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 12/16/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies have found a consistent positive association between maternal smoking and non-syndromic orofacial clefts (NSOFC). However, no comprehensive assessment of the association between NSOFC and passive smoking has been undertaken. This systematic review and meta-analysis explores the relationship between maternal passive smoking and NSOFC, and compares the associations between passive and active smoking. METHODS AND FINDINGS Search strategy, inclusion / exclusion criteria, and data extraction from studies reporting maternal passive smoking and NSOFC was implemented without language restrictions. Risks of bias in the identified studies were assessed and this information was used in sensitivity analyses to explain heterogeneity. Meta-analysis and meta-regression of the extracted data were performed. Egger's test was used to test for small study effects. Fourteen eligible articles were identified. Maternal passive smoking exposure was associated with a twofold increase in risk of NSOFC (odds ratio: 2.11, 95% confidence interval: 1.54-2.89); this was apparent for both cleft lip with and without palate (OR: 2.05, 95% CI: 1.27-3.3) and cleft palate (OR: 2.11, 95% CI: 1.23-3.62). There was substantial heterogeneity between studies. In the studies that provided data enabling crude and adjusted odd ratios to be compared, adjustment for potential confounders attenuated the magnitude of association to about a 1.5-fold increase in risk. CONCLUSION Overall, maternal passive smoking exposure results in a 1.5 fold increase in risk of NSOFC, similar to the magnitude of risk reported for active smoking, but there is marked heterogeneity between studies. This heterogeneity is not explained by differences in the distribution of cleft types, adjustment for covariates, broad geographic region, or study bias/quality. This thorough meta-analysis provides further evidence to minimize exposure to environmental tobacco smoke in policy making fora and in health promotion initiatives.
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Affiliation(s)
- Heba J. Sabbagh
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Oral Health Sciences, University of Dundee, Dundee, Scotland, United Kingdom
| | - Mona Hassan Ahmed Hassan
- Department of Dental Public Health, Faculty of Dentistry Kind Abdulaziz University, Jeddah, Saudi Arabia
- Department of Biostatistics, High Institute of Public Health, Alexandria University. Alexandria, Egypt
| | - Nicola P. T. Innes
- Paediatric Dentistry, Department of Oral Health Sciences, University of Dundee, Dundee, Scotland, United Kingdom
| | - Heba M. Elkodary
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
- Faculty of Dental Medicine (Girls’ Branch), Al Azhar University, Cairo, Egypt
| | - Julian Little
- Human Genome Epidemiology, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter A. Mossey
- Division of Oral Health Sciences and WHO Collaborating Centre for Oral Health & Craniofacial Anomalies, University of Dundee, Dundee, Scotland, United Kingdom
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Watkins SE, Meyer RE, Strauss RP, Aylsworth AS. Classification, epidemiology, and genetics of orofacial clefts. Clin Plast Surg 2014; 41:149-63. [PMID: 24607185 DOI: 10.1016/j.cps.2013.12.003] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Orofacial clefts (OFCs) include a broad range of facial conditions that differ in cause and disease burden. In the published literature, there is substantial ambiguity in both terminology and classification of OFCs. This article discusses the terminology and classification of OFCs and the epidemiology of OFCs. Demographic, environmental, and genetic risk factors for OFCs are described, including suggestions for family counseling. This article enables clinicians to counsel families regarding the occurrence and recurrence of OFCs. Although much of the information is detailed, it is intended to be accessible to all health professionals for use in their clinical practices.
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Affiliation(s)
- Stephanie E Watkins
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr Boulevard, Chapel Hill, NC, USA.
| | - Robert E Meyer
- Birth Defects Monitoring Program, Division of Public Health, North Carolina Department of Health and Human Services, State Center for Health Statistics, 222 North Dawson Street, Cotton Building, Raleigh, NC 27603, USA
| | - Ronald P Strauss
- UNC Center for AIDS Research, UNC School of Dentistry, UNC School of Medicine, University of North Carolina at Chapel Hill, 104 South Building, CB# 3000, Chapel Hill, NC 27599-3000, USA
| | - Arthur S Aylsworth
- Departments of Pediatrics and Genetics, University of North Carolina at Chapel Hill, CB# 7487, UNC Campus, Chapel Hill, NC 27599-7487, USA
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Heil SH, Herrmann ES, Badger GJ, Solomon LJ, Bernstein IM, Higgins ST. Examining the timing of changes in cigarette smoking upon learning of pregnancy. Prev Med 2014; 68:58-61. [PMID: 25016042 PMCID: PMC4252916 DOI: 10.1016/j.ypmed.2014.06.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 06/28/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE AND METHOD Timeline Follow-back interviews were conducted with 107 pregnant women enrolling in smoking cessation and relapse prevention clinical trials in the Burlington, VT area between 2006 and 2009 to examine the time course of changes in smoking between learning of pregnancy and the first prenatal care visit. We know of no systematic studies of this topic. RESULTS Women reported learning of pregnancy at 5.1±2.2 weeks gestation and attending a first prenatal care visit at 10.1±3.6 weeks gestation. In the intervening five weeks, 22% of women became abstainers, 62% reduced their smoking, and 16% maintained or increased their smoking. Women who made changes typically reported doing so within the first 2 days after learning of pregnancy, with few changes occurring beyond the first week after learning of pregnancy. CONCLUSION In this first effort to systematically characterize the time course of changes in smoking upon learning of pregnancy, the majority of pregnant smokers who quit or made reductions reported doing so soon after receiving the news. Further research is needed to assess the reliability of these results and to examine whether devising strategies to provide early interventions for women who continue smoking after learning of pregnancy is warranted.
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Affiliation(s)
- Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA.
| | | | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, USA
| | | | - Ira M Bernstein
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA
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Levis DM, Stone-Wiggins B, O'Hegarty M, Tong VT, Polen KND, Cassell CH, Council M. Women's perspectives on smoking and pregnancy and graphic warning labels. Am J Health Behav 2014; 38:755-64. [PMID: 24933145 DOI: 10.5993/ajhb.38.5.13] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To explore women's knowledge, attitudes, and beliefs about adverse outcomes associated with smoking during pregnancy and which outcomes might motivate cessation; to explore reactions to graphic warnings depicting 2 adverse outcomes. METHODS Twelve focus groups were conducted with women of childbearing age who were current smokers. RESULTS Participants had low to moderate awareness of many outcomes and believed it was acceptable to smoke in the first trimester before knowledge of pregnancy. Perceived susceptibility to outcomes was low. Motivators included risk-focused information, especially serious risks to the baby (eg, stillbirth, SIDS). Graphic warnings produced strong reactions, especially the warning with a real photo. CONCLUSIONS Despite barriers to reducing rates of smoking during pregnancy, educational information and photos depicting babies' risks could motivate women to quit.
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Affiliation(s)
- Denise M Levis
- Centers for Disease Control and Prevention, Division of Birth Defects and Developmental Disabilities, Atlanta, GA, USA.
| | - Brenda Stone-Wiggins
- RTI International, Public Health Research Division, Research Triangle Park, NC, USA
| | - Michelle O'Hegarty
- Centers for Disease Control and Prevention, Office on Smoking and Health, Atlanta, GA, USA
| | - Van T Tong
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, GA, USA
| | - Kara N D Polen
- Centers for Disease Control and Prevention, Division of Birth Defects and Developmental Disabilities, Atlanta, GA, USA
| | - Cynthia H Cassell
- Centers for Disease Control and Prevention, Division of Birth Defects and Developmental Disabilities, Atlanta, GA, USA
| | - Mary Council
- RTI International, Public Health Research Division, Research Triangle Park, NC, USA
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Mines D, Tennis P, Curkendall SM, Li DK, Peterson C, Andrews EB, Calingaert B, Chen H, Deshpande G, Esposito DB, Everage N, Holick CN, Meyer NM, Nkhoma ET, Quinn S, Rothman KJ, Chan KA. Topiramate use in pregnancy and the birth prevalence of oral clefts. Pharmacoepidemiol Drug Saf 2014; 23:1017-25. [DOI: 10.1002/pds.3612] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 01/23/2014] [Accepted: 02/17/2014] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - De-Kun Li
- Division of Research, Kaiser Foundation Research Institute; Kaiser Permanente; Oakland CA USA
| | | | | | | | - Hong Chen
- Division of Research, Kaiser Foundation Research Institute; Kaiser Permanente; Oakland CA USA
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Mashuda F, Zuechner A, Chalya PL, Kidenya BR, Manyama M. Pattern and factors associated with congenital anomalies among young infants admitted at Bugando medical centre, Mwanza, Tanzania. BMC Res Notes 2014; 7:195. [PMID: 24679067 PMCID: PMC3974194 DOI: 10.1186/1756-0500-7-195] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 03/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital anomalies or birth defects are among the leading causes of infant mortality and morbidity around the world. The impact of congenital anomalies is particularly severe in middle- and low-income countries where health care resources are limited. The prevalence of congenital anomalies varies in different parts of the world, which could reflect different aetiological factors in different geographical regions. METHODS Between October 2012 and January 2013, a cross-sectional study was conducted involving young infants below 2 months of age, admitted at a university teaching hospital in Tanzania. Face-to-face interviews with parents/caretakers of young infants were carried out to collect socio-demographic and clinical information. Physical examinations were performed on all young infants. Echocardiography, X-ray, cranial as well as abdominal ultrasonographies were performed when indicated. RESULTS Analysis of the data showed that among 445 young infants enrolled in the study, the prevalence of congenital anomalies was 29%, with the Central Nervous System (CNS) as the most commonly affected organ system. Maternal factors that were significantly associated with congenital anomalies included the lack of peri-conceptional use of folic acid (OR = 3.1; 95% CI = 1.4-6.7; p = 0.005), a maternal age of above 35 years (OR = 2.2; 95% CI = 1.1-4.3; p = 0.024) and an inadequate attendance to antenatal clinic (OR = 2.1; 95% CI = 1.4-3.3; p < 0.001). Infant factors that were significantly associated with congenital anomalies were female sex, a birth weight of 2.5 kg or more, singleton pregnancy and a birth order above 4. CONCLUSIONS Due to the high prevalence of congenital anomalies observed in this particular context, the hospital should mobilize additional resources for an optimal and timely management of the patients with congenital anomalies. In this study, the proportion of women taking folic acid supplements during early pregnancy was very low. Efforts should be made to ensure that more women use folic acid during the peri-conceptional period, as the use of folic acid supplement has been linked by several authors to a reduced occurrence of some congenital anomalies.
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Affiliation(s)
- Florentina Mashuda
- Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Antke Zuechner
- Department of Pediatrics and Child Health, Bugando Medical Centre, Mwanza, Tanzania
| | | | - Benson R Kidenya
- Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mange Manyama
- Department of Anatomy and Cell Biology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Xu Y, Li J, Shi B. Sufficient downward rotation of the christa philtri on the cleft side: a modified technique. Front Med 2013; 7:510-16. [DOI: 10.1007/s11684-013-0299-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 09/26/2013] [Indexed: 10/26/2022]
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Song T, Wu D, Wang Y, Li H, Yin N, Zhao Z. Association of NAT1 and NAT2 genes with nonsyndromic cleft lip and palate. Mol Med Rep 2013; 8:211-6. [PMID: 23660777 DOI: 10.3892/mmr.2013.1467] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 04/24/2013] [Indexed: 11/05/2022] Open
Abstract
Nonsyndromic cleft lip and palate (NSCLP) is a common congenital deformity, often associated with environmental risk factors, including alcohol, smoking, drugs and radiation exposure. N-acetyltransferase (NAT)1 and NAT2 genes are involved in the detoxification and metabolic activation of numerous drugs and chemicals. The aim of the present study was to investigate whether genetic variations in these two genes and gene‑gene interactions are associated with NSCLP. We investigated eight NAT1 tag single nucleotide polymorphisms (SNPs) and five NAT2 tag SNPs, selected from HapMap data. These SNPs were examined for associations with NSCLP in 204 patients and 226 controls. Strong evidence of an association with NSCLP was identified for rs4921580 in the NAT1 gene, and haplotype analysis supported these findings. We also found a significant difference between NSCLP and control groups for rs1041983 in the NAT2 gene. The results of gene‑gene interaction analyses also indicated that the combination of rs4921580 (Cg+gg) x rs1041983 (Ct+tt) increased the risk of NSCLP. Thus, the present study provides evidence for the role of NAT1 and NAT2 variations in NSCLP, and indicates that interactions between the NAT1 and NAT2 genes may be important in susceptibility to NSCLP.
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Affiliation(s)
- Tao Song
- Center of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, PR China
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Langlois PH, Hoyt AT, Lupo PJ, Lawson CC, Waters MA, Desrosiers TA, Shaw GM, Romitti PA, Lammer EJ. Maternal occupational exposure to polycyclic aromatic hydrocarbons and risk of oral cleft-affected pregnancies. Cleft Palate Craniofac J 2013; 50:337-46. [PMID: 23136939 PMCID: PMC4096036 DOI: 10.1597/12-104] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate whether there is an association between maternal occupational exposure to polycyclic aromatic hydrocarbons and oral clefts in offspring. This is the first human study of polycyclic aromatic hydrocarbons and clefts of which the authors are aware. DESIGN Case-control study. SETTING, PARTICIPANTS Data for 1997 to 2002 from the National Birth Defects Prevention Study, a large population-based case-control study in the United States, were analyzed. Maternal telephone interviews yielded information on jobs held in the month before through 3 months after conception. Two industrial hygienists independently assessed occupational exposure to polycyclic aromatic hydrocarbons; all jobs rated as exposed or with rating difficulty were reviewed with a third industrial hygienist to reach consensus on all exposure parameters. Logistic regression estimated crude and adjusted odds ratios with 95% confidence intervals for cleft lip with or without cleft palate and cleft palate alone. RESULTS There were 2989 controls (3.5% exposed), 805 cases of cleft lip with or without cleft palate (5.8% exposed), and 439 cases of cleft palate alone (4.6% exposed). The odds of maternal occupational exposure to polycyclic aromatic hydrocarbons (any versus none) during pregnancy was increased for cleft lip with or without cleft palate cases as compared with controls (odds ratio, 1.69; 95% confidence interval, 1.18 to 2.40); the odds ratio was 1.47 (95% confidence interval 1.02 to 2.12) when adjusted for maternal education. There was a statistically significant adjusted exposure-response relationship for cleft lip with or without cleft palate (Ptrend = .02). Odd ratios for cleft palate alone were not statistically significant. CONCLUSIONS Maternal occupational exposure to polycyclic aromatic hydrocarbons was associated with increased risk of cleft lip with or without cleft palate in offspring.
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Affiliation(s)
- Peter H Langlois
- Texas Center for Birth Defects Research and Prevention, Texas Department of State Health Services, PO Box 149347, MC 1964, Austin, TX 78714-9347, USA.
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Abstract
Prenatal substance abuse continues to be a significant problem in this country and poses important health risks for the developing fetus. The primary care pediatrician's role in addressing prenatal substance exposure includes prevention, identification of exposure, recognition of medical issues for the exposed newborn infant, protection of the infant, and follow-up of the exposed infant. This report will provide information for the most common drugs involved in prenatal exposure: nicotine, alcohol, marijuana, opiates, cocaine, and methamphetamine.
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Chung MK, Lao TT, Ting YH, Leung TY, Lau TK, Wong TW. Environmental Factors in the First Trimester and Risk of Oral-Facial Clefts in the Offspring. Reprod Sci 2012; 20:797-803. [DOI: 10.1177/1933719112466311] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Man-Kin Chung
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Terence T. Lao
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Yuen-Ha Ting
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Tak-Yeung Leung
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Tze-Kin Lau
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Tze-Wai Wong
- Division of Occupational and Environmental Health, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
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Wehby GL, Goco N, Moretti-Ferreira D, Felix T, Richieri-Costa A, Padovani C, Queiros F, Guimaraes CVN, Pereira R, Litavecz S, Hartwell T, Chakraborty H, Javois L, Murray JC. Oral cleft prevention program (OCPP). BMC Pediatr 2012. [PMID: 23181832 PMCID: PMC3532199 DOI: 10.1186/1471-2431-12-184] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Oral clefts are one of the most common birth defects with significant medical, psychosocial, and economic ramifications. Oral clefts have a complex etiology with genetic and environmental risk factors. There are suggestive results for decreased risks of cleft occurrence and recurrence with folic acid supplements taken at preconception and during pregnancy with a stronger evidence for higher than lower doses in preventing recurrence. Yet previous studies have suffered from considerable design limitations particularly non-randomization into treatment. There is also well-documented effectiveness for folic acid in preventing neural tube defect occurrence at 0.4 mg and recurrence with 4 mg. Given the substantial burden of clefting on the individual and the family and the supportive data for the effectiveness of folic acid supplementation as well as its low cost, a randomized clinical trial of the effectiveness of high versus low dose folic acid for prevention of cleft recurrence is warranted. Methods/design This study will assess the effect of 4 mg and 0.4 mg doses of folic acid, taken on a daily basis during preconception and up to 3 months of pregnancy by women who are at risk of having a child with nonsyndromic cleft lip with/without palate (NSCL/P), on the recurrence of NSCL/P. The total sample will include about 6,000 women (that either have NSCL/P or that have at least one child with NSCL/P) randomly assigned to the 4 mg and the 0.4 mg folic acid study groups. The study will also compare the recurrence rates of NSCL/P in the total sample of subjects, as well as the two study groups (4mg, 0.4 mg) to that of a historical control group. The study has been approved by IRBs (ethics committees) of all involved sites. Results will be disseminated through publications and presentations at scientific meetings. Discussion The costs related to oral clefts are high, including long term psychological and socio-economic effects. This study provides an opportunity for huge savings in not only money but the overall quality of life. This may help establish more specific clinical guidelines for oral cleft prevention so that the intervention can be better tailored for at-risk women. ClinicalTrials.gov Identifier NCT00397917
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Allareddy V, Turkistani K, Nanda V, Allareddy V, Gajendrareddy P, Venugopalan SR. Factors Associated With Hospitalization Charges for Cleft Palate Repairs and Revisions. J Oral Maxillofac Surg 2012; 70:1968-77. [DOI: 10.1016/j.joms.2011.07.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 07/21/2011] [Accepted: 07/26/2011] [Indexed: 11/28/2022]
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Yuan X, Liu L, Pu Y, Zhang X, He X, Fu Y. 2,3,7,8-Tetrachlorodibenzo-p-dioxin induces a proteomic pattern that defines cleft palate formation in mice. Food Chem Toxicol 2012; 50:2270-4. [DOI: 10.1016/j.fct.2012.04.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 04/17/2012] [Accepted: 04/19/2012] [Indexed: 11/15/2022]
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIMITTEL IN SCHWANGERSCHAFT UND STILLZEIT 2012. [PMCID: PMC7271212 DOI: 10.1016/b978-3-437-21203-1.10002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Taghavi N, Mollaian M, Alizadeh P, Moshref M, Modabernia S, Akbarzadeh AR. Orofacial clefts and risk factors in tehran, iran: a case control study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2012; 14:25-30. [PMID: 22737550 PMCID: PMC3372020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 09/14/2011] [Indexed: 10/26/2022]
Abstract
BACKGROUND Non-syndromic cleft lip with or without cleft palate (CL/P) or cleft palate only (CPO) are orofacial clefts with multifactorial etiology. These include environmental factors and heterogeneous genetic background. Therefore, studies on different and homogenous populations can be useful in detecting related factors. The aim of the present study was to evaluate the risk factors in patients with non-syndromic cleft in Tehran, Iran. METHODS Data from 300 patients and 300 controls were collected between 2005 and 2010. Binary logistic regression analyses were used to calculate relative risk by odds ratio (OR) and %95 confidence interval. RESULTS Low maternal age (OR=1.06, 95% CI, 1.011-1.113), low socioeconomic status (OR=0.23, 95% CI, 0.007-0.074), maternal systemic disease (OR=0.364; 95% CI, 0.152-0.873) and passive smoking (OR=0.613, 95% CI, 0.430-0.874) increased the risk for CL/P and CPO. There was a significant difference in iron and folic acid use during pregnancy when the case and control groups were compared. CONCLUSION In assessing for orofacial cleft risk, we should consider lack of folic acid supplementation use, maternal age and systemic diseases and passive smoking as risk factors.
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Affiliation(s)
- N Taghavi
- Department of Oral and Maxillofacial Pathology, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence: Nasim Taghavi, DMD, MSc, Assistant Professor of Oral and Maxillofacial Pathology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel.: +98-21-88784502, Fax: +98-21-88784502, E-mail:
| | - M Mollaian
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
| | - P Alizadeh
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
| | - M Moshref
- Department of Oral and Maxillofacial Pathology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sh Modabernia
- Dental Student, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A R Akbarzadeh
- Department of Basic Sciences, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mossey PA, Shaw WC, Munger RG, Murray JC, Murthy J, Little J. Global oral health inequalities: challenges in the prevention and management of orofacial clefts and potential solutions. Adv Dent Res 2011; 23:247-58. [PMID: 21490237 DOI: 10.1177/0022034511402083] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The birth prevalence of orofacial clefts, one of the most common congenital anomalies, is approximately one in 700 live births, but varies with geography, ethnicity, and socio-economic status. There is a variation in infant mortality and access to care both between and within countries, so some clefts remain unrepaired into adulthood. Quality of care also varies, and even among repaired clefts there is residual deformity and morbidity that significantly affects some children. The two major issues in attempts to address these inequalities are (a) etiology/possibilities for prevention and (b) management and quality of care. For prevention, collaborative research efforts are required in developing countries, in line with the WHO approach to implement the recommendations of the 2008 Millennium Development Goals (www.un.org/millenniumgoals). This includes the "common risk factor" approach, which analyzes biological and social determinants of health alongside other chronic health problems such as diabetes and obesity, as outlined in the Marmot Health inequalities review (2008) (www.ucl.ac.uk/gheg/marmotreview). Simultaneously, orofacial cleft research should involve clinical researchers to identify inequalities in access to treatment and identify the best interventions for minimizing mortality and residual deformity. The future research agenda also requires engagement with implementation science to get research findings into practice.
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Affiliation(s)
- P A Mossey
- University of Dundee Dental Hospital & School, Scotland, UK.
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Wlodarczyk BJ, Palacios AM, Chapa CJ, Zhu H, George TM, Finnell RH. Genetic basis of susceptibility to teratogen induced birth defects. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2011; 157C:215-26. [PMID: 21766441 DOI: 10.1002/ajmg.c.30314] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Birth defects remain the leading cause of infant death in US. The field of teratology has been focused on the causes and underlying mechanisms of birth defects for decades, yet our understanding of these critical issues remain unacceptably vague. Conclusions from years of animal and human studies made it clear that the vast majority of birth defects have multifactorial origins, with contributions from environmental and genetic factors. The environment comprises not only of the physical, biological, and chemical external environment surrounding the pregnant woman, but it also includes the internal environment of the woman's body that interact with the developing embryo in a complex fashion. The importance of maternal and embryonic genetic factors consisting of countless genetic variants/mutations that exist within every individual contribute to birth defect susceptibility is only now being more fully appreciated. This great complexity of the genome and its diversity within individuals and populations seems to be the principal reason why the same teratogenic exposure can induce severe malformation in one embryo, while fail to do so to other exposed embryos. As the interaction between genetic and environmental factors has long been recognized as the first "Principle of Teratology" by Wilson and Warkany [1965. Teratology: Principles and techniques. Chicago: University of Chicago Press], it is only recently that the appropriate investigative tools have been developed with which to fully investigate this fundamental principle. The introduction of high throughput technologies like whole genome sequencing or genome-wide association studies are promising to deliver an enormous amount of new data that will shed light on the genomic factors that contribute susceptibility to environmental teratogens. In this review, we attempt to summarize the epidemiological and experimental literature concerning birth defects whose phenotypic expression can be clearly related to the interactions between several select environmental factors and those genetic pathways in which they are most likely to have significant modifying effects. © 2011 Wiley-Liss, Inc.
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Affiliation(s)
- Bogdan J Wlodarczyk
- Dell Pediatric Research Institute, 1400 Barbara Jordan Blvd., Austin, TX 78723, USA.
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Hackshaw A, Rodeck C, Boniface S. Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Hum Reprod Update 2011; 17:589-604. [PMID: 21747128 PMCID: PMC3156888 DOI: 10.1093/humupd/dmr022] [Citation(s) in RCA: 419] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is uncertainty over whether maternal smoking is associated with birth defects. We conducted the first ever comprehensive systematic review to establish which specific malformations are associated with smoking. METHODS Observational studies published 1959–2010 were identified (Medline), and included if they reported the odds ratio (OR) for having a non-chromosomal birth defect among women who smoked during pregnancy compared with non-smokers. ORs adjusted for potential confounders were extracted (e.g. maternal age and alcohol), otherwise unadjusted estimates were used. One hundred and seventy-two articles were used in the meta-analyses: a total of 173 687 malformed cases and 11 674 332 unaffected controls. RESULTS Significant positive associations with maternal smoking were found for: cardiovascular/heart defects [OR 1.09, 95% confidence interval (CI) 1.02–1.17]; musculoskeletal defects (OR 1.16, 95% CI 1.05–1.27); limb reduction defects (OR 1.26, 95% CI 1.15–1.39); missing/extra digits (OR 1.18, 95% CI 0.99–1.41); clubfoot (OR 1.28, 95% CI 1.10–1.47); craniosynostosis (OR 1.33, 95% CI 1.03–1.73); facial defects (OR 1.19, 95% CI 1.06–1.35); eye defects (OR 1.25, 95% CI 1.11–1.40); orofacial clefts (OR 1.28, 95% CI 1.20–1.36); gastrointestinal defects (OR 1.27, 95% CI 1.18–1.36); gastroschisis (OR 1.50, 95% CI 1.28–1.76); anal atresia (OR 1.20, 95% CI 1.06–1.36); hernia (OR 1.40, 95% CI 1.23–1.59); and undescended testes (OR 1.13, 95% CI 1.02–1.25). There was a reduced risk for hypospadias (OR 0.90, 95% CI 0.85–0.95) and skin defects (OR 0.82, 0.75–0.89). For all defects combined the OR was 1.01 (0.96–1.07), due to including defects with a reduced risk and those with no association (including chromosomal defects). CONCLUSIONS Birth defects that are positively associated with maternal smoking should now be included in public health educational materials to encourage more women to quit before or during pregnancy.
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Affiliation(s)
- Allan Hackshaw
- CRUK & UCL Trials Centre, University College London, , 90 Tottenham Court Road, London, UK.
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Wehby G, Jugessur A, Murray JC, Moreno L, Wilcox A, Lie RT. GENES AS INSTRUMENTS FOR STUDYING RISK BEHAVIOR EFFECTS: AN APPLICATION TO MATERNAL SMOKING AND OROFACIAL CLEFTS. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2011; 11:54-78. [PMID: 22102793 DOI: 10.1007/s10742-011-0071-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study uses instrumental variable (IV) models with genetic instruments to assess the effects of maternal smoking on the child's risk of orofacial clefts (OFC), a common birth defect. The study uses genotypic variants in neurotransmitter and detoxification genes relateded to smoking as instruments for cigarette smoking before and during pregnancy. Conditional maximum likelihood and two-stage IV probit models are used to estimate the IV model. The data are from a population-level sample of affected and unaffected children in Norway. The selected genetic instruments generally fit the IV assumptions but may be considered "weak" in predicting cigarette smoking. We find that smoking before and during pregnancy increases OFC risk substantially under the IV model (by about 4-5 times at the sample average smoking rate). This effect is greater than that found with classical analytic models. This may be because the usual models are not able to consider self-selection into smoking based on unobserved confounders, or it may to some degree reflect limitations of the instruments. Inference based on weak-instrument robust confidence bounds is consistent with standard inference. Genetic instruments may provide a valuable approach to estimate the "causal" effects of risk behaviors with genetic-predisposing factors (such as smoking) on health and socioeconomic outcomes.
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Affiliation(s)
- George Wehby
- Assistant Professor, Dept. of Health Management and Policy, College of Public Health, University of Iowa, 200 Hawkins Drive, E205 GH, Iowa City, IA 52242 USA,
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