Introduction
The purpose of this study was to evaluate the association between maternal tobacco exposure and development of orofacial clefts (OFCs) in the child in a Pakistani population.
Methods
A case-control study was conducted at the Cleft Hospital and Bashir Hospital in Gujrat, Pakistan, from December 2015 to December 2016. All new cases of OFC at the Cleft Hospital were included. Patients at Bashir Hospital younger than 3 years and without congenital malformations were selected as control subjects. Risk factors associated with OFC were identified through bivariate analyses. Multiple logistic regression was then performed to calculate adjusted odds ratios (ORs) of developing OFC according to various risk factors.
Results
The study included 297 patients with OFC and 131 control subjects. Upon univariable analysis, the following were associated with OFC: maternal tobacco exposure (P < 0.001), complications during pregnancy (P < 0.001), maternal hypertension (P = 0.01), mother not on physician-recommended medications (P < 0.001), mother not receiving vaccinations (P < 0.001), consanguineous marriage (P < 0.001), and lower socioeconomic status (P < 0.001). Upon multivariable analysis, having a smoking parent (OR, 1.89; 95% confidence interval [CI], 1.10–3.26), complications during pregnancy (OR, 2.36; 95% CI, 1.43–3.88), and consanguineous marriage (OR, 1.79; 95% CI, 1.13–2.85) were associated with increased odds of development of OFC; receiving vaccinations (OR, 0.31; 95% CI, 0.16–0.63) and higher socioeconomic status (OR, 0.20; 95% CI, 0.05–0.74) were protective.
Conclusions
Patients with OFC were nearly twice as likely to have a parent who smokes as those without. Efforts to reduce tobacco consumption among prospective parents, such as perinatal tobacco cessation counseling programs, should be evaluated in this population.
Orofacial clefts represent the most common congenital craniofacial anomaly worldwide. This condition is best managed by an interdisciplinary team of specialists, often with gratifying results for both the patient and the care providers. Despite recent advances in the management, it remains a challenge today to provide cleft care in low-and middleincome countries (LMIC) due to the lack of basic health care infrastructure and long-term follow-up. International cleft mission trips have traditionally been successful in providing reconstructive plastic surgery to communities with limited resources. More recently, there has been a global efort in the cleft care community to facilitate development of sustainable local cleft care centers that are capable of providing longitudinal, comprehensive care to the indigenous population. This chapter focuses on the elements that are necessary for running a successful international cleft mission and a local cleft care facility, which include the essential personnel, operational protocols, equipment, logistics, patient selection, and follow-up. The challenges and future directions of providing cleft care in LMIC are also discussed.
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