Maternal Tobacco Exposure and Development of Orofacial Clefts in the Child

Abstract

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.

Cleft Lip and/or Palate and Associated Risks in Lower-Middle-Income Countries: A Systematic Review

“…Evidence illustrates that CL/P is a complex, heterogeneous and multifactorial disorder (Buyu et al, 2012;Kalaskar et al, 2013;Bui et al, 2018a) as demonstrated by the variety of biological and/or environmental risk factors found in this systematic review. Lower-middle-income countries present with higher birth rates as well as higher mortality rates compared to highincome countries (The World Bank, 2021a, 2021b) making it difficult to analyze risks from high-income countries in LMICs.…”

“…To date, no systematic review has investigated the risks associated with CL/P in LMICs. Low socioeconomic status (SES) was reported to be statistically significantly associated with CL/P in 4 studies (P < .05; Bui et al, 2018aBui et al, , 2018bAli & Hamid, 2019;Gendel et al, 2019). The type of cleft has been linked to different SES levels, as cleft lip (CL) was found to be more prevalent in a low SES population (Gendel et al, 2019).…”

“…Contact with heavy metals due to eating contaminated food or drinking polluted water is a risk individuals in rural areas are exposed to and has been linked to CL/P (Figueiredo et al, 2015;Mbuyi-Musanzayi et al, 2018). Mothers with a low SES may be less likely to receive guidance regarding appropriate nutrition during pregnancy due to poor access to health care (Figueiredo et al, 2015;Bui et al, 2018a;Mbuyi-Musanzayi et al, 2018;Gendel et al, 2019;Eshete et al, 2020). Low SES further negatively impacts the quality of education individuals receive.…”

“…Studies conducted in Brazil (Maranha ˜o et al, 2020), Mexico (Angulo-Castro et al, 2017, China (Xu et al, 2015;Xu et al, 2018;Hong et al, 2020), andThailand (McKinney et al, 2016) have found similar results, restating the biological origin of CL/P regardless of SES. Additionally, consanguineous marriage was associated with an increase in the occurrence of a CL/P (Bui et al, 2018a(Bui et al, , 2018bAli & Hamid, 2019). The presence of both consanguinity and a familial history may lead to a cumulative effect in the occurrence of CL/P.…”

“…A study conducted in the Netherlands determined that CL/P was more common in males while cleft palate (CP) was more common in females (Pool et al, 2020). While one study concluded similar results (Bui et al, 2018a), other studies identified CL/P, CL, and/or CP to be more prevalent in females (Omo-Aghoja et al, 2010;Kalaskar et al, 2013;Mbuyi-Musanzayi et al, 2018;Ali & Hamid, 2019) and CLP, CL and alveolus, and CP to be prevalent in males (Mbuyi-Musanzayi et al, 2018;Ali & Hamid, 2019). Due to the interplay between genetics and the environment, genetic testing in LMICs is important as this population may be exposed to additional environmental risk factors, such as poverty and lack of nutritious food, in comparison to individuals in high-income settings.…”