Neighborhood Deprivation and Risk of Congenital Heart Defects, Neural Tube Defects and Orofacial Clefts: A Systematic Review and Meta-Analysis

Abstract

BackgroundWe conducted this systematic review and meta-analysis to address the open question of a possible association between the socioeconomic level of the neighborhoods in which pregnant women live and the risk of Congenital Heart Defects (CHDs), Neural Tube Defects (NTDs) and OroFacial Clefts (OFCs).MethodsWe searched MEDLINE from its inception to December 20th, 2015 for case-control, cohort and ecological studies assessing the association between neighborhood socioeconomic level and the risk of CHDs, NTDs and the specific phenotypes Cleft Lip with or without Cleft Palate (CLP) and Cleft Palate (CP). Study-specific risk estimates were pooled according to random-effect and fixed-effect models.ResultsOut of 245 references, a total of seven case-control studies, two cohort studies and two ecological studies were assessed in the systematic review; all studies were enrolled in the meta-analysis with the exception of the two cohort studies. No significant association has been revealed between CHDs or NTDs and neighborhood deprivation index. For CLP phenotype subgroups, we found a significantly higher rate in deprived neighborhoods (Odds Ratios (OR) = 1.22, 95% CI: 1.10, 1.36) whereas this was not significant for CP phenotype subgroups (OR = 1.20, 95%CI: 0.89, 1.61).ConclusionIn spite of the small number of epidemiological studies included in the present literature review, our findings suggest that neighborhood socioeconomic level where mothers live is associated only with an increased risk of CLP phenotype subgroups. This finding has methodological limitations that impede the formulation of firm conclusions, and further investigations should confirm this association.

Understanding how the concentration of neighborhood advantage and disadvantage affects spina bifida risk among births to non‐Hispanic white and Hispanic women, Texas, 1999–2014

“…These data also add to the limited amount of existing data on the associations between neighborhood SES and spina bifida. Research on SES and spina bifida has focused almost exclusively on neighborhood deprivation, such as the percent of a population in a census tract below a poverty level (Deguen et al, ). While the utility of this measure in program development and poverty research is well documented, it does not allow researchers to account for additional neighborhood influences nor does it characterize the income level of the advantaged population (Krieger, Chen, Waterman, Rehkopf, & Subramanian, ; Krieger, Singh, & Waterman, ).…”

“…Spina bifida is a neural tube defect (NTD) with a prevalence of 4.00 per 10,000 live births in the United States (U.S.) (Atta et al, 2015; Botto et al, ; Williams et al, ). Studies have identified a number of risk factors for spina bifida including: obesity, diabetes, Hispanic ethnicity or Mexican‐origin, inadequate folic acid intake, periconceptional fever, and various individual and neighborhood measures of socioeconomic status (SES) (Agopian et al, ; Botto, Moore, Khoury, & Erickson, ; Canfield et al, ; Canfield et al, ; Copp et al, ; Deguen, Kihal, Jeanjean, Padilla, & Zmirou‐Navier, ; Farley, Hambidge, & Daley, ; Flores, Vellozzi, Valencia, & Sniezek, ; Shaw et al, ). A recent review and meta‐analysis of the association between neighborhood deprivation and neural tube defects (NTDs) identified five studies and found mixed results: three studies demonstrating increased risk (Agha, Glazier, Moineddin, Moore, & Guttmann, ; Vrijheid, Dolk, Abramsky, Alberman, & Scott, ; Wasserman, Shaw, Selvin, Gould, & Syme, ), and two studies no association (Grewal, Song, & Shaw, ; Pawluk et al, ).…”

Prevalence and Parental Risk Factors for Speech Disability Associated with Cleft Palate in Chinese Children—A National Survey

“…Unhealthy lifestyle elements such as these are not good for offspring [43] and may contribute to congenital defects such as cleft palate [15,44]. Furthermore, parental education level is one measure of neighborhood-based socio-economic status (SES), which was associated with the risk of oral cleft [8,45]. …”

Neighbourhood maternal socioeconomic status indicators and risk of congenital heart disease

“…However, the results were not consistent by all geographic areas and various SES indicators [ 12 ]. Conversely, another recent meta-analysis of two ecological, seven case-control and two cohort studies did not find associations between neighbourhood SES variables and the risk of CHD [ 13 ]. Moreover, a recent population-based study in Ontario, Canada found that children born in lower SES neighbourhoods (23% of all births) had 20% higher risk of CHD (RR: 1.20; 95% CI: 1.15–1.24) [ 14 ].…”