Risk factors and comorbidities in Brazilian patients with orofacial clefts

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.

Factors associated with the presence of cleft lip and / or cleft palate in Brazilian newborns

“…In addition, the greater prevalence of births with cleft lip and/or cleft palate is on the Asiatic and American continents, representing 1/500 births; while, in African populations, the prevalence of the anomaly that configures in 1/2500 live births, 17 reinforcing the results of this study that bring the nonwhite race/color as a protective factor for the occurrence of cleft lip and/or cleft palate in Brazil.…”

“…13 As regards the Brazilian regions most affected by this anomaly, the South and Southeast regions presented higher rates, a fact that is consistent with the literature, in which the higher prevalence of cleft lip and/or cleft palate in Brazil was verified in the South region, being the lowest rate corresponding to the northeast region. 17 However, it should be noted that, as evidenced in the results, the Northeast region presents an increasing trend for the development of anomaly, which can be explained by the improvement in the notifications of data also in this region. 17 In the period covered by the study, Brazilian rates of cleft lip and/or cleft palate showed an increasing trend, as has already been pointed out in studies conducted with data until 2013, 13 and in a similar manner to other countries such as the Netherlands 9 and Argentina.…”

“…17 However, it should be noted that, as evidenced in the results, the Northeast region presents an increasing trend for the development of anomaly, which can be explained by the improvement in the notifications of data also in this region. 17 In the period covered by the study, Brazilian rates of cleft lip and/or cleft palate showed an increasing trend, as has already been pointed out in studies conducted with data until 2013, 13 and in a similar manner to other countries such as the Netherlands 9 and Argentina. 18 In Brazil, the Northeastern and Southeastern regions also showed ascending rates, while the Midwest region showed discordant behavior to other regions with increasing rates, followed by a decreasing trend.…”

“…21 With respect to the presence of a companion, this study indicated that the absence of a partner is associated with cleft lip and/or cleft palate, thus ratifying, findings from other studies. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Another factor-associated care to children with cleft lip and/or cleft palate is the insufficient number of prenatal consultations, lower than the recommended minimum of seven. The quality and quantity of pre-natal consultations are essential for maternal and child safety, as they are linked directly with the rates of neonatal death.…”

Environmental mechanisms of orofacial clefts

“…There are significant personal, social, and financial burdens associated with OFCs among afflicted individuals and their families. Further, those suffering from OFCs may be at increased risk of associated morbidities (Silva et al, 2018). It is therefore a priority to understand all aspects of OFC etiology so that it may be prevented when possible.…”