Maternal Tobacco Exposure and Risk of Orofacial Clefts in the Child
Anthony H. Bui, BS1, Ayisha Ayub, MPhil2, Mairaj K. Ahmed, DDS, MS1, Emanuela Taioli, MD, PhD1, Peter J. Taub, MD, FACS, FAAP1.
1Icahn School of Medicine at Mount Sinai, New York, NY, USA, 2Gujrat Cleft Hospital, Gujrat, Pakistan.
BACKGROUND: While a relationship between maternal tobacco exposure and development of orofacial clefts in the child has been well-established for some time, the actual degree of risk conferred by this exposure has not been well quantified. A better understanding of this risk would be of particular benefit to prenatal specialists and providers when speaking with prospective parents. The purpose of this study was to quantify the risk for cleft lip and/or cleft palate (CLP) associated with maternal tobacco exposure. METHODS: A case-control study was conducted at the Cleft Hospital and the Bashir Hospital in Gujrat, Pakistan from December 2015 to December 2016. All cases of CLP at the Cleft Hospital during this time period were included in the study. Patients who were previously operated on for CLP at another hospital were excluded. During the same time period, infants and children of three years of age or less at the Bashir Hospital were chosen to serve as control cases if they had no congenital malformations, were born or living in the same area as the patients in the study with CLP, and were of comparable socioeconomic standing to those patients. Bivariate analyses were performed to identify demographic variables and risk factors associated with CLP. These variables were then included alongside maternal tobacco exposure (whether one or both parents smoke) in a multiple logistic regression to calculate the adjusted odds ratio of developing CLP associated with tobacco exposure. RESULTS: A total of 329 patients with CLP and 131 controls were included in the study. Upon bivariate analysis, the following factors demonstrated a statistically significant positive association with development of cleft: having one or two parents who smoke (p<0.001), complications during pregnancy or after birth (p<0.001), maternal hypertension during pregnancy (p=0.01), mother not on any medications (p<0.001), mother not receiving vaccinations (p<0.001), and lower socioeconomic status (p<0.001). After adjustment for these variables, having a smoking parent was associated with a 2.09 times increased odds of the child developing CLP (95% CI 1.22-3.58). Complications during or after pregnancy (OR=2.38, 95% CI 1.45-3.90), mother receiving vaccinations (OR=0.32, 95% CI 0.16-0.64), and higher socioeconomic status (OR=0.15, 95% CI 0.04-0.63) were also statistically significantly associated with CLP within this model. CONCLUSIONS: While previous studies have consistently shown maternal tobacco exposure to be associated with development of orofacial clefts in the child, this study identifies and accounts for possible confounding variables in a case-control design, thereby providing a quantified estimate of the risk conferred by maternal tobacco exposure. This finding will be of value to providers in the context of perinatal counseling.
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