Prenatal Ultraviolet Exposure and Risk of Orofacial Clefts: A United States Birth Analysis
Giap H. Vu*, Sara Neimanis, Howard Langstein, Clinton Morrison
Division of Plastic Surgery, University of Rochester Medical Center, Rochester, NY
The etiology of orofacial clefts is thought to be multifactorial, consisting of both genetic and environmental factors. Among the environmental elements, maternal ultraviolet (UV) exposure has not been shown to influence the risk of orofacial clefting in newborns. This study investigated the associations between prenatal UV doses - during the first trimester and during the three months prior to conception - and the odds of cleft lip with/without cleft palate (CLP) and cleft palate only (CPO) in the U.S.
The U.S. 2014 and 2015 Natality Data were utilized (n = 7,986,908). Mean daily county-level population-weighted erythemally-weighted daily UV dose was calculated over two specific periods for each live birth, namely the first trimester and the three months prior to conception. Multivariable logistic regressions controlled for household demographics, prenatal characteristics, infant characteristics, and socioeconomic factors.
Of 7,692,735 live births included, 3,895 (0.05%) had CLP and 1,483 (0.02%) had CPO. Higher mean daily UV dose during the first trimester was associated with statistically significantly lower odds of CPO (aOR = 0.99 [0.99, 0.99], p < 0.001); this effect was not significant for CLP (aOR = 0.99 [0.99, 1.00], p = 0.596). The odds of CPO and CLP were independent of the mean daily UV dose during the three-month pre-conception period (p = 0.117 and 0.357, respectively). The models confirmed several known risk factors for CLP, including lower maternal education level, delayed prenatal care, and maternal obesity (all p < 0.001), and those for CPO, such as presence of other congenital disorders (p < 0.001) and maternal gestational diabetes (p = 0.039).
Higher daily maternal dose of UV during the first trimester was associated with decreased odds of CPO after controlling for risk factors for orofacial clefting. Given that palatogenesis occurs in the first trimester, our study suggested that UV and UV-mediated metabolic processes may be implicated in palatal development. Further studies are needed to confirm this association and elucidate its mechanism.
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