Environmental risk factors for cleft lip and palate in low-resource settings: a case-control study

Abstract

Background Cleft lip with or without palate is the most common birth defect with a global prevalence of 1 in 700 births. Although there is a clear algorithm of care in developed countries, the lack of access to surgery in low-income and middle-income countries (LMICs) means that millions of people live with this easily treated condition. Although smoke exposure from unsafe cooking practices no longer occurs in the developed world and is not routinely studied, exposure to smoke from cooking remains an important challenge to health in LMICs. We aimed to understand whether exposure to cooking smoke is associated with cleft lip and palate in these low-resource settings. Methods We conducted a case-control study of mothers of a child with cleft lip with or without palate (cases) and population-matched mothers of children who do not have the condition (controls) in partnership with Operation Smile. Participants were from Vietnam, the Philippines, Honduras, Nicaragua, Morocco, Democratic Republic of the Congo, and Madagascar. Participants provided written consent and the University of Southern California gave ethical approval for the study. The primary exposure of interest was smoke inhalation in the form of smoking before or during pregnancy, paternal (ie, the father of the child) smoking, living with any smoker, or cooking indoors over a fire. We used logistic regression with multiple adjustment models to assess these smoke exposures as possible risk factors for cleft lip and palate. Findings We included data from 2168 cases and 2080 controls, recruited between 2011 and 2017. We found that <1% of the mothers in our study smoked cigarettes, but 59•3% (n=1234) cases and 39•1% (n=848) controls cooked over a fire inside their home. We did not find a significant effect of household smoking, smoking 3 months before or during pregnancy, or paternal smoking in our data. Case mothers were 1•47 (95% CI 1•2-1•8) times more likely to cook over a fire indoors than were controls, after mutual adjustment for all other smoke exposure, confounders, and urban versus rural place of dwelling. Interpretation Exposure to smoke while cooking is a well-established health risk in LMICs for a wide variety of diseases, but has never been studied with respect to cleft lip and palate. We have shown that it may play a role in the risk of cleft lip and palate, and that it may be a larger risk factor than active or passive tobacco smoke exposure. Exposures specific to low-resource settings must be taken into account when we study preventable risk factors in order to develop strategies that will address the populations at the highest risk of having to live with this condition.

A Retrospective and Prospective Cohort Study Comparing Pediatric Patients With Cleft Lip and Palate From the United States and Guatemala

“…Exposure to cooking fire smoke has recently been indicated as a risk factor for OFC, potentially larger than active or passive tobacco smoke exposure. 39 Nearly 85% of the SFG parents reported maternal exposure to cooking fire smoke either inside the house, outside the house, in a kitchen separated from the house, or some combination of the three. This is corroborated by one estimate that 87% of all energy used in Alta Verapaz is generated by firewood.…”

The Risk of Orofacial Cleft Lip/Palate Due to Maternal Ambient Air Pollution Exposure: A Call for Further Research in South Africa

“…There are no substantial African studies demonstrating the association between air pollutants and CLP risk. Related African studies have focused on socioeconomic status, educational level, cigarette smoking, alcohol consumption, indoor cooking with charcoal, and the use of multivitamins, among other factors [42][43][44]. Data collection on air quality in several Sub-Saharan African countries is reportedly insufficient to inform science-driven health research [45].…”

Recent Advances in Nasoalveolar Molding Therapy Using 3D Technology

“…[1][2][3][4] Several studies have demonstrated that the etiology of OFC is both polygenic and multifactorial in nature. [5][6][7][8][9][10] The prevalence of cleft anomalies vary widely according to gender, 11,12 socioeconomic status, 13 ancestry, 4 maternal nutrition, 14 and environmental determinants such as prenatal exposure to tobacco and other teratogenic agents. [15][16][17] Corrective treatment of cleft lip with or without palate involves extensive multispecialty longitudinal assessment and management.…”