Epidemiologic Trends of Infants With Orofacial Clefts in a Multiethnic Country: A Retrospective Population-based Study

Abstract

Objectives: To establish the population-based prevalence and trends of cleft live births, evaluate associated malformations and infant mortality rate (IMR), and delineate the orofacial cleft (OFC) topography, ethnic and gender-specific features of the resident-population in Singapore from 2003 to 2012. Cleft-births surveillance and data of affected individuals, families, ethnic groups, locations and environment are essential in upstream healthcare planning. Well-informed decisions supported by data are all-important in health policies.Methods: Resident population-based data were compiled from the National Birth Defects Registry (NBDR). The Registry’s data was established from multiple sources: cytogenetics and histopathology laboratories, neonatal wards and maternity hospitals, medi-claims, birth defects, death certificates with reported congenital anomalies, stillbirths and abortuses (spontaneous and elective). The significance level of trend testing was set at p<0.05.Results: Prevalence per 10 000 for all cleft live births was 16.72; isolated clefts with no associated malformations, cleft lip, cleft palate, and cleft lip with cleft palate were 8.77, 6.85, 3.16, and 6.71, respectively. Prevalence in cleft live births was sexually dimorphic and ethnic-specific: Male, 17.72; Female, 15.78; Chinese group, 17.17; Malay group, 16.92; Indian group, 10.74; and mixed ethnicity group, 21.73. Infants with isolated clefts, non-isolated clefts with other malformations, and syndromic clefts were 52.5%, 42.1%, and 5.4%, respectively. Upward trend in infants with non-isolated clefts was significant (p=0.0287). The mortality rate in infants with clefts was 4.76%.Conclusions: The population-based prevalence for cleft live births was 16.72 per 10 000 with no significant upward trend. Co-occurrence of malformations and syndromes was found in almost half of all cleft live births. The IMR of infants with OFC was double that of the population norm.