Incidence, Risk Factors, and Mortality Associated With Orofacial Cleft Among Children in Ontario, Canada

Abstract

IMPORTANCE Orofacial cleft (OFC) is one of the most common congenital malformations, with a wide variation in incidence worldwide. However, population-based studies on the incidence of OFC in North America are lacking. OBJECTIVES To examine the incidence of OFC in Ontario, Canada, and to compare risk factors and mortality associated with children with OFC vs children without OFC. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used health administrative data from the province of Ontario, Canada. Children with OFC who were born from April 1, 1994, to March 31, 2017, in Ontario were each matched to 5 children without OFC based on sex, date of birth (±30 days), and mother's age (±5 years). Analyses were conducted from September 2018 to January 2019. EXPOSURES Children born with OFC. MAIN OUTCOMES AND MEASURES Incidence of OFC over time and regional variation. Risk factors for OFC were assessed using 1-way analysis of variance for means, Kruskal-Wallis for medians, and χ 2 tests for categorical variables. Adjusted Cox regression models were used to assess mortality.

Modifiable Risk Factors of Non-Syndromic Orofacial Clefts: A Systematic Review

“…Among fetal conditions, a study conducted in Brazil counts preterm birth (gestational age less than 37 weeks) before the stage of fetal weight gain, which is often associated with cesarean delivery [ 49 ]. A low-weight fetus (<1.5 kg) usually goes to post-partum mortality [ 50 , 51 ].…”

Higher maternal age is associated with higher occurrence of cleft lip/palate in neonates under intensive care

“…As isolated CL was detected in only one patient and isolated CP was not detected, it can be hypothesized that this isolated malformation does not justify admission to a neonatal ICU. Higher mortality rates are also expected in neonates with CL/P when compared to neonates without this malformation (5.08 vs. 0.33 deaths in every 1,000 births per year, p<0.001) 24 . Despite these previous findings, no neonate in the present study with CL/P died before ICU discharge.…”

Role of Maternal Infections and Inflammatory Responses on Craniofacial Development

“…Further, clefting can occur either as isolated (non-syndromic) or as a part of a syndrome with other symptoms. OFC is caused by a combination of environmental factors (e.g., maternal illness, smoking/alcohol consumption, and malnutrition), and genetic predisposition [ 285 , 286 ]. Studies have reported an association between maternal hyperpyrexia, illnesses, and infections with the occurrence of CLP in the newborns with no gender differences [ 287 ], though the mechanism is poorly understood.…”