Interaction between smoking and body mass index and risk of oral clefts

Abstract

Purpose To examine maternal smoking and body mass index (BMI) interactions in contributing to risk of oral clefts. Methods We studied 4935 cases and 10,557 controls from 6 population-based studies and estimated a pooled logistic regression of individual-level data, controlling for study fixed effects and individual-level risk factors. Results We found a significant negative smoking-BMI interaction, with cleft risk with smoking generally declining with higher BMI. For all clefts combined, the OR for smoking was 1.61 (95% CI: 1.39–1.86) at BMI 17 (underweight), 1.47 (95% CI: 1.34–1.62) at BMI 22 (normal weight), 1.35 (95% CI: 1.22–1.48) at BMI 27 (overweight), 1.21 (95% CI: 1.04–1.41) at BMI 33 (obese), and 1.13 (95% CI: 0.92–1.38) at BMI 37 (very obese). A negative interaction was also observed for isolated clefts and across cleft types but was more pronounced for cleft lip only and cleft palate only. Conclusions Our findings suggest that the risk of oral clefts associated with maternal smoking is largest among underweight mothers, although the smoking-BMI interaction is strongest for cleft lip only and cleft palate only. BMI was not protective for the effects of smoking; a clinically relevant increase in smoking-related cleft risk was still present among heavier women.

Risk factors and comorbidities in Brazilian patients with orofacial clefts

“…2 Family history of CL/P in the present study corroborates previous findings of high rates of familial recurrence. 1,32 Brito et al, 32 in a study with 1,042 families from five different locations in Brazil, observed a familial recurrence similar to that observed in the present study, in Barbalha (37%) and in Fortaleza (40%) in the Brazilian state of Ceará. Martelli-Junior et al 33 found that 35.1% of 185 non-syndromic CL/P patients from Minas Gerais, Brazil, had a positive family history of orofacial clefts.…”

“…Cleft lip and/or cleft palate (CL/P) is a congenital malformation characterized by the lack of fusion of the upper lip and/or palate, which may be present in isolation or in association with a syndrome. 1 The highest prevalence at birth of CL/P is found in Asian and native American populations (1 in 500 live births), while the lowest prevalence is observed in populations of African descent, with approximately 1 in 2,500 live births. 2 In Brazil, recent studies have indicated that the mean prevalence of CL/P is 5.86 per 10,000 live births, but these rates can vary across different states.…”

“…Moreover, in vitro studies have shown that tobacco inhibits palatal fusion and affects cell proliferation, leading to medial edge epithelial cell death. 1 In addition, some drugs such as anticonvulsants with antifolate activity, antihypertensives, and corticosteroids administered during morphogenesis may lead to CL/P through different cellular mechanisms. 8 By contrast, folic acid supplementation, alone or in combination with vitamins and minerals, prevents the development of neural tube defects, and its use from before conception to 12 weeks' gestation is recommended by the World Health Organization (WHO); however, there is no clear evidence of its preventive effect on CL/P.…”

Neonatal near miss and the occurrence of negative outcomes in the first year of life: data from a national survey, Nascer no Brasil (Born in Brazil), 2011-2012

“…11,14 Among maternal characteristics confounders, social class, paid work, and schooling represent directly or indirectly on the socioeconomic situation. Maternal smoking, as a confounder, is associated with prematurity, low birth weight and cleft lip, 24,25 characteristics that may be present in the classification of neonatal near miss cases and these are also related to a longer hospitalization. Additionally, smoking itself leads to a higher frequency of neonatal hospitalization, 26 and a higher incidence of pulmonary bronchodysplasia which increases hospitalization length.…”

Efeitos adversos da expansão rápida da maxila nos tecidos dentários e de suporte de indivíduos jovens com fissura labiopalatina unilateral

“…Entende-se a fissura labial e/ou palatina como uma malformação caracterizada pela falta de fusão do lábio superior e/ou palato, podendo se apresentar de maneira isolada ou associada a alguma síndrome (Wehby et al, 2017 (Oliveira et al, 2014).…”