Risk of Oral Clefts in Relation to Prepregnancy Weight Change and Interpregnancy Interval

Villamor, Eduardo; Sparén, Pär; Cnattingius, Sven

doi:10.1093/aje/kwn065

Cited by 41 publications

(40 citation statements)

References 37 publications

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“…Possible confounders were selected based on previously reported associations with oral clefts and biologically plausible associations with infection or fever (Acs et al, 2005(Acs et al, , 2006bHashmi et al, 2005;Krost and Schubert, 2006;Villamor et al, 2008). Based on these criteria, the following potential covariates were examined: maternal body mass index (BMI), age, education, race/ethnicity, parity, and season of conception (winter, December to February; spring, March to May; summer, June to August; fall, September to November).…”

Section: Methodsmentioning

confidence: 99%

Maternal fever during early pregnancy and the risk of oral clefts

Hashmi¹,

Gallaway

Waller

et al. 2010

Birth Defects Research

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An increased risk of birth defects after hyperthermic exposures has been confirmed in animal studies, but population studies have yielded inconsistent results. Oral clefts are a common birth defect and have been associated with these exposures in some of these studies. In this study, data from the National Birth Defects Prevention Study was used to evaluate the association of maternal report of febrile illness in early pregnancy and the risk of oral clefts. All oral cleft cases born between 1997 and 2004 were compared with nonmalformed controls born in the same geographical region during the same time period. Mothers reporting febrile illness during pregnancy were stratified by fever grade and antipyretic use. Logistic regression models were used to generate crude and adjusted odds ratios for exposure to fever and association with each oral cleft phenotype. The dataset included 5821 controls, 1567 cases of cleft lip with or without cleft palate (CL+/-P) and 835 cases of cleft palate only. A modestly increased risk was observed for isolated CL+/-P (odds ratio, 1.28; 95% confidence interval, 1.01-1.63). Stratification by fever grade (body temperature <101.5 degrees or > or =101.5 degrees F) did not yield significant differences in risk. Risk estimates were higher among women who reported a fever, but did not take antipyretics to control their fever, particularly for nonisolated compared with isolated oral clefts. This finding suggests that adequate control of fever may diminish the deleterious effects of fever in cases of oral cleft.

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Section: Methodsmentioning

confidence: 99%

Maternal fever during early pregnancy and the risk of oral clefts

Hashmi¹,

Gallaway

Waller

et al. 2010

Birth Defects Research

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“…corticosteroids are taken as a result of the underlying disease and associated flares. 23 Whether maternal disease or disease activity is associated with oral clefts, directly or through common causes such as smoking, alcohol, inter-pregnancy interval or obesity, 31,32 remains unanswered. Consequently, studies that group any underlying indication for corticosteroids without statistical adjustment for the disease or severity are difficult to interpret.…”

Section: Oral Cleftsmentioning

confidence: 99%

A Review of Systemic Corticosteroid Use in Pregnancy and the Risk of Select Pregnancy and Birth Outcomes

Bandoli

Palmsten

Smith

et al. 2017

Rheumatic Disease Clinics of North America

213

136

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Synopsis The evidence to date regarding corticosteroid exposure in pregnancy and select pregnancy and birth outcomes is limited and inconsistent. Here we provide a narrative review of published literature summarizing the findings for oral clefts, preterm birth, birth weight, preeclampsia and gestational diabetes mellitus. Whenever possible, the results are limited to oral or systemic administration with a further focus on use in autoimmune disease. Although previous studies of corticosteroid exposure in pregnancy reported an increased risk of oral clefts in the offspring, more recent studies have not replicated these findings. Further, most of the literature lacks robust statistical analysis accounting for underlying disease or disease activity. The evidence to date suggests that first trimester corticosteroid use may confer a small increase in the odds of cleft lip with or without cleft palate, although data are conflicting and it is unknown to what extent the underlying maternal disease may contribute. There is little support that systemic corticosteroid use in pregnancy independently causes increases in risks of preterm birth, low birth weight, or preeclampsia. There is not sufficient evidence to determine whether corticosteroids could contribute to gestational diabetes mellitus.

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“…Some studies also report that maternal obesity increases OFC risk (e.g. (Stothard et al 2009; Villamor, Sparen, and Cnattingius 2008) but others do not find significant effects (Shaw 2000). Food insecurity may also increase cleft palate risk (Carmichael et al 2007).…”

mentioning

confidence: 99%

Genes as instruments for studying risk behavior effects: an application to maternal smoking and orofacial clefts

Wehby

Jugessur

Murray

et al. 2011

Health Serv Outcomes Res Method

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This study uses instrumental variable (IV) models with genetic instruments to assess the effects of maternal smoking on the child’s risk of orofacial clefts (OFC), a common birth defect. The study uses genotypic variants in neurotransmitter and detoxification genes relateded to smoking as instruments for cigarette smoking before and during pregnancy. Conditional maximum likelihood and two-stage IV probit models are used to estimate the IV model. The data are from a population-level sample of affected and unaffected children in Norway. The selected genetic instruments generally fit the IV assumptions but may be considered “weak” in predicting cigarette smoking. We find that smoking before and during pregnancy increases OFC risk substantially under the IV model (by about 4–5 times at the sample average smoking rate). This effect is greater than that found with classical analytic models. This may be because the usual models are not able to consider self-selection into smoking based on unobserved confounders, or it may to some degree reflect limitations of the instruments. Inference based on weak-instrument robust confidence bounds is consistent with standard inference. Genetic instruments may provide a valuable approach to estimate the “causal” effects of risk behaviors with genetic-predisposing factors (such as smoking) on health and socioeconomic outcomes.

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Risk of Oral Clefts in Relation to Prepregnancy Weight Change and Interpregnancy Interval

Cited by 41 publications

References 37 publications

Maternal fever during early pregnancy and the risk of oral clefts

Maternal fever during early pregnancy and the risk of oral clefts

A Review of Systemic Corticosteroid Use in Pregnancy and the Risk of Select Pregnancy and Birth Outcomes

Genes as instruments for studying risk behavior effects: an application to maternal smoking and orofacial clefts

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