To determine the role of racial background, public health initiatives, and residence on the prevalence of orofacial clefts (OFCs) in New York City (NYC).
Design/Methods:
Retrospective review of OFC cases from the New York State Congenital Malformations Registry.
Patients/Participants:
Patients born with an OFC and all live births to mothers residing in NYC between 1983 and 2010.
Main Outcome Measures:
Orofacial cleft birth prevalence by cleft type, race, and borough of maternal residence for each year and by time period around the implementation of public health interventions including folate supplementation.
Results:
A total of 3557 cases were reviewed. The prevalence remained stable for cleft palate and cleft lip with or without cleft palate (CL ± P) in sequential time periods of the study. Among CL ± P cases, cleft lip prevalence decreased early in the study compared to increases in cleft lip and palate prevalence. For most years, the prevalence of OFCs was lower among African Americans than whites. A total of 12% to 26% of mothers in 4 of the NYC boroughs deliver outside of their borough of residence, choosing to give birth in Manhattan most often. No difference in OFC prevalence was shown in any of the 5 NYC boroughs.
Conclusions:
The period prevalence remained relatively stable during the time periods before and after the implementation of folate supplementation for OFCs in NYC. Prevalence of OFC subtypes was lower for most time periods during this study among African Americans compared to whites. Several factors may explain the choice of birthplace outside of the mother’s borough of residence.
AbergAWestbomLKallenB. Congenital malformations among infants whose mothers had gestational diabetes or preexisting diabetes. Early Hum Dev. 2001;61(2):85–95.
2.
AbbottMKokorowskiPJMearaJG. Timeliness of surgery in children with special health care needs: delayed palate repair for publicly insured and minority children with cleft palate. J Pediatr Surg. 2011;46(7):1319–1324.
3.
AmideiRLHammanRFKassebaumDKMarshallJA. Birth prevalence of cleft lip and palate in colorado by sex distribution, seasonality, race/ethnicity, and geographic variation. Spec Care Dentist. 1994;14(6):233–240.
4.
ArosarenaOA. Cleft lip and palate. Otolaryngol Clin North Am. 2007;40(1):27–60.
5.
BlantonSHHenryRRYuanQMullikenJBStalSFinnellRHHechtJT. Folate pathway and nonsyndromic cleft lip and palate. Birth Defects Res A Clin Mol Teratol. 2011;91(1):50–60.
6.
BroderHWilson-GendersonMSischoL. Health disparities among children with cleft. Am J Public Health. 2012;102(5):828–830.
7.
CanfieldMACollinsJSBottoLDWilliamsLJMaiCTKirbyRSMulinareJ. Changes in the birth prevalence of selected birth defects after grain fortification wiht folic acid in the United States: findings from a multi-state population-based study. Birth Defects Res A Clin Mol Teratol. 2005;73(10):679–689.
8.
CarlsonLHatcherKWVander BurgR. Elevated infant mortality rates among oral cleft and isolated oral cleft cases: a meta-analysis of studies from 1943 to 2010. Cleft Palate Craniofac J. 2013;50(1):2–12.
9.
CassellCHMeyerRDanielsJ. Health care expenditures among medicaid enrolled children with and without orofacial clefts in North Carolina, 1995-2002. Birth Defects Res A Clin Mol Teratol. 2008;82(11):785–794.
10.
CedergrenMKallenB. Maternal obesity and the risk for orofacial clefts in the offspring. Cleft Palate Craniofac J. 2005;42(4):367–371.
DasS. K.RunnelsR. S.SmithJ. C.CohlyH. H. Epidemiology of cleft lip and cleft palate in Mississippi. South Med J. 1995;88(4):437–442.
13.
DruschelC. M.HughesJ. POlsenC. L. First year-of-life mortality among infants with oral clefts: New York state, 1983-1990. Cleft Palate Craniofac J. 1996;33(5):400–405.
14.
FinleyW. H.GustavsonK. H.HallT. M.HurstD. C.BarganierC. M.WiedmeyerJ. A. Birth defects surveillance: Jefferson County, Alabama, and Uppsala County, sweden. South Med J. 1994;87(4):440–445.
15.
ForresterM. B.MerzR. D. Descriptive epidemiology of oral clefts in a multiethnic population, Hawaii, 1986-2000. Cleft Palate Craniofac J. 2004;41(6):622–628.
16.
Greater New York Hospital Association. Retrieved fromhttp://www.gnyha.org. Accessed December 1, 2016
17.
HoneinM. A.RasmussenS. A.ReefhuisJ.RomittiP. A.LammerE. J.SunL.CorreaA. Maternal smoking and environmental tobacco smoke exposure and the risk of orofacial clefts. Epidemiology. 2007;18(2):226–233.
18.
JohnsonC. Y.HoneinM. A.HobbsC. A.RasmussenS. A., National Birth Defects Prevention Study. Prenatal diagnosis of orofacial clefts, National Birth Defects Prevention Study, 1998-2004. Prenat Diagn. 2009;29(9):833–839.
19.
JohnsonC. Y.LittleJ. Folate intake, markers of folate status and oral clefts: is the evidence converging?Int J Epidemiol. 2008;37(5):1041–1058.
20.
KhouryM. J.WeinsteinA.PannyS.HoltzmanN. A.LindsayP. K.FarrelK.EisenbergM. Maternal cigarette smoking and oral clefts: a population-based study. Am J Public Health. 1987;77(5):623–625.
21.
KucikJ. E.AlversonC. J.GilboaS. M.CorreaA. Racial/ethnic variations in the prevalence of selected major birth defects, metropolitan Atlanta, 1994-2005. Public Health Rep. 2012;127(1):52–61.
22.
LammerE. J.ShawG. M.IovannisciD. M.FinnellR. H. Maternal smoking, genetic variation of glutathione s-transferases, and risk for orofacial clefts. Epidemiology. 2005;16(5):698–701.
23.
LiW.SebekK.HuynhM.CastroA.GurrD.KelleyD.KennedyJ.MaduroG.LeeE.SunY.. Summary of Vital Statistics, 2015. New York: New York City Department of Health and Mental Hygiene, Bureau of Vital Statistics; 2017.
24.
MiliF.EdmondsL. D.KhouryM. J.McClearnA. B. Prevalence of birth defects among low-birth-weight infants. a population study. Am J Dis Child. 1991;145(11):1313–1318.
25.
New York State Department of Health Congenital Malformations Registry. Statistical Summary of Children Born in 2008 and Diagnosed through 2010. 2013:1–76.
26.
New York State Department of Health Congenital Malformations Registry. Congenital Malformations Registry (CMR) Handbook 2016. 1–49.
27.
SaadANParinaRPTokinCChangDCGosmanA. Incidence of oral clefts among different ethnicities in the state of California. Ann Plast Surg. 2014;72(suppl 1):S81–S83.
28.
SeverLE, ed. National Birth Defects Prevention Network. Guidelines for Conducting Birth Defects Surveillance. Atlanta, GA: National Birth Defects Prevention Network, Inc; 2004.
29.
ShawGMCarmichaelSLLaurentCRasmussenSA. Maternal nutrient intakes and risk of orofacial clefts. Epidemiology. 2006;17(3):285–291.
30.
ShawGMCroenLACurryCJ. Isolated oral cleft malformations: associations with maternal and infant characteristics in a California population. Teratology. 1991;43(3):225–228.
31.
ShiMChristensenKWeinbergCRRomittiPBathumLLozadaAMurrayJC. Orofacial cleft risk is increased with maternal smoking and specific detoxification-gene variants. Am J Hum Genet. 2007;80(1):76–90.
32.
SteinbergJPGosainAK. Thirty years of prenatal cleft diagnosis: what have we learned?Plast Reconstr Surg. 2015;136(3):550–557.
33.
TongVTJonesJRDietzPMD’AngeloDBombardJM. Trends in smoking before, during, and after pregnancy—Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 31 sites, 2000–2005. MMWR Surveill Summ. 2009;58(4):1–29.
WangWGuanPXuWZhouB. Risk factors for oral clefts: a population-based case-control study in Shenyang, China. Paediatr Perinat Epidemiol. 2009;23(4):310–320.
36.
WatkinsSEMeyerREStraussRPAylsworthAS. Classification, epidemiology, and genetics of orofacial clefts. Clin Plast Surg. 2014;41(2):149–163.
37.
WehbyGLMurrayJC. Folic acid and orofacial clefts: a review of the evidence. Oral Dis. 2010;16(1):11–19.
38.
WilcoxAJLieRTSolvollKTaylorJMcConnaugheyDRAbyholmFDrevonCA. Folic acid supplements and risk of facial clefts: national population based case-control study. BMJ. 2007;334(7591):464.
