To determine the association between prenatal care and cleft lip with or without cleft palate (CL ± P) and examine differences in newborn complications among infants diagnosed with CL ± P as a function of prenatal care
Design
Population-based retrospective cohort study
Setting
2018 United States National Vital Statistics System—Natality component (NVSS-N) was used to examine nationwide birth certificate data
Participants
3,414,338 infants from the 2018 National Vital Statistics System, of which 1,699 had CL ± P
Main Outcome Measure
Diagnosis of CL ± P and presence of newborn complications as a function of prenatal care
Results
Significant differences were found among various infant- and mother-specific variables when baseline comparisons were made between infants with and without CL ± P. After controlling for baseline differences, results indicated decreased odds of a diagnosis of CL ± P in cases where overall adequate prenatal care was obtained (OR = .841; 95% CI .757, .934), including prenatal care beginning in the 1st trimester (OR = .839; 95% CI .750, .939) and an adequate number of prenatal visits received (OR = .864; 95% CI .764, .976). Of infants with CL ± P, reduced odds of the infant admitted to the neonatal intensive care unit (OR = .777; 95% CI .613, .985) or transferred (OR = .601; 95% CI .407, .888) were apparent when adequate prenatal care was received.
Conclusion
Results suggest adequate prenatal care not only reduces the likelihood of CL ± P in infants but may also decrease the severity of negative outcomes in infants diagnosed with CL ± P. These findings emphasize necessity for adequate prenatal care.
ParkerSEMaiCTCanfieldMA, et al.Updated national birth prevalence estimates for selected birth defects in the United States, 2004–2006. Birth Defects Res A Clin Mol Teratol. 2010;88(12):1008-1016. doi:https://doi.org/10.1002/bdra.20735
2.
SunYHuangYYinA, et al.Genome-wide association study identifies a new susceptibility locus for cleft lip with or without a cleft palate. Nat Commun. 2015;6(1):1-7. doi:https://doi.org/10.1038/ncomms7414
3.
WatkinsSEMeyerREStraussRPAylsworthAS. Classification, epidemiology, and genetics of orofacial clefts. Clin Plastic Surg. 2014;41(2):149-163. doi:https://doi.org/10.1016/j.cps.2013.12.003
4.
DixonMJMarazitaMLBeatyTHMurrayJC. Cleft lip and palate: Understanding genetic and environmental influences. Nat Rev Genet. 2011;12(3):167-178. doi:https://doi.org/10.1038/nrg2933
5.
MaiCTCassellCHMeyerRE, et al.Birth defects data from population-based birth defects surveillance programs in the United States, 2007 to 2011: Highlighting orofacial clefts. Birth Defects Res A Clin Mol Teratol. 2014;100(11):895-–904. doi:https://doi.org/10.1002/bdra.23329
6.
VuGHWardenCZimmermanCE, et al.Poverty and risk of cleft lip and palate: An analysis of United States birth data. Plast Reconstr Surg. 2021;149(1):169-182. doi:https://doi.org/10.1097/PRS.0000000000008636
7.
MitenieceEPavlovaMShengeliaLRechelBGrootW. Barriers to accessing adequate maternal care in Georgia: A qualitative study. BMC Health Serv Res. 2018;18(631):1-12. doi:https://doi.org/10.1186/s12913-018-3432-z
8.
DurningPChestnuttIGMorganMZLesterNJ. The relationship between orofacial clefts and material deprivation in Wales. Cleft Palate Craniofac J. 2007;44(2):203-207. doi:https://doi.org/10.1597/06-004.1
9.
LupoPJDanyshHESymanskiELangloisPHCaiYSwartzMD. Neighborhood-based socioeconomic position and risk of oral clefts among offspring. Am J Public Health. 2015;105(12):2518-2525. doi:https://doi.org/10.2105/FAJPH.2015.302804
10.
AlfwaressFSDKhwailehFARawashdehMAAlomariMANazzalMS. Cleft lip and palate: Demographic patterns and the associated communication disorders. J Craniofac Surg. 2017;28(8):2117-2121. doi:https://doi.org/10.1097/scs.0000000000003984
CarmichaelSLMaCShawGM. Socioeconomic measures, orofacial clefts, and conotruncal heart defects in california. Birth Defects Res A Clin Mol Teratol. 2009;85(10):850-857. doi:https://doi.org/10.1002/bdra.20614
13.
LiHLuoMLuoJ, et al.A discriminant analysis prediction model of non-syndromic cleft lip with or without cleft palate based on risk factors. BMC Pregnancy Childbirth. 2016;16(1):1-8. doi:https://doi.org/10.1186/s12884-016-1116-4
14.
HughesCDBabigianAMcCormackS, et al.The clinical and economic impact of a sustained program in global plastic surgery: Valuing cleft care in resource-poor settings. Plast Reconstr Surg. 2012;130(1):87e-94e. doi:https://doi.org/10.1097/prs.0b013e318254b2a2
15.
AlkireBHughesCDNashKVincentJRMearaJG. Potential economic benefit of cleft and palate repair in sub-saharan Africa. World J Surg. 2011;35(6):1194-1201. doi:https://doi.org/10.1007/s00268-011-1055-1
16.
MungerRGSauberlichHECorcoranCNepomucenoBDaack-HirschSSolonFS. Maternal vitamin B-6 and folate status and risk of oral cleft birth defects in the Philippines. Birth Defects Res A Clin Mol Teratol. 2004;70(7):464-471. doi:https://doi.org/10.1002/bdra.20037
17.
ButaliALittleJChevrierC, et al.Folic acid supplementation use and the MTHFR C677T polymorphism in orofacial clefts etiology: An individual participant data pooled-analysis. Birth Defects Res A Clin Mol Teratol. 2013;97(8):509-514. doi:https://doi.org/10.1002/bdra.23133
18.
TamuraTMungerRGCorcoranCBacayaoJYNepomucenoBSolonFS. Plasma zinc concentrations of mothers and the risk of nonsyndromic oral clefts in their children: A case-control study in the Philippines. Birth Defects Res A Clin Mol Teratol. 2005;73(9):612-616. doi:https://doi.org/10.1002/bdra.20179
19.
LorenteCCordierSGoujardJ, et al.Tobacco and alcohol use during pregnancy and risk of oral clefts. Am J Public Health. 2000;90(3):415-419. doi:https://doi.org/10.2105/ajph.90.3.415
20.
HolmesLWyszynskiDFLiebermanE. The AED (antiepileptic drug) pregnancy registry: A 6-year experience. Arch Neurol. 2004;61(5):673-678. doi:https://doi.org/10.1001/archneur.61.5.673
XaveriusPAlmanCHoltzLYarberL. Risk factors associated with very low birth weight in a large urban area, stratified by adequacy of prenatal care. Matern Child Health J. 2016;20(3):623-629. doi:https://doi.org/10.1007/s10995-015-1861-4
23.
OstermanMJKMartinJA. Timing and adequacy of prenatal care in the United States, 2016. Natl Vital Stat Rep. 2018;67(3):1-14.
24.
KessnerDMSingerJKalkCESchlesingerER. Infant Death: An Analysis by Maternal Risk and Health Care. Institute of Medicine and National Academy of Sciences; 1973, chap 2.
25.
AlexanderGRKotelchuckM. Assessing the role and effectiveness of prenatal care: History, challenges, and directions for future research. Public Health Rep. 2001;116(4):306-316. doi:https://doi.org/10.1016/S0033-3549(04)50052-3
26.
Centers for Disease Control and Prevention. User guide to the 2018 natality public use file [database user guide]. Available at: https//ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/natality/UserGuide2018-508.pdf. Accessed, 2022.
27.
KimMKLeeSMBaeSH, et al.Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system. Int J Equity Health. 2018;17(2):1-8. doi:https://doi.org/10.1186/s12939-017-0715-7
28.
RaghavanRCamarataSWhiteKBarbaresiWParishSKrahnG. Population health in pediatric speech and language disorders: Available data sources and a research agenda for the field. J Speech Lang Hear Res. 2018;61(5):1279-1291.
29.
JahanbinAShadkamEMiriHHShiraziASAbtahiM. Maternal folic acid supplementation and the risk of oral clefts in offspring. J Craniofac Surg. 2018;29(6):e534-e541.
30.
XuWYiLDengC,et al.Maternal periconceptional folic acid supplementation reduced risks of non-syndromic oral clefts in offspring. Sci Rep.2021;11(1):1-6.
31.
Mbuyi-MusanzayiSKayembeTJKashalMK,et al.Non-syndromic cleft lip and/or cleft palate: Epidemiology and risk factors in lubumbashi (DR Congo): A case-control study. J Cranio-Maxillofac Surg. 2018;46(7):1051-1058.
BuescherPALarsonLCNelsonMDLenihanAJ. Prenatal WIC participation can reduce low birth weight and newborn medical costs: A cost-benefit analysis of WIC participation in North Carolina. J Am Diet Assoc. 1993;93(2):163-166. doi:https://doi.org/10.1016/0002-8223(93)90832-6
35.
ChungKCKowalskiCPMyra KimHBuchmanSR. Maternal cigarette smoking during pregnancy and the risk of having a child with cleft lip/palate. Plast Reconstr Surg. 2000;105(2):485-491. doi:https://doi.org/10.1097/00006534-200002000-00001
36.
LittleJCardyAMungerRG. Tobacco smoking and oral clefts: A meta-analysis. Bull World Health Organ. 2004;82(3):213-218.
37.
Hashmi SSGallwayMSWallerDKLangloisPH, Hecht JT and the National Birth Defects Prevention Study. Maternal fever during early pregnancy and the risk of oral clefts. Birth Defects Res A Clin Mol Teratol. 2010;88(3):186-194.
38.
LinKJMitchellAAYauWPLouikCHernandez-DiazS. Maternal exposure to amoxicillin and the risk of oral clefts. Epidemiology. 2012;23(5):699-705.
39.
MosseyPALittleJMungerRGDixonMJShawWC. Cleft lip and palate. Lancet. 2009;374(1903):1773-1785.
40.
ColeATomlinsonJSlatorRReadingJ. Understanding cleft lip and palate. 3: Feeding the baby. J Fam Health Care. 2009;19(5):157-158.
41.
ObeidatHMBondEAClark CallisterL. The parental experience of having an infants in the newborn intensive care unit. J Perinat Educ. 2009;18(3):23-29. doi:https://doi.org/10.1624/105812409x461199
42.
ToscanoMWoodJSpielmanSFerriRWhaleyNSeligmanNS. Prenatal care utilization in pregnant women who consider but do not have abortions. BMC Pregnancy Childbirth.2022;22(53):1-11. doi: 0.1186/s12884-021-04343-x
