To investigate the association between pregnancy planning and orofacial clefts in the United Kingdom.
Design:
Case–control study.
Setting:
Scotland and the Manchester and Merseyside regions of England.
Participants:
One hundred and ninety-one children born with nonsyndromic orofacial cleft, 1997 to 2000, and 247 controls.
Main outcome measure:
Cleft lip with and without cleft palate, and cleft palate.
Results:
There was an inverse association between planning for pregnancy and orofacial cleft in the offspring (odds ratio [OR] = 0.51, 95% confidence interval [CI] = 0.33–0.79). An unplanned pregnancy together with smoking in the first trimester of pregnancy resulted in almost treble the risk of a child with an orofacial cleft when compared with those who planned their pregnancy and did not smoke (OR = 2.92, CI = 1.50–5.65).
Conclusions:
Planned pregnancies were associated with a lower risk of orofacial clefts. Isolation of the elements of pregnancy planning implicated in these results is difficult. Current preconception advice needs to reach a wider audience; however, for maximum impact, efforts are needed to reduce the numbers of unplanned pregnancies.
BarrettG.WellingsK.What is a planned pregnancy? Empirical data from a British study.Soc Sci Med.2002; 55: 545–557.
2.
CharltonA.Children and passive smoking: a review.J Fam Pract.1994; 38: 267–277.
3.
ClarkJ.D.MosseyP.A.SharpL.LittleJ.Socio-economic status and orofacial clefts in Scotland, 1989–1998.Cleft Palate Craniofac J.2003; 40: 481–485.
4.
CzeizelA.E.Prevention of oral clefts through the use of folic acid and multivitamin supplements: evidence and gaps. In: WyszynskiD.F., ed. Cleft Lip and Palate: From Origin to Treatment.Oxford: Oxford University Press;2002: 443–457.
5.
Delgado-RodriguezM.Gomez-OlmedoM.Bueno-CavanillasA.Glavez-VargasR.Unplanned pregnancy as a major determinant in inadequate use of prenatal care.Prev Med.1997; 26: 834–838.
De WeerdS.PolderJ.J.Cohen-OverbeekT.E.ZimmermannL.J.SteegersE.A.Preconception care: preliminary estimates of costs and effects of smoking cessation and folic acid supplementation.J Reprod Med.2004; 49: 338–344.
8.
FinerL.B.HenshawS.K.Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.Perspect Sex Reprod Health.2006; 38: 90–96.
9.
GartonM.J.The Point Accuracy of Adult Registration on the Community Health Index in Aberdeen.Aberdeen, Scotland: University of Aberdeen;1993. Thesis.
10.
HayesC.Environmental risk factors and oral clefts. In: WyszynskiD.F., ed. Cleft Lip and Palate: From Origin to Treatment.Oxford: Oxford University Press;2002: 159–169.
11.
HeyesT.LongS.MathersN.Preconception care: practice and beliefs of primary care workers.Fam Pract.2004; 21: 22–27.
12.
Information and Statistics Division, Scotland.Smoking at booking by age of mother and deprivation quintile. Available at: http://www.isdscotland.org/. Accessed January 5, 2006.
13.
KostK.LandryD.J.DarrochJ.E.Predicting maternal behaviors during pregnancy: does intention status matter?Fam Plann Perspect.1998; 30: 79–88.
14.
KrapelsI.P.C.Periconceptional health and lifestyle factors of both parents affect the risk of children with orofacial clefts. In: The Etiology of Orofacial Clefts: An Emphasis on Lifestyle and Nutrition Other than Folate.Nijmegen: University of Nijmegen; 2005. Thesis.
15.
LittleJ.CardyA.ArslanM.T.GilmourM.MosseyP.A.Smoking and orofacial clefts: a United Kingdom–based case–control study.Cleft Palate Craniofac J.2004a; 41: 381–386.
16.
LittleJ.CardyA.MungerR.G.Tobacco smoking and oral clefts: a meta-analysis.Bull World Health Organ.2004b; 82: 213–218.
17.
MassonL.F.McNeillG.TomanyJ.O.SimpsonJ.A.PeaceH.S.WeiL.GrubbD.A.Bolton-SmithC.Statistical approaches for assessing the relative validity of a food frequency questionnaire: use of correlation coefficients and the kappa statistic.Public Health Nutr.2003; 6: 313–321.
18.
McGovernE.MossH.GrewalG.TaylorA.BjornssonS.PellJ.Factors affecting the use of folic acid supplements in pregnant women in Glasgow.Br J Gen Pract.1997; 48: 922–923.
19.
MoosM-K. Preconceptional health promotion: progress in changing a prevention paradigm.J Perinatal Neonatal Nurs.2004; 18: 2–13.
20.
MosseyP.A.LittleJ.Epidemiology of oral clefts: an international perspective. In: WyszynskiD.F., ed. Cleft Lip and Palate: From Origin to Treatment.Oxford: Oxford University Press;2002: 127–158.
21.
RamsayC.R.CampbellM.K.GlazenerC.M.A.Linking Community Health Index and Scottish morbidity records for neonates: the Grampian experience.Health Bull.1999; 57: 70–75.
22.
RayJ.G.SinghG.BurrowsR.F.Evidence for suboptimal use of periconceptional folic acid supplements globally.Br J Obstet Gynae.2004; 111: 399–408.
23.
RosenbergK.D.GelowJ.M.SandovalA.P.Pregnancy intendedness and use of periconceptional folic acid.Pediatrics.2003; 111: 1142–1145.
24.
RoworthM.A.JonesI.G.The Community Health Index—how accurate is it?Community Med.1988; 10: 327–330.
25.
SenS.ManzoorA.DeviasumathyM.NewtonC.Maternal knowledge, attitude and practice regarding folic acid intake during the periconceptional period.Public Health Nutr.2001; 4: 909–912.
26.
SperberG.Craniofacial Development.Hamilton: BC Decker;2001.
27.
TolarovaM.HarrisJ.Reduced recurrence of orofacial clefts after periconceptual supplementation with high-dose folic acid and multivitamins.Teratology.1995; 51: 71–78.
28.
WallaceM.HurwitzB.Preconception care: who needs it, who wants it, and how should it be provided?Br J Gen Pract.1998; 48: 963–966.
