Family history and socioeconomic risk factors for non-syndromic cleft lip and palate: A matched case-control study in a less developed country
Keywords:
Cleft lip, cleft palate, epidemiology, risk factors, socioeconomic factors, folic acid, Mexico
Abstract
Introduction. From an epidemiological point of view, non-syndromic orofacial clefts are the most common oral congenital deformities worldwide.
Objective. Family histories were traced and socioeconomic risk factors were identified for non-syndromic cleft lip with or without cleft palate.
Material and methods. A case-control study was carried out with 208 cases of non-syndromic cleft lip with or without cleft palate, and matched by age and sex with 416 controls. Cases were patients attending a referral clinic from 2002 through 2004 in Campeche, Mexico. A questionnaire was administered to collect sociodemographic and socioeconomic variables as well as familial background relevant to non-syndromic cleft lip with or without cleft palate. Conditional logistic regression models were used; adjusted odds ratios and 95% confidence intervals were calculated.
Results. In the multivariate model, the following risk factors were identified: 1) low socioeconomic status; 2) birth in the southern region of Campeche state; 3) home delivery or delivery in a publicly funded hospital; 4) occurrence of prior non-syndromic cleft lip with or without cleft palate cases in the father's or mother's family: 5) having a sibling with non-syndromic cleft lip with or without cleft palate; 6) the proband having another malformation, and 7) a history of infections during pregnancy. Prenatal care consisting of vitamin supplementation was a protective factor for non-syndromic cleft lip with or without cleft palate (odds ratio=0.29).
Conclusions. A "social gradient in health" was seen to link oral malformation with diet components, and several socioeconomic and socio-demographic factors broadly encompassed in low socioeconomic status. Further characterization of risk factors will guide the assemblage of a pro-active counseling and prevention program for families at risk for non-syndromic cleft lip and cleft palate.
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References
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2. Armendares S, Lisker R. Análisis genético del labio y paladar hendidos y paladar hendido solo. Estudio en población mexicana. Rev Invest Clin. 1974;26:317-32.
3. Secretaría de Salud. Comunicado de prensa No. 213. 15/abril/2006. México, DF. Fecha de consulta: 3 y 4 de febrero de 2007. Disponible en: http://www.salud.gob.mx/ssa_app/noticias/datos/2006-04-15_2143.html
4. World Health Organization. International Collaborative Research on Craniofacial Anomalies. Typical orofacial clefts- cumulative data by register. Updated: February 2006. Fecha de consulta: 16 de febrero de 2007. Disponible en: http://www.who.int/genomics/anomalies/cumulative_data/en/index.html.
5. Rosenquist TH, Gelineau van Waes J, Shaw GM, Finnell R. Nutrient effects upon embryogenesis: Folate, vitamin A and iodine. In: Hornstra G, Uauy R, Yang X, editors. The impact of maternal nutrition on the offspring. Basel: Nestlé Nutrition Workshop Series Pediatric Program; 2005. p. 29-47.
6. Dudas M, Li WY, Kim J, Yang A, Kaartinen V. Palatal fusion - Where do the midline cells go? A review on cleft palate, a major human birth defect. Acta Histochem. 2007;109:1-14.
7. Wehby GL, Murray JC. Folic acid and orofacial clefts: A review of the evidence. Oral Dis. 2010;16:11-9.
8. van Rooij IA, Vermeij-Keers C, Kluijtmans LA, Ocké MC, Zielhuis GA, Goorhuis-Brouwer SM, et al. Does the interaction between maternal folate intake and the methylenetetrahydrofolate reductase polymorphisms affect the risk of cleft lip with or without cleft palate? Am J Epidemiol. 2003;157:583-91.
9. Wilcox AJ, Lie RT, Solvoll K, Taylor J, McConnaughey DR, Abyholm F, et al. Folic acid supplements and risk of facial clefts: National population based case-control study. BMJ. 2007;334:464.
10. Metneki J, Puho E, Czeizel AE. Maternal diseases and isolated orofacial clefts in Hungary. Birth Defects Res A Clin Mol Teratol. 2005;73:617-23.
11. Carinci F, Rullo R, Farina A, Morano D, Festa VM, Mazzarella N, et al. Non-syndromic orofacial clefts in Southern Italy: Pattern analysis according to gender, history of maternal smoking, folic acid intake and familial diabetes. J Craniomaxillofac Surg. 2005;33:91-4.
12. Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: A systematic review and meta-analysis. JAMA. 2009;301:636-50.
13. Leite ICG, Paumgartten FJR, Koifman S. Chemical exposure during pregnancy and oral clefts in newborns. Cad Saude Publica. 2002;18:17-31.
14. Li Z, Liu J, Ye R, Zhang L, Zheng X, Ren A. Maternal passive smoking and risk of cleft lip with or without cleft palate. Epidemiology. 2010;21:240-2.
15. Puho EH, Szunyogh M, Metneki J, Czeizel AE. Drug treatment during pregnancy and isolated orofacial clefts in Hungary. Cleft Palate Craniofac J. 2007;44:194-202.
16. Chevrier C, Dananche B, Bahuau M, Nelva A, Herman C, Francannet C, et al. Occupational exposure to organic solvent mixtures during pregnancy and the risk of non-syndromic oral clefts. Occup Environ Med. 2006;63:617-23.
17. Jugessur A, Farlie PG, Kilpatrick N. The genetics of isolated orofacial clefts: From genotypes to subphenotypes. Oral Dis. 2009;15:437-53.
18. Vieira AR, McHenry TG, Daack-Hirsch S, Murray JC, Marazita ML. Candidate gene/loci studies in cleft lip/palate and dental anomalies finds novel susceptibility genes for clefts. Genet Med. 2008;10:668-74.
19. Scapoli L, Palmieri A, Martinelli M, Vaccari C, Marchesini J, Pezzetti F, et al. Study of the PVRL1 gene in Italian nonsyndromic cleft lip patients with or without cleft palate. Ann Hum Genet. 2006;70:410-3.
20. Riley BM, Mansilla MA, Ma J, Daack-Hirsch S, Maher BS, Raffensperger LM, et al. Impaired FGF signaling contributes to cleft lip and palate. Proc Natl Acad Sci USA. 2007;104:4512-7.
21. Harville EW, Wilcox AJ, Lie RT, Vindenes H, Abyholm F. Cleft lip and palate versus cleft lip only: Are they distinct defects? Am J Epidemiol. 2005;162:448-53.
22. Krapels IP, Zielhuis GA, Vroom F, de Jong-van den Berg LT, Kuijpers-Jagtman AM, van der Molen AB, et al. Periconceptional health and lifestyle factors of both parents affect the risk of live-born children with orofacial clefts. Birth Defects Res A Clin Mol Teratol. 2006;76:613-20.
23. Clark JD, Mossey PA, Sharp L, Little J. Socioeconomic status and orofacial clefts in Scotland, 1989 to 1998. Cleft Palate Craniofac J. 2003;40:481-5.
24. Carmichael SL, Ma C, Shaw GM. Socioeconomic measures, orofacial clefts, and conotruncal heart defects in California. Birth Defects Res A Clin Mol Teratol. 2009;85:850-7.
25. Puho E, Metneki J, Czeizel AE. Maternal employment status and isolated orofacial clefts in Hungary. Cent Eur J Public Health. 2005;13:144-8.
26. Escoffie-Ramírez M, Medina-Solís CE, Pontigo-Loyola AP, Acuña-González G, Casanova-Rosado JF, Colome-Ruiz GE. Asociación de labio y/o paladar hendido con variables de posición socioeconómica: un estudio de casos y controles. Rev Bras Saude Mater Infant. 2010;10:323-9.
27. Kernahan DA. The striped Y - a symbolic classification for cleft lips and palates. Plast Reconstr Surg. 1971;47:469-70.
28. Bronfman M, Guiscafré H, Castro V, Castro R, Gutiérrez G. La medición de la desigualdad: una estrategia metodológica, análisis de las características socioeconómicas de la muestra. Arch Invest Med. 1988;19:351-60.
29. Hosmer D, Lemeshow S. Applied logistic regression. 2nd edition. New York: Wiley-Interscience Publication; 2000.
30. Bagley SC, White H, Golomb BA. Logistic regression in the medical literature: Standards for use and reporting, with particular attention to one medical domain. J Clin Epidemiol. 2001;54:979-85.
31. López-Camelo JS, Castilla EE, Orioli IM; INAGEMP (Instituto Nacional de Genética Médica Populacional); ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congénitas). Folic acid flour fortification: Impact on the frequencies of 52 congenital anomaly types in three South American countries. Am J Med Genet A. 2010;152A:2444-58.
32. Nazer J, Ramírez MC, Cifuentes L. Evolution of prevalence rates of orofacial clefts in a maternity of a Chilean clinical hospital. Rev Med Chil. 2010;138:567-72.
33. Rittler M, López-Camelo JS, Castilla EE, Bermejo E, Cocchi G, Correa A, et al. Preferential associations between oral clefts and other major congenital anomalies. Cleft Palate Craniofac J. 2008;45:525-32.
34. Tamura T, Picciano MF. Folate and human reproduction. Am J Clin Nutr. 2006;83:993-1016.
35. Chawla A, Repa JJ, Evans RM, Mangelsdorf DJ. Nuclear receptors and lipid physiology: Opening the X-files. Science. 2001;294:1866-70.
36. Johnson CY, Little J. Folate intake, markers of folate status and oral clefts: Is the evidence converging? Int J Epidemiol. 2008;37:1041-58.
37. Kawachi I. Income inequality in health. En: Berkman L, Kawachi I. Social epidemiology. New York: Oxford University Press; 2000. p. 76-93.
38. Lynch J, Kaplan G. Socioeconomic position. En: Berkman L, Kawachi I. Social epidemiology. New York: Oxford University Press; 2000. p. 13-35.
39. Kosteniuk JG, Dickinson HD. Tracing the social gradient in the health of Canadians: Primary and secondary determinants. Soc Sci Med. 2003;56:263-76.
40. Medina-Solís CE, Maupomé G, Pelcastre-Villafuerte B, Ávila-Burgos L, Vallejos-Sánchez AA, Casanova-Rosado AJ. Desigualdades socioeconómicas en salud bucal: caries dental en niños de 6 a 12 años de edad. Rev Invest Clin. 2006;58:296-304.
41. Bower E, Gulliford M, Steele J, Newton T. Area deprivation and oral health in Scottish adults: A multilevel study. Community Dent Oral Epidemiol. 2007;35:118-29.
42. Ferro R, Besostri A, Meneghetti B, Olivieri A, Benacchio L, Tabaccanti S, et al. Oral health inequalities in preschool children in North-Eastern Italy as reflected by caries prevalence. Eur J Paediatr Dent. 2007;8:13-8.
43. Jamieson LM, Parker EJ, Armfield JM. Indigenous child oral health at a regional and state level. J Paediatr Child Health. 2007;43:117-21.
44. Villalobos-Rodelo JJ, Medina-Solís CE, Maupomé G, Vallejos-Sánchez AA, Lau-Rojo L, Ponce de León-Viedas MV. Socioeconomic and socio-demographic variables associated with oral hygiene status in Mexican school children aged 6 to 12 years. J Periodontol. 2007;78:816-22.
45. Villalobos-Rodelo JJ, Medina-Solís CE, Maupomé G, Pontigo-Loyola AP, Lau-Rojo L, Verdugo-Barraza L. Caries dental en escolares de una comunidad del noroeste de México con dentición mixta, y su asociación con algunas variables clínicas, socioeconómicas y sociodemográficas. Rev Invest Clin. 2007;59:256-67.
46. Herrera MS, Lucas-Rincón SE, Medina-Solís CE, Maupomé G, Márquez-Corona ML, Islas-Granillo H, et al. Desigualdades socioeconómicas en salud bucal: factores asociados al cepillado dental en escolares nicaragüenses. Rev Invest Clin. 2009;61:489-96.
47. Villalobos-Rodelo JJ, Medina-Solís CE, Maupomé G, Lamadrid-Figueroa H, Casanova-Rosado AJ, Casanova-Rosado JF, et al. Dental needs and socioeconomic status associated with dental services' utilization taking place in the presence of dental pain: A case control study. J Orofac Pain. 2010;24:279-86.
48. Laaksonen M, Rahkonen O, Martikainen P, Lahelma E. Socioeconomic position and self-rated health: The contribution of childhood socioeconomic circumstances, adult socioeconomic status, and material resources. Am J Public Health. 2005;95:1403-9.
2. Armendares S, Lisker R. Análisis genético del labio y paladar hendidos y paladar hendido solo. Estudio en población mexicana. Rev Invest Clin. 1974;26:317-32.
3. Secretaría de Salud. Comunicado de prensa No. 213. 15/abril/2006. México, DF. Fecha de consulta: 3 y 4 de febrero de 2007. Disponible en: http://www.salud.gob.mx/ssa_app/noticias/datos/2006-04-15_2143.html
4. World Health Organization. International Collaborative Research on Craniofacial Anomalies. Typical orofacial clefts- cumulative data by register. Updated: February 2006. Fecha de consulta: 16 de febrero de 2007. Disponible en: http://www.who.int/genomics/anomalies/cumulative_data/en/index.html.
5. Rosenquist TH, Gelineau van Waes J, Shaw GM, Finnell R. Nutrient effects upon embryogenesis: Folate, vitamin A and iodine. In: Hornstra G, Uauy R, Yang X, editors. The impact of maternal nutrition on the offspring. Basel: Nestlé Nutrition Workshop Series Pediatric Program; 2005. p. 29-47.
6. Dudas M, Li WY, Kim J, Yang A, Kaartinen V. Palatal fusion - Where do the midline cells go? A review on cleft palate, a major human birth defect. Acta Histochem. 2007;109:1-14.
7. Wehby GL, Murray JC. Folic acid and orofacial clefts: A review of the evidence. Oral Dis. 2010;16:11-9.
8. van Rooij IA, Vermeij-Keers C, Kluijtmans LA, Ocké MC, Zielhuis GA, Goorhuis-Brouwer SM, et al. Does the interaction between maternal folate intake and the methylenetetrahydrofolate reductase polymorphisms affect the risk of cleft lip with or without cleft palate? Am J Epidemiol. 2003;157:583-91.
9. Wilcox AJ, Lie RT, Solvoll K, Taylor J, McConnaughey DR, Abyholm F, et al. Folic acid supplements and risk of facial clefts: National population based case-control study. BMJ. 2007;334:464.
10. Metneki J, Puho E, Czeizel AE. Maternal diseases and isolated orofacial clefts in Hungary. Birth Defects Res A Clin Mol Teratol. 2005;73:617-23.
11. Carinci F, Rullo R, Farina A, Morano D, Festa VM, Mazzarella N, et al. Non-syndromic orofacial clefts in Southern Italy: Pattern analysis according to gender, history of maternal smoking, folic acid intake and familial diabetes. J Craniomaxillofac Surg. 2005;33:91-4.
12. Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: A systematic review and meta-analysis. JAMA. 2009;301:636-50.
13. Leite ICG, Paumgartten FJR, Koifman S. Chemical exposure during pregnancy and oral clefts in newborns. Cad Saude Publica. 2002;18:17-31.
14. Li Z, Liu J, Ye R, Zhang L, Zheng X, Ren A. Maternal passive smoking and risk of cleft lip with or without cleft palate. Epidemiology. 2010;21:240-2.
15. Puho EH, Szunyogh M, Metneki J, Czeizel AE. Drug treatment during pregnancy and isolated orofacial clefts in Hungary. Cleft Palate Craniofac J. 2007;44:194-202.
16. Chevrier C, Dananche B, Bahuau M, Nelva A, Herman C, Francannet C, et al. Occupational exposure to organic solvent mixtures during pregnancy and the risk of non-syndromic oral clefts. Occup Environ Med. 2006;63:617-23.
17. Jugessur A, Farlie PG, Kilpatrick N. The genetics of isolated orofacial clefts: From genotypes to subphenotypes. Oral Dis. 2009;15:437-53.
18. Vieira AR, McHenry TG, Daack-Hirsch S, Murray JC, Marazita ML. Candidate gene/loci studies in cleft lip/palate and dental anomalies finds novel susceptibility genes for clefts. Genet Med. 2008;10:668-74.
19. Scapoli L, Palmieri A, Martinelli M, Vaccari C, Marchesini J, Pezzetti F, et al. Study of the PVRL1 gene in Italian nonsyndromic cleft lip patients with or without cleft palate. Ann Hum Genet. 2006;70:410-3.
20. Riley BM, Mansilla MA, Ma J, Daack-Hirsch S, Maher BS, Raffensperger LM, et al. Impaired FGF signaling contributes to cleft lip and palate. Proc Natl Acad Sci USA. 2007;104:4512-7.
21. Harville EW, Wilcox AJ, Lie RT, Vindenes H, Abyholm F. Cleft lip and palate versus cleft lip only: Are they distinct defects? Am J Epidemiol. 2005;162:448-53.
22. Krapels IP, Zielhuis GA, Vroom F, de Jong-van den Berg LT, Kuijpers-Jagtman AM, van der Molen AB, et al. Periconceptional health and lifestyle factors of both parents affect the risk of live-born children with orofacial clefts. Birth Defects Res A Clin Mol Teratol. 2006;76:613-20.
23. Clark JD, Mossey PA, Sharp L, Little J. Socioeconomic status and orofacial clefts in Scotland, 1989 to 1998. Cleft Palate Craniofac J. 2003;40:481-5.
24. Carmichael SL, Ma C, Shaw GM. Socioeconomic measures, orofacial clefts, and conotruncal heart defects in California. Birth Defects Res A Clin Mol Teratol. 2009;85:850-7.
25. Puho E, Metneki J, Czeizel AE. Maternal employment status and isolated orofacial clefts in Hungary. Cent Eur J Public Health. 2005;13:144-8.
26. Escoffie-Ramírez M, Medina-Solís CE, Pontigo-Loyola AP, Acuña-González G, Casanova-Rosado JF, Colome-Ruiz GE. Asociación de labio y/o paladar hendido con variables de posición socioeconómica: un estudio de casos y controles. Rev Bras Saude Mater Infant. 2010;10:323-9.
27. Kernahan DA. The striped Y - a symbolic classification for cleft lips and palates. Plast Reconstr Surg. 1971;47:469-70.
28. Bronfman M, Guiscafré H, Castro V, Castro R, Gutiérrez G. La medición de la desigualdad: una estrategia metodológica, análisis de las características socioeconómicas de la muestra. Arch Invest Med. 1988;19:351-60.
29. Hosmer D, Lemeshow S. Applied logistic regression. 2nd edition. New York: Wiley-Interscience Publication; 2000.
30. Bagley SC, White H, Golomb BA. Logistic regression in the medical literature: Standards for use and reporting, with particular attention to one medical domain. J Clin Epidemiol. 2001;54:979-85.
31. López-Camelo JS, Castilla EE, Orioli IM; INAGEMP (Instituto Nacional de Genética Médica Populacional); ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congénitas). Folic acid flour fortification: Impact on the frequencies of 52 congenital anomaly types in three South American countries. Am J Med Genet A. 2010;152A:2444-58.
32. Nazer J, Ramírez MC, Cifuentes L. Evolution of prevalence rates of orofacial clefts in a maternity of a Chilean clinical hospital. Rev Med Chil. 2010;138:567-72.
33. Rittler M, López-Camelo JS, Castilla EE, Bermejo E, Cocchi G, Correa A, et al. Preferential associations between oral clefts and other major congenital anomalies. Cleft Palate Craniofac J. 2008;45:525-32.
34. Tamura T, Picciano MF. Folate and human reproduction. Am J Clin Nutr. 2006;83:993-1016.
35. Chawla A, Repa JJ, Evans RM, Mangelsdorf DJ. Nuclear receptors and lipid physiology: Opening the X-files. Science. 2001;294:1866-70.
36. Johnson CY, Little J. Folate intake, markers of folate status and oral clefts: Is the evidence converging? Int J Epidemiol. 2008;37:1041-58.
37. Kawachi I. Income inequality in health. En: Berkman L, Kawachi I. Social epidemiology. New York: Oxford University Press; 2000. p. 76-93.
38. Lynch J, Kaplan G. Socioeconomic position. En: Berkman L, Kawachi I. Social epidemiology. New York: Oxford University Press; 2000. p. 13-35.
39. Kosteniuk JG, Dickinson HD. Tracing the social gradient in the health of Canadians: Primary and secondary determinants. Soc Sci Med. 2003;56:263-76.
40. Medina-Solís CE, Maupomé G, Pelcastre-Villafuerte B, Ávila-Burgos L, Vallejos-Sánchez AA, Casanova-Rosado AJ. Desigualdades socioeconómicas en salud bucal: caries dental en niños de 6 a 12 años de edad. Rev Invest Clin. 2006;58:296-304.
41. Bower E, Gulliford M, Steele J, Newton T. Area deprivation and oral health in Scottish adults: A multilevel study. Community Dent Oral Epidemiol. 2007;35:118-29.
42. Ferro R, Besostri A, Meneghetti B, Olivieri A, Benacchio L, Tabaccanti S, et al. Oral health inequalities in preschool children in North-Eastern Italy as reflected by caries prevalence. Eur J Paediatr Dent. 2007;8:13-8.
43. Jamieson LM, Parker EJ, Armfield JM. Indigenous child oral health at a regional and state level. J Paediatr Child Health. 2007;43:117-21.
44. Villalobos-Rodelo JJ, Medina-Solís CE, Maupomé G, Vallejos-Sánchez AA, Lau-Rojo L, Ponce de León-Viedas MV. Socioeconomic and socio-demographic variables associated with oral hygiene status in Mexican school children aged 6 to 12 years. J Periodontol. 2007;78:816-22.
45. Villalobos-Rodelo JJ, Medina-Solís CE, Maupomé G, Pontigo-Loyola AP, Lau-Rojo L, Verdugo-Barraza L. Caries dental en escolares de una comunidad del noroeste de México con dentición mixta, y su asociación con algunas variables clínicas, socioeconómicas y sociodemográficas. Rev Invest Clin. 2007;59:256-67.
46. Herrera MS, Lucas-Rincón SE, Medina-Solís CE, Maupomé G, Márquez-Corona ML, Islas-Granillo H, et al. Desigualdades socioeconómicas en salud bucal: factores asociados al cepillado dental en escolares nicaragüenses. Rev Invest Clin. 2009;61:489-96.
47. Villalobos-Rodelo JJ, Medina-Solís CE, Maupomé G, Lamadrid-Figueroa H, Casanova-Rosado AJ, Casanova-Rosado JF, et al. Dental needs and socioeconomic status associated with dental services' utilization taking place in the presence of dental pain: A case control study. J Orofac Pain. 2010;24:279-86.
48. Laaksonen M, Rahkonen O, Martikainen P, Lahelma E. Socioeconomic position and self-rated health: The contribution of childhood socioeconomic circumstances, adult socioeconomic status, and material resources. Am J Public Health. 2005;95:1403-9.
How to Cite
1.
Acuña-González G, Medina-Solís CE, Maupomé G, Escoffie-Ramírez M, Hernández-Romano J, Márquez-Corona M de L, et al. Family history and socioeconomic risk factors for non-syndromic cleft lip and palate: A matched case-control study in a less developed country. biomedica [Internet]. 2011 Mar. 31 [cited 2024 May 11];31(3):381-91. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/378
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