Maternal stress as a risk factor for non-syndromic orofacial clefts: Systematic review and meta-analysis

The impact of maternal stress on non-syndromic clefts: a retrospective case-control study

PURPOSE

To assess the effect of COVID-19 related maternal psychological stress (MS) in the first trimester of pregnancy on non-syndromic orofacial-clefts (NSOFCs).

METHODS

This retrospective case-control cross-sectional study included infants who were born during the COVID-19 pandemic. Sample size was determined based on differences in MS and their effect on clefts etiology. Infants were divided into two groups: cases (with NSOFCs) and controls (healthy); two controls were selected for each case, matched by gender and residence. Data was collected from mothers through phone-based questionnaires which consisted of three parts: demographics, risk factors, and maternal stress using the Life Events Questionnaire (LEQ) and Fear of COVID-19 Scale (FCV-19S). Descriptive statistics, correlations and logistic regression were done, level of significance was set at (P ≤ 0.05).

RESULTS

The final sample included 192 infants: (64 cases, 128 controls), mostly females, born full-term, with normal weight (55.2%, 72.9%, and 62.5%, respectively). Mothers ages were 19-41 years. Prevalence of NSOFCs was 1.41 birth per 1000 live births. The LEQ showed that changing residence (P = 0.012) and overall stress (P = 0.019) were significant factors for mothers in both groups. Regression analysis showed that low gestational age of the infant (P = 0.009), lack of folic acid intake during the first trimester (P = 0.037), parental consanguinity (P = 0.019) and maternal stress due to COVID-19 pandemic (P = 0.039) were risk factors for NSOFCs.

CONCLUSION

Despite limitations of reliance on self-reported MS, this study suggests that maternal stress is a risk factor for NSOFCs. More studies need to be conducted addressing MS during prenatal and perinatal periods.

Cleft lip and palate and periconception COVID-19 infection in five arab countries

BACKGROUND

Little is known about factors associated with the severity of cleft lip with or without cleft palate (CL/P) especially during the COVID-19 pandemic with its dramatic changes.

OBJECTIVES

The aim of this multi-national study is to measure the association between CL/P severity, COVID-19 infection, and fear of COVID-19 in five Arab countries.

METHODS

This cross-sectional study took place in major governmental hospitals in five Arab countries from November 2020 to April 2023. Participants were infants born with CL/P and their mothers who were in their 1st trimester during the COVID-19 pandemic. Clinical examination was carried out, and CL/P cases were grouped according to phenotype: cleft lip and palate (CLP) versus cleft lip (CL), cleft extension (incomplete versus complete), and site (unilateral versus bilateral) to assess severity. Information on maternal COVID-19 infection and fear of COVID-19 were gathered.

RESULTS

The study recruited 273 CL/P infants. Maternal COVID-19 infection during one-month pre-gestation and 1st trimester was significantly associated with higher odds of CL/P severity (AOR = 2.707; P = 0.002) than mothers without the COVID-19 infection. Using supplements during pregnancy showed a protective effect (AOR = 0.573; P = 0.065).

CONCLUSION

Mothers infected with COVID-19 before and during pregnancy had more than twofold higher odds of having an infant with a more severe CL/P phenotype.

COVID-19 vaccine and non-syndromic orofacial clefts in five arab countries. A case-control study

OBJECTIVES

Risk factors for non-syndromic orofacial cleft (NSOFCs) include genetic profile and environmental exposure to medication and illnesses during pregnancy. We assessed the association between the COVID-19 vaccination and the incidence of NSOFC across five Middle Eastern countries.

MATERIALS AND METHODS

This multi-country, hospital-based, case-control study included infants with NSOFCs whose first 3 intrauterine months coincided with the time when pregnant women were allowed to receive COVID-19 vaccination in the countries participating in the study. Newborns with NSOFCs were examined for cleft type and their parents were interviewed for maternal exposures and COVID-19 vaccination. Controls were newborns matched to cases in gender and setting.

RESULTS

The study recruited 977 (348 children with NSOFCs and 629 controls). Maternal use of nicotine (Adjusted Odds Ratio (AOR): 2.437; P = 0.044) and family history of NSOFC (AOR: 11.059; P < 0.001) increased significantly the AOR of having a child with NSOFC. On the other hand, COVID-19 vaccine administration to pregnant mothers have significantly decreased the AOR of having a child with NSOFC (AOR: 0.337; P = 0.006).

CONCLUSION

This study suggests that COVID-19 vaccination is not related to NSOFC and might protect against having a child affected with such a congenital anomaly.

CLINICAL RELEVANCE

The finding of this study is important for healthcare providers for considering COVID-19 vaccination for pregnant woman. Clear communication and education about the potential risks and benefits would be crucial for informed decision-making. The study's results would directly impact pregnant individuals, as they would need accurate information to make informed decisions about their health and the health of their infants.

Assessment of non-syndromic orofacial cleft severity and associated environmental factors in Saudi Arabia: A cross-sectional study

Objective

To evaluate the relationship between different environmental risk factors and the severity of cleft lip with/without palate (CL ± P) and cleft palate (CP) in Saudi Arabia.

Methods

This was a cross-sectional national study, of government hospitals in 10 cities distributed across major regions of Saudi Arabia, from June 2020 to June 2021. All newborns with CL ± P or CP were clinically examined and evaluated for cleft phenotype severity using the LAHSHAL classification system. Various environmental factors were evaluated by interviewing parents using a validated questionnaire. The severity of CL ± P and CP was evaluated in relation to environmental factors.

Results

We recruited 174 patients with non-syndromic orofacial cleft (NSOFC); 122 (70.1 %) had CL ± P and 52 (29.9 %) had CP. After adjusting the odds ratios by ordinal regression for CL ± P and logistic regression analysis for CP, environmental factors that significantly increased the severity of CL ± P were family history of NSOFC, maternal illnesses, and maternal medication use (P = 0.02, adjusted odds ratio [AOR]:2.70; P = 0.002, AOR:3.70; and P = 0.03, AOR:2.14, respectively). Folic acid supplementation in the first trimester significantly reduced the severity of CL ± P and CP (P = 0.001, AOR:0.18 and P = 0.001, AOR:0.012, respectively).

Conclusion

The severity of CL ± P was affected by some maternal exposures during the 3-month pre-gestation period. Therefore, our results suggest the possibility of controlling the severity of NSOFC.

Maternal Exposure to Stress During Covid-19 and Non-Syndromic Orofacial Clefts: A Cohort Retrospective Study

OBJECTIVE

The coronavirus (COVID-19) pandemic presents an opportunity to study stress's effect on the development of non-syndromic orofacial clefts (NSOFCs). This study was aimed at assessing maternal stress exposure during the pregestational to first trimester pregnancy periods and the development of NSOFCs during a year of the COVID-19 pandemic.

DESIGN

Cohort study of infants with NSOFCs and controls matched based on recruitment site and age.

SETTING

Government hospitals in Saudi Arabia between November 2020 and November 2021.

MAIN OUTCOME MEASURES

Data collection included NSOFC clinical examination and maternal stress exposure assessment using the Modified Life Events Questionnaire, the Fear of COVID-19 Scale, and a focus on the lack of pregnancy planning and a threatened miscarriage.

RESULTS

Of the 557 infants recruited, 191 had NSOFCs. Logistic regression analysis with adjusted odds ratios (AORs) that removed the effects of confounders showed that any of the seven stressful life events (AOR:3.78, P < .001) and the family histories of relatives with NSOFCs (AOR:9.73, P < .001) increased the AOR for NSOFC development. In contrast, maternal folic acid (AOR:0.56, P.010), threatened miscarriage (AOR:0.17, P = .001), fear of COVID-19 (AOR:0.83, P = .038), and suspected COVID-19 infection (AOR:0.43, P = .008) decreased the AOR for NSOFC development.

CONCLUSION

Along with an established risk associated with family history of birth defects, stressful life events may be a risk factor for NSOFC development. Beyond folic acid's known benefit, it may be that higher maternal health concerns contribute to increased protective health behaviors during pregnancy. Ongoing research is needed to specify the maternal risk factors for NSOFC.