Prevalence of orofacial clefts in Korean live births

Incidence of cleft lip and palate, and epidemiology of perinatal deaths related to cleft lip and palate in Hunan Province, China, 2016-2020

This study aimed to analyze the epidemiological characteristics of cleft lip and/or palate (CL/P) and CL/P-related perinatal deaths, provide some information for intervention programs to reduce the incidence of CL/P and provide clues for future researchers. Data were obtained from the Birth Defects Surveillance System in Hunan Province, China, 2016-2020. Incidences of CL/P [number of cases per 1000 fetuses (births and deaths at 28 weeks of gestation and beyond)] with 95% confidence intervals (CI) were calculated by residence, gender, maternal age, year, and major types [cleft lip only (CL), cleft palate only (CP), and cleft lip with palate (CLP)]. Crude odds ratios (ORs) were calculated to examine the association of each maternal characteristic with CL/P. Pearson chi-square tests (χ²) were used to examine the association of each maternal characteristic with CL/P-related perinatal deaths. A total of 847,755 fetuses were registered, and 14,459 birth defects were identified, including 685 CL/P (accounted for 4.74% of all birth defects). CL, CP, and CLP accounted for 24.67% (169 cases), 36.79% (252 cases), and 38.54% (264 cases) of all CL/P, respectively. The incidence of CL/P was 0.81‰ (95%CI 0.75-0.87). The incidence of CL was 0.20‰ (95%CI 0.17-0.23) (169 cases), of CP was 0.30‰ (95%CI 0.26-0.33) (252 cases), and of CLP was 0.31‰ (95%CI 0.27-0.35) (264 cases). CL was more common in males than females (0.24‰ vs. 0.15‰, OR = 1.62, 95%CI 1.18-2.22). CP was more common in urban than rural (0.36‰ vs. 0.25‰, OR = 1.43, 95%CI 1.12-1.83), and less common in males than females (0.22‰ vs. 0.38‰, OR = 0.59, 95%CI 0.46-0.75). CLP was more common in males than females (0.35‰ vs. 0.26‰, OR = 1.36, 95%CI 1.06-1.74). Compared to mothers 25-29 years old, mothers < 20 years old were risk factors for CLP (OR = 3.62, 95%CI 2.07-6.33) and CL/P (OR = 1.80, 95%CI 1.13-2.86), and mothers ≥ 35 years old was a risk factor for CLP (OR = 1.43, 95%CI 1.01-2.02). CL/P-related perinatal deaths accounted for 24.96% (171/685) of all CL/P, of which 90.64% (155/171) were terminations of pregnancy. Rural residents, low income, low maternal age, and early prenatal diagnosis are risk factors for perinatal death. In conclusion, we found that CP was more common in urban areas and females, CL and CLP were more common in males, and CL/P was more common in mothers < 20 or ≥ 35 years old. In addition, most CL/P-related perinatal deaths were terminations of pregnancy. CL/P-related perinatal deaths were more common in rural areas, and the proportion of CL/P-related perinatal deaths decreased with the increase in maternal age, parity, and per-capita annual income. Several mechanisms have been proposed to explain these phenomena. Our study is the first systematic research on CL/P and CL/P-related perinatal deaths based on birth defects surveillance. It is significant for intervention programs to prevent CL/P and CL/P-related perinatal deaths. As well, more epidemiological characteristics of CL/P (such as the location of CL/P) and approaches to reduce CL/P-related perinatal deaths need to be studied in the future.

The prevalence, risk of premature births, mortality and causes of death of cleft lip with or without palate in South Korea: a nationwide population-based cohort study

BACKGROUND

Very few recent nationwide studies have assessed the epidemiology of cleft lip with or without palate (CL/P). The purpose of this study was to identify the prevalence, risk of premature births, mortality and cause of death of CL/P.

METHODS

This nationwide population-based cohort study evaluated all 5 747 830 live births in South Korea, including CL/P infants, from 2006 to 2018. The prevalence with trend analysis, risk of premature births, mortality and cause of death of CL/P with or without associated syndromes (non-syndromic, syndromic CL/P) and subgroups (cleft lip only, cleft palate only, cleft lip with palate) were evaluated.

RESULTS

Among 5 747 830 live births, 11 284 children were identified as having CL/P during the study period. The annual prevalence was 1.96 per 1000 births. The prevalence ratio, which shows the trend during the period, was 1.021. Both non-syndromic and syndromic CL/P children had higher risk of premature births compared with children without CL/P (odds ratio: non-syndromic 1.43, syndromic 5.29). The mortality rates per 1000 person-years were 0.39 for children without CL/P, 0.98 for non-syndromic CL/P children and 12.20 for syndromic CL/P children. The causes of deaths were not different for children without CL/P in non-syndromic CL/P, but the most common cause of deaths was cardiovascular anomalies in syndromic CL/P.

CONCLUSION

The reported prevalence of 1.96 per 1000 births is one of the highest prevalences worldwide. CL/P children had high risks of premature births and risk of mortality. The most common cause of deaths was cardiovascular anomalies.

Prevalence of cleft lip and/or cleft palate in Guangdong province, China, 2015-2018: a spatio-temporal descriptive analysis

OBJECTIVES

This study aimed to investigate the temporal and spatial characteristics of cleft lip and/or palate based on a large-scale birth defect monitoring database.

METHODS

Data on perinatal infants and children with cleft lip and/or palate defects from 1 January 2015 to 31 December 2018 in Guangdong province of China were collected. The variables including the demographic data, basic family information (address, education level, etc.), the infant's birth weight, gender and other basic parameters were collected and analysed.

RESULTS

During the study period, the prevalence of cleft lip and/or palate was 7.55 per 10 000 perinatal infants. The prevalence of cleft lip, cleft palate and cleft lip and palate were 2.34/10 000, 2.22/10 000 and 2.98/10 000, respectively. The prevalence of cleft lip and/or palate showed a pronounced downward trend, reducing from 8.47/10 000 in 2015 to 6.51/10 000 in 2018. We observed spatial heterogeneity of prevalence of cleft lip and/or palate across the study period in Guangdong. In the Pearl River Delta region, the overall prevalence of cleft lip and/or palate was 7.31/10 000, while the figure (7.86/10 000) was slightly higher in the non-Pearl River Delta region (p<0.05). Concerning infant gender, the prevalence was in general higher in boys than girls (p<0.05). In addition, the higher prevalence was more common in mothers older than 35 years old. For the birth season, infants born in spring tended to have a higher prevalence than those born in other seasons, regardless of the prevalence of cleft lip and palate calculated separately or jointly (p<0.05). The majority of newborns with cleft lip and palate were accompanied by other birth defects.

CONCLUSION

This study contributes a better understanding of the characteristics of spatio-temporal trends for birth defects of cleft lip and/or palate in south China.

Global prevalence of cleft palate, cleft lip and cleft palate and lip: A comprehensive systematic review and meta-analysis

BACKGROUND

Birth defect is widely used as a term for congenital anomalies. Children with cleft lip and palate may have serious speech, hearing, nutrition, and mental and social development disorders; therefore, this study was designed to determine the overall prevalence of cleft palate, lip, and cleft palate through systematic review and meta-analysis.

METHODS

In this study, systematic review and meta-analysis of data from studies on the prevalence of cleft lip and palate in Scopus, Embase, Magiran, Web of Science (WoS), PubMed and Science Direct databases were extracted between January 2000 and June 2020. In order to perform the analysis of qualified studies, the model of random effects was used and the inconsistency of studies with I² index was investigated. Data analysis was performed with Comprehensive Meta-Analysis software (Version 2).

RESULTS

According to the results of the present study on cleft palate, the total number of samples entered in the study in 59 studies were 21,088,517 individuals, the prevalence of cleft palate based on the meta-analysis of the reviewed studies in every 1000 live births was obtained 0.33 (95% CI: 0.28-0.38). In the case of cleft lip, the total number of samples entered in the 57 reviewed studies were 17,907,569 individuals. The prevalence of cleft lip obtained based on the meta-analysis of the reviewed studies was 0.3 in every 1000 live births (95% CI: 0.26-0.34), and in the case of cleft lip and palate, the total number of samples entered in the 55 reviewed studies was 17,894,673. The prevalence of cleft lip and palate based on the meta-analysis of the studies reviewed in each 1000 live births was 0.45 (95% CI: 0.38-0.52).

CONCLUSION

Due to the high prevalence of oral clefts such as cleft palate, cleft lip, and cleft lip and palate; health system policymakers need to take precautionary measures to reduce the number of patients, as well as diagnostic and therapeutic measures to reduce the effects of this disorder in children.

Data analysis of recent cleft lip and palate surgery in Korea using the National Health Insurance Service (NHIS) database

BACKGROUND

No national epidemiological investigations have been conducted on several aspects of cleft lip and palate surgery.

METHODS

The study was performed using the data of 5727 people who underwent cleft lip and palate surgery during the 6-year period from 2013 to 2018 archived by the National Health Information Database (NHID) of the Health Insurance Review and Assessment Service. Disease and operation codes were utilized for the analysis.

RESULTS

Most patients underwent surgery during the first 5 years of life. The number of operations per patient remained almost constant during the study period, but hospital costs per patient gradually increased. When hospital costs per patient were subdivided by institution type, they were found to have steadily increased on an annual basis at all types with the exception of hospital .Since 2016, average hospital stay per operation decreased slightly, but the number of outpatient visits tended to increase.

CONCLUSIONS

Accessibility to tertiary hospitals has improved and patients increasingly choose to be treated at larger hospitals in metropolitan areas. Furthermore, these tendencies are expected to be maintained. Despite reductions in hospitalization stays, the cost of treatment, including operation costs, have increasing considerably. Changes in the insurance system are required to reduce financial burdens imposed on patients and on the National Health Insurance Service.

Clinical and economic analysis of the 2009 H1N1 influenza pandemic among pregnant Korean women

BACKGROUND/AIMS

Unlike Western countries, the 2009 pandemic influenza infection among pregnant women was reported as mild in a previous interim study in South Korea. However, several mortalities were reported thereafter, suggesting that nationwide data were lacking.

METHODS

This case-control study covers the entire 2009 pandemic inf luenza period, from May 2009 to February 2010. The clinical and economic data of pregnant (case) and age-matched non-pregnant (control) women with influenza A (H1N1) pdm09 virus (H1N1pdm09) infection were retrospectively collected from nine hospitals in South Korea.

RESULTS

A total of 130 pregnant women with H1N1pdm09 infection were identified. The mean age of the pregnant women was 31.1 years (range, 19 to 41) and mean gestational age was 18.4 weeks (range, 3 to 40). Both case and control groups were similar in terms of age (p = 0.43) and comorbidities (p = 0.18). The overall rate of complications was comparable between the two groups (p = 0.648). However, mortality was reported only among the cases, so mean economic per capita burden is estimated to be higher for pregnant women compared to the control (4,821,992 Korean won [KRW] vs. 351,233 KRW, p = 0.31). Obstetric complications were observed in 12 cases, including preterm labor (n = 7), low birth-weight (n = 3), miscarriage (n = 1), stillbirth (n = 1), and cleft lip (n = 1).

CONCLUSION

Although statistically insignificant, the detrimental impact of influenza A H1N1pdm09 on pregnancy can be serious in some complicated cases in South Korea. Thus, the strong recommendation of influenza vaccination should be maintained for pregnant women as a high priority.

Congenital Heart Disease in Cleft Lip and Palate Patients: How Common Is the Association?

Aims and Objectives:

To determine the prevalence of congenital heart disease in patients with orofacial cleft in a Nigerian population.

Materials and Methods:

A retrospective review of all the case files of patients with orofacial cleft managed at the Dental and Maxillofacial Surgery unit of the Aminu Kano Teaching Hospital between 2007 and 2014. Data were analyzed using SPSS version 16.

Results:

A total of 133 patients with cleft lip and palate were seen during the period of study comprising 77 males and 56 females, giving an M:F ratio of 1:0.7. The age range was 15 days–36 years with a mean age of 6 years. There were five cases of congenital heart disease made up of two males and three females, giving a prevalence of 3.76 per cent.

Conclusion:

This study showed that the prevalence of congenital heart disease in patients with orofacial cleft was low. However, the need for routine echocardiography in all orofacial cleft patients especially children should not be overlooked.

Prevalence of Orofacial Clefts among Live Births in China: A Systematic Review and Meta-Analysis

BACKGROUND

Orofacial clefts (OFCs) are common human birth defects in China. However, studies on the prevalence of OFCs present inconsistent results. The overall prevalence and geographic distribution of OFCs are poorly described in China. Thus, we conducted a systematic review and meta-analysis to estimate the prevalence of OFCs.

METHODS

The systematic review and meta-analysis were conducted on the basis of an established protocol (PROSPERO 2015: CRD42015030198). We systematically searched for articles in four electronic databases, including Embase, PubMed, Wanfang Database, and China National Knowledge Infrastructure (CNKI) to identify relevant studies about prevalence of OFCs in China. Meta-analysis, including subgroup analysis, was conducted to estimate the pooled prevalence.

RESULTS

A total of 41 studies published between 1986 and 2015 were included in our analysis. The sample size ranged from 2,586 to 4,611,808 live births. The random-effects model of meta-analysis showed that the overall prevalence of OFCs in China was 1.4 per 1000 live births (95% confidence interval [CI], 1.1-1.7). In subgroup analysis based on geographic regions, we found that OFC prevalence in Southwest (2.3 per 1000 live births, 95% CI, 1.1-4.7) was higher than that in other regions of China. There were no significant time trends of OFCs during the study period (p-value = 0.47).

CONCLUSION

The overall prevalence of OFCs in China was 1.4 per 1000 live births. No significant secular trend of prevalence has been found in this analysis. Further studies need to be conducted to explore the etiology of OFC to better control the risk of this common birth defect. Birth Defects Research 109:1011-1019, 2017. © 2017 Wiley Periodicals, Inc.