Risk Factors Associated with Cleft Etiology: A Multicenter Experience

Abstract

Background: The etiology of cleft lip and palate is complex and thought to involve genetic influences with variable interactions from environmental factors. Although genetic and environmental triggers are important for syndromic cleft lip and palate, the etiology of the more common non-syndromic (isolated) forms remains poorly understood. Recognition of etiology, risk factors and natural history is essential to define how prevention and treatment should be planned and implemented. Objective: This study is aimed at assessing the possible risk factors in the etiology of patients presenting with cleft lip and palate. Materials and methods: A total of 254 children (children 12years and below) for cleft surgery at three surgical centers (Mercyland orthopedic Hospital, Galaxy Medical Center and shifa Royal Hospital) in the North Eastern under the Smile Train, project for a 2-year period (January 2021 to December 2022) were included in this study. A Self- administered questionnaire was prepared to fill in data about the patients' gender, family history of cleft, consanguineous marriages, maternal risk factors. Ages of the children were ascertained in months and years as told by the parents. Paternal and maternal ages were also recorded. Statistical analysis was done using the Statistical Package for Social Sciences (IBM) 23.0 version. The significant level was set at a p value of \0.05 at 95% confidence interval. Results: Median age at presentation was 4 month, varying from <1 months to 12 years. The gender distribution was 133 (52.4%) males and 121 (47.6%) females (M:F = 1:0.9). Majority (214, 84.3%) of the affected children belonged to low socioeconomic group while only a few (12, 4.7%). High proportion of mothers between the age of 26 to 35 years (42.5%) was observed, but no association was found between maternal age and clefts (p=0.331). There was evidence of association between paternal age >35years old and cleft (p=0.005). Conclusion: This study revealed a strong association between consanguineous marriage, low socioeconomic status and persistent maternal fever during the first trimester and cleft. Increasing paternal age was also found to increase the risk of cleft. The relevance of this study is for public health workers and clinicians to be equipped with adequate information to provide useful counseling to parents particularly those with history of cleft.it may also provide adequate information for policy makers when making policies of public health concerns.