Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, California, USA.
Children's Hospital Los Angeles, Los Angeles, California, USA.
J Glob Health. 2020 Dec;10(2):020410. doi: 10.7189/jogh.10.020410.
Cleft is one of the most common birth defects globally and the lack of access to surgery means millions are living untreated. Smoke exposure from cooking occurs infrequently in developed countries but represents a high-proportion of smoke exposure in less-developed regions. We aimed to study if smoke exposure from cooking is associated with an increased risk in cleft, while accounting for other smoke sources.
We conducted a population-sampled case-control study of children with cleft lip and/or palate and healthy newborns from Vietnam, Philippines, Honduras, Nicaragua, Morocco, Congo, and Madagascar. Multivariable regression models were used to assess associations between maternal cooking during pregnancy, parental smoking, and household tobacco smoke with cleft.
2137 cases and 2014 controls recruited between 2012-2017 were included. While maternal smoking was uncommon (<1%), 58.3% case and 36.1% control mothers cooked over an open fire inside. Children whose mothers reported cook smoke exposure were 49% (95% confidence interval (CI) = 1.2-1.8) more likely to have a child with a cleft. This was consistent in five of seven countries. No significant associations were found for any other smoke exposure.
Our finding of maternal cook smoke and cleft in low-resource countries, similar to maternal tobacco smoke in high-resource countries, may reflect a common etiology. This relationship was present across geographically diverse countries with variable socioeconomic statuses and access to care. Exposures specific to low-resource settings must be considered to develop public health strategies that address the populations at increased risk of living with cleft and inform the mechanisms leading to cleft development.
唇腭裂是全球最常见的出生缺陷之一，由于无法获得手术治疗，数以百万计的患者未得到治疗。在发达国家，烹饪产生的烟雾暴露并不常见，但在欠发达地区，烟雾暴露占很大比例。我们旨在研究烹饪产生的烟雾暴露是否与唇腭裂风险增加有关，同时考虑其他烟雾来源。
我们对来自越南、菲律宾、洪都拉斯、尼加拉瓜、摩洛哥、刚果和马达加斯加的唇裂和/或腭裂患儿和健康新生儿进行了一项基于人群的病例对照研究。使用多变量回归模型评估母亲在怀孕期间烹饪、父母吸烟和家庭烟草烟雾与唇腭裂之间的关联。
2012 年至 2017 年间共纳入 2137 例病例和 2014 例对照。虽然母亲吸烟（<1%）不常见，但 58.3%的病例和 36.1%的对照母亲在室内使用明火烹饪。报告有烹饪烟雾暴露的母亲所生的孩子患有唇腭裂的可能性增加 49%（95%置信区间[CI] 1.2-1.8）。在七个国家中的五个国家均发现了这种一致性。任何其他烟雾暴露均与唇腭裂无显著关联。
我们发现，在资源匮乏的国家中，母亲烹饪烟雾与唇腭裂之间存在关联，与资源丰富的国家中母亲吸烟与唇腭裂之间的关联类似，这可能反映了一种共同的病因。这种关系存在于地理位置不同、社会经济地位和获得医疗保健机会各异的国家。必须考虑到资源匮乏环境中的特定暴露，以制定针对高风险人群的公共卫生策略，解决唇腭裂患者的问题，并了解导致唇腭裂发生的机制。
