From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine.
Plast Reconstr Surg. 2022 Jan 1;149(1):169-182. doi: 10.1097/PRS.0000000000008636.
The relationship between poverty and incidence of cleft lip and cleft palate remains unclear. The authors investigated the association between socioeconomic status and cleft lip with or without cleft palate and cleft palate only in the United States after controlling for demographic and environmental risk factors.
The U.S. 2016 and 2017 natality data were utilized. Proxies for socioeconomic status included maternal education, use of the Special Supplemental Nutrition Program for Women, Infants, and Children, and payment source for delivery. Multiple logistic regression controlled for household demographics, prenatal care, maternal health, and infant characteristics.
Of 6,251,308 live births included, 2984 (0.05 percent) had cleft lip with or without cleft palate and 1180 (0.02 percent) had cleft palate only. Maternal education of bachelor's degree or higher was protective against, and delayed prenatal care associated with, cleft lip with or without cleft palate (adjusted ORs = 0.73 and 1.14 to 1.23, respectively; p < 0.02). Receiving assistance under the Special Supplemental Nutrition Program for Women, Infants, and Children was associated with cleft palate only (adjusted OR = 1.25; p = 0.003). Male sex, first-trimester tobacco smoking, and maternal gestational diabetes were also associated with cleft lip with or without cleft palate (adjusted ORs = 1.60, 1.01, and 1.19, respectively; p < 0.05). Female sex, prepregnancy tobacco smoking, and maternal infections during pregnancy were associated with cleft palate only (adjusted ORs = 0.74, 1.02, and 1.60, respectively; p < 0.05).
Increased incidence of orofacial clefts was associated with indicators of lower socioeconomic status, with different indicators associated with different cleft phenotypes. Notably, early prenatal care was protective against the development of cleft lip with or without cleft palate.
CLIINCAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
贫困与唇裂和腭裂发生率之间的关系尚不清楚。作者在美国，在控制人口统计学和环境风险因素后，研究了社会经济地位与唇裂伴或不伴腭裂以及单纯腭裂之间的关系。
利用了美国 2016 年和 2017 年的出生率数据。社会经济地位的代表包括母亲的教育程度、是否使用妇女、婴儿和儿童特别补充营养计划以及分娩的支付来源。多变量逻辑回归控制了家庭人口统计学、产前护理、产妇健康和婴儿特征。
在纳入的 6251308 例活产儿中，有 2984 例（0.05%）患有唇裂伴或不伴腭裂，1180 例（0.02%）患有单纯腭裂。学士学位或更高学历的母亲教育程度可预防唇裂伴或不伴腭裂的发生，且延迟产前护理可增加唇裂伴或不伴腭裂的发生风险（调整后的比值比分别为 0.73、1.14 至 1.23；p<0.02）。接受妇女、婴儿和儿童特别补充营养计划援助与单纯腭裂有关（调整后的比值比=1.25；p=0.003）。男性性别、妊娠早期吸烟以及产妇妊娠期糖尿病也与唇裂伴或不伴腭裂有关（调整后的比值比分别为 1.60、1.01 和 1.19；p<0.05）。女性性别、孕前吸烟以及妊娠期间的母亲感染与单纯腭裂有关（调整后的比值比分别为 0.74、1.02 和 1.60；p<0.05）。
唇裂和腭裂的发生率增加与社会经济地位较低的指标有关，不同的指标与不同的唇裂表型有关。值得注意的是，早期产前护理可预防唇裂伴或不伴腭裂的发生。
临床问题/证据水平：风险，III。
