Tsuchiya Shinobu, Tsuchiya Masahiro, Momma Haruki, Igarashi Kaoru, Nagatomi Ryoichi, Saito Masatoshi, Arima Takahiro, Yaegashi Nobuo
Department of Orthodontics and Speech Therapy for Craniofacial Anomalies, Tohoku University Hospital, Sendai, Japan.
Division of Oral Dysfunction Science, Tohoku University Graduate School of Dentistry, Sendai, Japan.
Front Glob Womens Health. 2024 Sep 17;5:1302808. doi: 10.3389/fgwh.2024.1302808. eCollection 2024.
Cleft lip and/or palate (CL/P), the most prevalent congenital anomaly, has been associated with higher rates of child maltreatment. In particular, the presence of cleft lip has more of an impact on external appearance and may increase the risks of negative health outcomes such as parental postpartum depression; however, this concept remains controversial. Item #10 of the Edinburgh Postpartum Depression Scale is the assessment of parental self-harm ideation, and its presence in postpartum mothers merits risk assessments as an emergent issue that may affect the health of both mothers and infants. This study focused on the impact of CL/P on maternal self-harm ideation.
Of 100,300 live births from a nationwide birth cohort in Japan, 238 mothers of infants with CL/P [186 children born with cleft lip (CL ± P) and 52 born with isolated cleft palate (CP)] were included in the analyses. The prospective association of children with CL/P and maternal self-harm ideation, which were acquired using item #10 in the Edinburgh Postpartum Depression Scale at 1 and 6 months postpartum, was examined using binomial logistic regression analyses after multiple imputations and with adjustments for several maternal (age at delivery, smoking habit, and alcohol intake) and child-related (sex and prevalence of other congenital diseases) variables.
The prevalence of self-harm ideation in 238 mothers of infants with CL/P at 1 and 6 months were 14.7% (35/238) and 18.8% (45/238) [8.2% (8,185/100,062) and 12.9% (12,875/100,062) in the control group], respectively. The odds ratio (95% confidence interval) for maternal self-harm ideation increased with CL/P prevalence [1.80 (1.22-2.65) and 1.47 (0.98-2.18)] at 1 and 6 months of age, respectively. After stratified by the prevalence of cleft lip, we found significant differences in the CL ± P group but not in the CP group. Furthermore, persistent self-harming ideation was associated with a higher risk in the CL ± P group [2.36 (1.43-3.89)].
CL/P, particularly cleft lip, which is more noticeable externally, was associated with an increased prevalence of maternal self-harm ideation. The findings in this study indicate some potential benefits of increasing support for mothers who have infants with CL/P.
唇腭裂（CL/P）是最常见的先天性异常，与儿童受虐待率较高有关。特别是唇裂的存在对外观影响更大，可能会增加诸如父母产后抑郁等负面健康结果的风险；然而，这一概念仍存在争议。爱丁堡产后抑郁量表的第10项是对父母自伤意念的评估，产后母亲中出现这种情况值得作为一个可能影响母婴健康的紧急问题进行风险评估。本研究聚焦于CL/P对母亲自伤意念的影响。
在日本全国出生队列的100,300例活产中，分析纳入了238名唇腭裂婴儿的母亲[186名唇裂（CL±P）患儿的母亲和52名单纯腭裂（CP）患儿的母亲]。使用爱丁堡产后抑郁量表第10项在产后1个月和6个月获取唇腭裂患儿与母亲自伤意念的前瞻性关联，在多次插补并对几个母亲相关（分娩年龄、吸烟习惯和饮酒情况）和儿童相关（性别和其他先天性疾病患病率）变量进行调整后，使用二项逻辑回归分析进行检验。
238名唇腭裂婴儿母亲在产后1个月和6个月时自伤意念的患病率分别为14.7%（35/238）和18.8%（45/238）[对照组分别为8.2%（8,185/100,062）和12.9%（12,875/100,062）]。母亲自伤意念的优势比（95%置信区间）随唇腭裂患病率在1个月和6个月时分别增加[分别为1.80（1.22 - 2.65）和1.47（0.98 - 2.18）]。按唇裂患病率分层后，我们发现唇裂合并或不合并腭裂组有显著差异，而单纯腭裂组无显著差异。此外，持续性自伤意念在唇裂合并或不合并腭裂组中与更高风险相关[2.36（1.43 - 3.89）]。
唇腭裂，特别是外观上更明显的唇裂，与母亲自伤意念患病率增加有关。本研究结果表明，增加对有唇腭裂婴儿母亲的支持可能有一些潜在益处。
