ArticlePaediatric and perinatal epidemiology2021
Risk of non-syndromic orofacial clefts by maternal rural-urban residence and race/ethnicity: A population-based case-control study in Washington State 1989-2014.
Article in Paediatric and perinatal epidemiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Accuracy of congenital anomaly coding in live birth children recorded in European health care databases, a EUROlinkCAT study.European journal of epidemiology · 2023Pooled it
- Determinants of cleft lip and cleft palate in Ethiopian children: Insights from a hospital-based study using Bayesian modeling.The Journal of international medical research · 2026Article
- Food Security Impacts Health of Children With Orofacial Clefts: An 8-Year Review of the Global Burden of Disease Study.The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association · 2026Article
- Polymorphisms and environmental factors associated with orofacial clefts as potential markers for oral cancer risk.Brazilian oral research · 2025Article
- Contemporary Prevalence of Oral Clefts in the US: Geographic and Socioeconomic Considerations.Journal of clinical medicine · 2024Article
- The relationship between cleft palate repair technique and audiological outcomes: A retrospective cohort study.Laryngoscope investigative otolaryngology · 2024Article
- Characteristics of Factors Influencing the Occurrence of Cleft Lip and/or Palate: A Case Analysis and Literature Review.Children (Basel, Switzerland) · 2024Article
- Distribution of maternal risk factors for orofacial cleft in infants in Indonesia: a multicenter prospective study.Archives of craniofacial surgery · 2024Article
- Isolated nonsyndromic cleft palate: multicenter epidemiological study in the Brazil.BMC oral health · 2023Article
- Incidence of cleft lip and palate, and epidemiology of perinatal deaths related to cleft lip and palate in Hunan Province, China, 2016-2020.Scientific reports · 2023Article
- Modifiable Risk Factors of Non-Syndromic Orofacial Clefts: A Systematic Review.Children (Basel, Switzerland) · 2022Review
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Authors and funding
5 authors.
Funding
Abstract
backgroundOrofacial clefts (OFC) have multifactorial aetiology. Established risk factors explain a small proportion of cases.
objectivesTo evaluate OFC risk by maternal rural residence and race/ethnicity, and test whether these associations changed after US-mandated folic acid fortification.
methodsThis population-based case-control study included all non-syndromic OFC cases among Washington State singleton livebirths between 1989-2014 and birth year-matched controls. Data sources included birth certificates and hospital records. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for OFC by maternal rural-urban residence (adjusted for maternal race/ethnicity) and by maternal race/ethnicity. We evaluated additive and multiplicative effect measure modification by time of folic acid fortification (before vs. after). Probabilistic quantitative bias analysis accounted for potential differential case ascertainment for infants born to Black mothers.
resultsThe overall non-syndromic OFC birth prevalence was 1.0 per 1000 livebirths (n = 2136 cases). Among controls (n = 25 826), 76% of mothers were urban residents and 72% were of White race/ethnicity. OFC risk was slightly higher for infants born to rural than to urban mothers, adjusting for race/ethnicity (OR 1.12, 95% CI 1.01, 1.25). The association was similar before and after US-mandated folic acid fortification. Compared with infants born to White mothers, OFC risk was higher for American Indian mothers (OR 1.73, 95% CI 1.35, 2.23) and lower for Black (OR 0.62, 95% CI 0.48, 0.81), Hispanic (OR 0.75, 95% CI 0.64, 0.87), and Asian/Pacific Islander (API) mothers (OR 0.87, 95% CI 0.74, 1.02). Bias analysis suggests the observed difference for Black mothers may be explained by selection bias. Post-fortification, the association of OFC with maternal API race/ethnicity decreased and with maternal Black race/ethnicity increased relative to maternal White race/ethnicity.
conclusionsInfants born to rural mothers and to American Indian mothers in Washington State during 1989-2014 were at higher OFC risk before and after US-mandated folic acid fortification.
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