CONICET | Buscador de Institutos y Recursos Humanos

Background: There is disagreement about theassociation between cleft lip with or without cleft palate and multigravidity,which could be explained by differences of adjusting for maternal age,Amerindian ancestry, and socioeconomic status.Objective: The aim was to evaluate gravidity4+ (four or more gestations) as a risk factor for cleft lip with or withoutcleft palate in South America.Design: We used a matched (1:1)case-control study with structural equation modeling for related causes. Datawere obtained from 1,371,575 consecutive newborn infants weighing ≥500 g whowere born in the hospitals of the Estudio Colaborativo Latinoamericano deMalformaciones Congénitas (ECLAMC) network between 1982 and 1999. There were atotal of 1,271 cases with cleft lip with or without cleft palate (excludingmidline and atypical cleft lip with or without cleft palate). A total of 1,227case-control pairs were obtained, matched by maternal age, newborn gender, andyear and place of birth. Potential confounders and intermediary variables wereanalyzed with structural equation modeling.Results: The crude risk of gravidity 4+ was1.41 and the 95% confidence interval was 1.14 to 1.61. When applying structuralequation modeling, the effect of multigravidity on the risk of cleft lip withor without cleft palate was 1.22 and the 95% confidence interval was 0.91 to1.39.Conclusions: Multigravid mothers (more than fourgestations) showed no greater risk of bearing children who had cleft lip withor without cleft palate than mothers with two or three births. Therefore, theoften observed and reported association between multigravidity and oral cleftslikely reflects the effect of other risk factors related to low socioeconomicstatus in South American populations.

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