Multigravidity as risk factors for isolated Cleft Lip with or without Cleft Palate

GILI, JUAN ANTONIO; POLETTA, FA; CAMPAÑA, H; COMAS, B; PAWLUK, M; RITTLER, M; LOPEZ-CAMELO, JORGE SANTIAGO

BUENOS AIRES

Congreso; International Clearinghouse for Birth Defects Surveillance and Research Annual Meeting.; 2010

International Clearinghouse for Birth Defects Surveillance and Research

Background: Discordance exists about cleft lip +/-palate (CL/P) and multigravidity (generally considered as four or more pregnancies) association. These, could be explained by differences in adjustment for two major confounding factors, these are maternal age and socioeconomic status. Aim: to evaluate the risk of CL/P for multigravidity, using a matched case control study in South America. Methods: Data were obtained from 1,371,575 consecutive newborn infants, weighing ≥500g ascertained by hospitals of the ECLAMC (Estudio Colaborativo Latinoamericano de Malformaciones Congénitas) between 1982 and 1999. A total of 1,271 CL/P were diagnosed (non-syndromic forms and from non-primigravid women). A matched (1:1) case control study was performed using maternal age, maternal education, fetal gender, ethnicity, moment and place of birth as matching variables. A total of 727 matched pairs were obtained. Results: Multigravidity, consanguinity, and acute maternal illnesses have showed a significant risks for CL/P (OR=1.4, IC95% 1.0-2.0; OR=3.0, IC95% 1.0-9.4; OR=1.4, IC95% 1.0-2.0, respectively). It was not found interaction between variables and there were not phenotypic differences between CL/P born from a multigravid and those born from a mother with gravidity 2-3. Conclusions: Multigravid mothers have a moderate risk for CL/P (OR 1.4, 95% CI 1.0 – 2.0) than gravidity 2-3 mothers, even after matching for maternal age and education, ethnicity, fetal sex, place and moment of birth. In Latin America, where about 28% of women have 4 or more gestations, a primary prevention public health policy could help to prevent 10% of oral clefts cases.