title: Periconceptional health and lifestyle factors of both parents affect the risk of live-born children with orofacial clefts.
abstract: BACKGROUND
  Nonsyndromic cleft lip with or without cleft palate (CL/P) or cleft palate only (CPO) are orofacial clefts and have a multifactorial etiology. The identification of amendable parental risk factors may contribute to a reduced occurrence of these malformations in the future.
  
  
  METHODS
  Standardized demographic and periconceptional exposure data from 284 parents of a child with CL/P, 66 parents of a child with a CPO and 222 parents of a child without congenital malformations were collected at approximately 24 months after the periconceptional period of the index child. Univariate and multivariate logistic regression analyses were used to estimate relative risks by odds ratios (ORs) and 95% confidence intervals (95% CIs).
  
  
  RESULTS
  Univariate results suggest that low parental education, periconceptional maternal medication use and illnesses, paternal smoking, and first-trimester maternal common cold increased CL/P risk. Pregnancy planning and periconceptional folic acid supplementation, however, reduced CL/P risk by approximately 50% (OR, 0.5; 95% CI, 0.3-0.8) and 40% (OR, 0.6; 95% CI, 0.4-0.9), respectively. Mostly comparable results were obtained for CPO. Being a boy (OR, 2.0; 95% CI, 1.4-3.0), folic acid supplementation (OR, 0.6; 95% CI, 0.4-0.9), and low paternal education (OR, 1.6; 95% CI, 1.0-2.3) mainly determined CL/P in the multivariate analyses, compared to low paternal (OR, 4.5; 95% CI, 2.1-9.4) and maternal medication use (OR, 2.0; 95% CI, 1.0-4.0) for CPO.
  
  
  CONCLUSIONS
  Preconceptional counseling for orofacial cleft risk assessment should pay attention to maternal medication use, periconceptional folic acid supplementation, and exposures of the father. These determinants can be amended, thereby modifying orofacial cleft risk.
authors.affiliation: Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Ingrid P C
authors.initials: IP
authors.lastname: Krapels
authors.forename: Gerhard A
authors.initials: GA
authors.lastname: Zielhuis
authors.forename: Fokaline
authors.initials: F
authors.lastname: Vroom
authors.forename: Lolkje T W
authors.initials: LT
authors.lastname: de Jong-van den Berg
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Kuijpers-Jagtman
authors.forename: Aebele B Mink
authors.initials: AB
authors.lastname: van der Molen
authors.forename: Régine P M
authors.initials: RP
authors.lastname: Steegers-Theunissen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002971:Cleft Lip / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D002972:Cleft Palate / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D006304:Health Status; D006801:Humans; D007231:Infant, Newborn; D008019:Life Style; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010290:Parents; D011247:Pregnancy; D012307:Risk Factors
chemical_list: D005492:Folic Acid