title: Risk factors associated with the occurrence of frontoethmoidal encephalomeningocele.
abstract: OBJECTIVE
  To determine factors associated with the occurrence of frontoethmoidal encephalomeningocele (FEEM), a congenital defect with unique geographical distribution.
  
  
  METHODS
  The subjects of this study were 160 unrelated cases of FEEM. Subjects were recruited between 1999 and 2006 from 15 medical centers throughout Thailand. Data obtained from FEEM cases were analyzed and compared with data from 349 cases of oral clefts studied in the same centers and during the same time and those from the general population (GP) taken in 2003.
  
  
  RESULTS
  About 52% of FEEM cases had brain anomalies which were not different among types of FEEM. We found familial aggregation reflected by an increased risk to siblings. All of the FEEM cases were of Thai nationality and came from low socioeconomic status. Seven FEEM cases had amniotic rupture sequences. Compared with oral clefts, advanced maternal age (OR: 1.08, 95% CI: 1.02-1.15) was found to be associated with FEEM. In addition, the interpregnancy interval between the FEEM cases and their previous siblings was significantly longer than that of the oral cleft patients and unaffected sibs (OR: 1.17, 95% CI: 1.06-1.28).
  
  
  CONCLUSIONS
  Low socioeconomic status, advanced maternal age, and a long interpregnancy interval may lead to an unfavorable intrauterine environment which, with a certain genetic background such as Thai ethnicity, could contribute to the occurrence of FEEM.
authors.affiliation: Division of Medical Genetics and Metabolism, Department of Pediatrics, Sor Kor Building 11th Floor, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand.
authors.forename: Kanya
authors.initials: K
authors.lastname: Suphapeetiporn
authors.forename: Charan
authors.initials: C
authors.lastname: Mahatumarat
authors.forename: Nond
authors.initials: N
authors.lastname: Rojvachiranonda
authors.forename: Chopiew
authors.initials: C
authors.lastname: Taecholarn
authors.forename: Pichit
authors.initials: P
authors.lastname: Siriwan
authors.forename: Sumarlee
authors.initials: S
authors.lastname: Srivuthana
authors.forename: Vorasuk
authors.initials: V
authors.lastname: Shotelersuk
mesh_terms: D000328:Adult; D001721:Birth Intervals; D001722:Birth Order; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000453:epidemiology / Q000473:pathology; D004475:Ectoderm / Q000196:embryology / Q000473:pathology; D004677:Encephalocele / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D008588:Meningocele / Q000453:epidemiology* / Q000473:pathology; D009436:Neural Tube Defects / Q000453:epidemiology* / Q000473:pathology; D016017:Odds Ratio; D012307:Risk Factors; D012959:Socioeconomic Factors; D013785:Thailand / Q000453:epidemiology; D014057:Tomography, X-Ray Computed