title: Oral cleft recurrence risk and subsequent maternal fertility preferences and behavior in Brazil.
abstract: BACKGROUND
  Oral clefts are among the most common birth defects with numerous impacts on affected individuals and families. However, little is known about how being at a greater risk of having an affected child affects subsequent maternal fertility decisions. We investigated differences in fertility preferences and behavior between mothers who are themselves affected with cleft lip with/without cleft palate but have had no affected children and unaffected mothers of an affected child. We also compared these outcomes between unaffected mothers of a first versus another affected child.
  
  
  METHODS
  The sample included 1475 Brazilian women interviewed between 2004 and 2009. The outcomes were wanting more children, contraceptive use and type, and maternal age at first child. Comparisons between the various maternal groups were performed using regression analysis adjusting for conceptually relevant demographic, socioeconomic, and geographic factors.
  
  
  RESULTS
  Affected mothers of unaffected children were less likely to use contraceptives than unaffected mothers of affected children by 31% (95% confidence interval, 1-53%). Among unaffected mothers, those who had a first affected child were 67% (95% confidence interval, 15-144%) more likely to use contraceptives.
  
  
  CONCLUSIONS
  The results suggest that having an affected child represents a stronger signal of recurrence risk to the mother than her own cleft status, and that cleft status of the first child is especially important in influencing subsequent maternal fertility decisions in affected families. These findings highlight the importance of adequate counseling of at-risk women about recurrence risks and available care resources and policies that improve access to quality cleft care.
authors.affiliation: University of Iowa & NBER, Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa.
authors.forename: George L
authors.initials: GL
authors.lastname: Wehby
authors.forename: Kwame A
authors.initials: KA
authors.lastname: Nyarko
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Murray
mesh_terms: D000328:Adult; D001938:Brazil; D002648:Child; D002971:Cleft Lip / Q000235:genetics / Q000473:pathology / Q000523:psychology*; D002972:Cleft Palate / Q000235:genetics / Q000473:pathology / Q000523:psychology*; D003268:Contraception Behavior / Q000523:psychology; D003376:Counseling; D004522:Educational Status; D005193:Family Planning Services; D005260:Female; D005298:Fertility; D020022:Genetic Predisposition to Disease; D006801:Humans; D040582:Inheritance Patterns; D008297:Male; D008423:Maternal Age; D009035:Mothers / Q000523:psychology*; D010353:Patient Education as Topic; D012044:Regression Analysis; D012306:Risk
keywords: birth defects; contraception; family planning; fertility; oral clefts