Maternal Cigarette Smoking and Cleft Lip and Palate: A Systematic Review and Meta-Analysis

Matthew Fell; Kyle Dack; Shaheel Chummun; Jonathan Sandy; Yvonne Wren; Sarah Lewis

doi:10.1177/10556656211040015

Maternal Cigarette Smoking and Cleft Lip and Palate: A Systematic Review and Meta-Analysis

Matthew Fell^*, Kyle Dack, Shaheel Chummun, Jonathan Sandy, Yvonne Wren, Sarah Lewis

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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Abstract

A systematic review and meta-analysis to determine the association between active maternal smoking and cleft lip and palate etiology.

Medline, Embase, Web of Science and the Cochrane Library from inception to November, 2020.

Observational studies of cigarette smoking habits in pregnant women. Outcomes included cleft lip and/or palate, cleft lip ± palate and cleft palate only.

Publication bias analyses were performed and the Newcastle Ottawa scales were used to assess study quality. Fixed or random effect models were used in the meta-analysis, dependent on risk of statistical heterogeneity.

Forty-five studies were eligible for inclusion of which 11 were cohort and 34 were case-control studies. Sixteen studies were of sufficient standard for inclusion in the meta-analysis. The summary odds ratio for the association between smoking and cleft lip and/or palate was 1.42 (95%CI 1.27-1.59) with a population attributable fraction of 4% (95%CI 3%-5%). There was limited evidence to show a dose-response effect of smoking.

This review reports a moderate association between maternal smoking and orofacial cleft but the overall quality of the conventional observational studies included was poor. There is a need for high quality and novel research strategies to further define the role of smoking in the etiology of cleft lip and palate.

Original language	English
Pages (from-to)	1185-1200
Number of pages	16
Journal	Cleft Palate-Craniofacial Journal
Volume	59
Issue number	9
Early online date	27 Sept 2021
DOIs	https://doi.org/10.1177/10556656211040015 https://doi.org/10.1177/10556656211040015
Publication status	Published - Sept 2022

Bibliographical note

Funding Information:
MF is supported by the VTCT Foundation for a research fellowship with the Cleft Collective at the University of Bristol. KD is supported by a PhD studentship from the MRC Integrative Epidemiology Unit at the University of Bristol (faculty matched place for MRC and Peter and Jean James Scholarship). SJL is supported by a project grant from the Medical Research Council to identify genetic and environmental risk factors for cleft (MR/T002093/1).

Funding Information:
The authors thank Emma Place, Bristol Dental School Librarian, for her help with this study. MF is supported by the VTCT Foundation for a research fellowship with the Cleft Collective at the University of Bristol. KD is supported by a PhD studentship from the MRC Integrative Epidemiology Unit at the University of Bristol (faculty matched place for MRC and Peter and Jean James Scholarship). SJL is supported by a project grant from the Medical Research Council to identify genetic and environmental risk factors for cleft (MR/T002093/1).

Publisher Copyright:
© 2021, American Cleft Palate-Craniofacial Association.

Keywords

cleft lip and palate
cleft palate
orofacial cleft
pregnancy
smoking

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abstract = "A systematic review and meta-analysis to determine the association between active maternal smoking and cleft lip and palate etiology.Medline, Embase, Web of Science and the Cochrane Library from inception to November, 2020.Observational studies of cigarette smoking habits in pregnant women. Outcomes included cleft lip and/or palate, cleft lip ± palate and cleft palate only.Publication bias analyses were performed and the Newcastle Ottawa scales were used to assess study quality. Fixed or random effect models were used in the meta-analysis, dependent on risk of statistical heterogeneity.Forty-five studies were eligible for inclusion of which 11 were cohort and 34 were case-control studies. Sixteen studies were of sufficient standard for inclusion in the meta-analysis. The summary odds ratio for the association between smoking and cleft lip and/or palate was 1.42 (95%CI 1.27-1.59) with a population attributable fraction of 4% (95%CI 3%-5%). There was limited evidence to show a dose-response effect of smoking.This review reports a moderate association between maternal smoking and orofacial cleft but the overall quality of the conventional observational studies included was poor. There is a need for high quality and novel research strategies to further define the role of smoking in the etiology of cleft lip and palate.",

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author = "Matthew Fell and Kyle Dack and Shaheel Chummun and Jonathan Sandy and Yvonne Wren and Sarah Lewis",

note = "Funding Information: MF is supported by the VTCT Foundation for a research fellowship with the Cleft Collective at the University of Bristol. KD is supported by a PhD studentship from the MRC Integrative Epidemiology Unit at the University of Bristol (faculty matched place for MRC and Peter and Jean James Scholarship). SJL is supported by a project grant from the Medical Research Council to identify genetic and environmental risk factors for cleft (MR/T002093/1). Funding Information: The authors thank Emma Place, Bristol Dental School Librarian, for her help with this study. MF is supported by the VTCT Foundation for a research fellowship with the Cleft Collective at the University of Bristol. KD is supported by a PhD studentship from the MRC Integrative Epidemiology Unit at the University of Bristol (faculty matched place for MRC and Peter and Jean James Scholarship). SJL is supported by a project grant from the Medical Research Council to identify genetic and environmental risk factors for cleft (MR/T002093/1). Publisher Copyright: {\textcopyright} 2021, American Cleft Palate-Craniofacial Association.",

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N2 - A systematic review and meta-analysis to determine the association between active maternal smoking and cleft lip and palate etiology.Medline, Embase, Web of Science and the Cochrane Library from inception to November, 2020.Observational studies of cigarette smoking habits in pregnant women. Outcomes included cleft lip and/or palate, cleft lip ± palate and cleft palate only.Publication bias analyses were performed and the Newcastle Ottawa scales were used to assess study quality. Fixed or random effect models were used in the meta-analysis, dependent on risk of statistical heterogeneity.Forty-five studies were eligible for inclusion of which 11 were cohort and 34 were case-control studies. Sixteen studies were of sufficient standard for inclusion in the meta-analysis. The summary odds ratio for the association between smoking and cleft lip and/or palate was 1.42 (95%CI 1.27-1.59) with a population attributable fraction of 4% (95%CI 3%-5%). There was limited evidence to show a dose-response effect of smoking.This review reports a moderate association between maternal smoking and orofacial cleft but the overall quality of the conventional observational studies included was poor. There is a need for high quality and novel research strategies to further define the role of smoking in the etiology of cleft lip and palate.

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JO - Cleft Palate-Craniofacial Journal

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Maternal Cigarette Smoking and Cleft Lip and Palate: A Systematic Review and Meta-Analysis

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