Abstract
Objective
To assess whether women who experience stressful life events during the periconceptional period are at higher risk of giving birth to a baby with an orofacial cleft (OFC).
Design
Systematic review and meta-analysis of studies reporting the proportion of babies born with OFC to mothers exposed and unexposed to population-level or personal-level stressful life events during the periconceptional period. Six electronic databases were searched from inception to August 2020. Risk of bias was assessed using the Newcastle-Ottawa scale. Odds ratios (ORs) for the odds of OFC in babies of exposed mothers relative to unexposed controls were extracted and/or calculated. Random effects meta-analysis was undertaken, stratified by cleft subtype.
Results
Of 12 eligible studies, 8 examined experience of personal events and 4 examined population-level events. Studies demonstrated low-moderate risk of bias and there was indication of publication bias. There was some evidence that personal stressful life events were associated with greater odds of cleft lip and/or palate (six studies, OR 1.63, 95% confidence interval (CI) 1.16, 2.30, P = 0.001) and cleft palate only (six studies, OR 1.45, 95% CI 1.02, 2.06, P = 0.04). Population-level events were associated with higher odds of OFC in studies that did not specify subtype (three studies, OR 1.64, 95% CI 1.19, 2.25, P = 0.002), but subtype stratified analyses were underpowered. Heterogeneity was high.
Conclusions
Limited evidence indicated a weak positive association between maternal stressful life events during the periconceptional period and risk of OFC in the offspring, but further studies with greater consistency in research design are needed.
To assess whether women who experience stressful life events during the periconceptional period are at higher risk of giving birth to a baby with an orofacial cleft (OFC).
Design
Systematic review and meta-analysis of studies reporting the proportion of babies born with OFC to mothers exposed and unexposed to population-level or personal-level stressful life events during the periconceptional period. Six electronic databases were searched from inception to August 2020. Risk of bias was assessed using the Newcastle-Ottawa scale. Odds ratios (ORs) for the odds of OFC in babies of exposed mothers relative to unexposed controls were extracted and/or calculated. Random effects meta-analysis was undertaken, stratified by cleft subtype.
Results
Of 12 eligible studies, 8 examined experience of personal events and 4 examined population-level events. Studies demonstrated low-moderate risk of bias and there was indication of publication bias. There was some evidence that personal stressful life events were associated with greater odds of cleft lip and/or palate (six studies, OR 1.63, 95% confidence interval (CI) 1.16, 2.30, P = 0.001) and cleft palate only (six studies, OR 1.45, 95% CI 1.02, 2.06, P = 0.04). Population-level events were associated with higher odds of OFC in studies that did not specify subtype (three studies, OR 1.64, 95% CI 1.19, 2.25, P = 0.002), but subtype stratified analyses were underpowered. Heterogeneity was high.
Conclusions
Limited evidence indicated a weak positive association between maternal stressful life events during the periconceptional period and risk of OFC in the offspring, but further studies with greater consistency in research design are needed.
| Original language | English |
|---|---|
| Pages (from-to) | 1253-1263 |
| Number of pages | 11 |
| Journal | Cleft Palate-Craniofacial Journal |
| Volume | 59 |
| Issue number | 10 |
| Early online date | 11 Jan 2022 |
| DOIs | |
| Publication status | E-pub ahead of print - 11 Jan 2022 |
Bibliographical note
Funding Information:The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the University of Bristol (grant number MRC MR/S036520/1, MC_UU_00011/5, MR/S009310/1).
Funding Information:
AH is funded through a National Institute for Health Research (NIHR) Clinical Lectureship
Funding Information:
Christina Tran received funding from the INSPIRE vacation studentship.
Funding Information:
GCS's contribution to this work is supported by the Medical Research Council [New Investigator Research Grant, MR/S009310/1] and the European Joint Programming Initiative “A Healthy Diet for a Healthy Life” (JPI HDHL, NutriPROGRAM project, UK MRC MR/S036520/1]. GCS works in the MRC Integrative Epidemiology Unit, which receives funds from the University of Bristol and the Medical Research Council MC_UU_00011/5.
Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the University of Bristol (grant number MRC MR/S036520/1, MC_UU_00011/5, MR/S009310/1). Christina Tran received funding from the INSPIRE vacation studentship. GCS's contribution to this work is supported by the Medical Research Council [New Investigator Research Grant, MR/S009310/1] and the European Joint Programming Initiative “A Healthy Diet for a Healthy Life” (JPI HDHL, NutriPROGRAM project, UK MRC MR/S036520/1]. GCS works in the MRC Integrative Epidemiology Unit, which receives funds from the University of Bristol and the Medical Research Council MC_UU_00011/5. AH is funded through a National Institute for Health Research (NIHR) Clinical Lectureship CEF is funded by the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol AAC has an honorary contract with Population Health Sciences, Bristol Medical School, University of Bristol
Publisher Copyright:
© 2022, American Cleft Palate-Craniofacial Association.