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American Association of Plastic Surgeons

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Is Poverty Associated with Cleft Lip and Palate? A Comparison of Orofacial Cleft Risk and Socioeconomic Status Utilizing United States Birth Data
Giap H. Vu, B.A.1, Clara Warden, B.A.2, Christopher L. Kalmar, M.D., M.B.A.1, Carrie E. Zimmerman, B.S.1, Laura S. Humphries, M.D.1, Scott P. Bartlett, M.D.1, Jesse A. Taylor, M.D.1, Jordan W. Swanson, M.D., M.Sc.1.
1Children's Hospital of Philadelphia, Philadelphia, PA, USA, 2Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

Purpose: The relationship between poverty and incidence of cleft lip/palate remains unclear. We investigate the association between socioeconomic status (SES) and cleft lip with/without cleft palate (CLP) and cleft palate only (CPO) in the U.S. after controlling for demographic and environmental risk factors.
Methods: The U.S. 2016 and 2017 Natality Data were utilized (n=7,820,866). Births with missing data, diagnoses of both CLP and CPO, or suspected syndromic disorders were excluded. Proxies for SES included maternal education, use of WIC, and payment source for delivery. Multiple logistic regression controlled for household demographics, prenatal care, maternal health, and infant sex and weight.
Results: Of 6,250,956 live births included, 3547 had CLP and 1418 had CPO. Maternal education of bachelorís degree or higher and prenatal care started in the first trimester were protective against CLP (AOR=0.73[0.62-0.85], p<0.001 and AOR=0.65[0.48-0.87], p=0.004, respectively) while receiving WIC was associated with an increased risk of CPO (AOR=1.24[1.06-1.45], p=0.009). Male sex, first-trimester tobacco smoking, maternal pre-pregnancy and gestational diabetes, and low birth weight were also associated with CLP (AORs=1.67[1.55-1.81], 1.02[1.00-1.03], 1.47[1.06-2.03], 1.20[1.04-1.39], 1.61[1.25-2.04]; p<0.05). Female sex, pre-pregnancy tobacco smoking, maternal infections during pregnancy, and increasing paternal age were associated with CPO (AORs=1.30[1.15-1.47], 1.02[1.01-1.03], 1.72[1.23-2.40], 1.01[1.00-1.03]; p<0.05).
Conclusions: Incidence of orofacial clefts was associated with indicators of lower SES. Notably, different indicators were associated with different cleft phenotypes. These findings suggest poverty may be the latent factor to the observable associations of maternal education and WIC status with cleft incidence. Our model also confirmed known risk factors for CLP.


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