Tobacco Consumption and Maternal Age as Risk Factors for Cleft Palate: A Cross-Sectional Study of Orofacial Cleft Phenotypes in Southeastern Iran
Amir Hossein Khazaei, Fatemeh Keikhaee, Abolfazl Payandeh, Fatollah Roshanzamir, Nasser NadjmiObjective
To characterize the distribution of nonsyndromic orofacial cleft phenotypes and identify demographic and maternal factors associated with specific cleft types in southeastern Iran.
Design
Cross-sectional descriptive-analytical study.
Setting
Zahedan Cleft Center, a referral center for cleft lip and palate reconstruction in southeastern Iran, from August 2018 to August 2024.
Patients, Participants
A total of 421 patients with nonsyndromic cleft lip and/or palate were included. Data were collected through clinical examination, medical records, and face-to-face interviews with parents.
Interventions
None.
Main Outcome Measure(s)
Cleft phenotype, categorized as isolated cleft lip (CL), isolated cleft palate (CP), or cleft lip and palate (CLP), and its associations with demographic and maternal factors. Associations were assessed using chi-square or Fisher exact tests and multivariable binary logistic regression.
Results
CLP was the most prevalent phenotype (246/421, 58.4%), followed by CP (124/421, 29.5%) and CL (51/421, 12.1%). Among patients with CL ± P, unilateral clefts predominated (71.0%), with the left side most frequently affected (64.5%). CP was significantly associated with female sex, Fars ethnicity, maternal tobacco use during the first trimester, and maternal age ≥35 years. In multivariable analysis, maternal tobacco use (adjusted odds ratio [aOR], 2.12; 95% CI, 1.24–3.59) and maternal age ≥35 years (aOR, 2.09; 95% CI, 1.18–3.70) were associated with CP. Family history of CL/P was associated with CL (aOR, 1.91; 95% CI, 1.06–3.45).
Conclusions
Distinct cleft phenotypes demonstrated different associated factors in this southeastern Iranian study. These findings support strengthened prenatal counseling and preventive strategies targeting potentially modifiable maternal risk factors.