Elsevier

The Journal of Pediatrics

Volume 162, Issue 1, January 2013, Pages 42-49.e1
The Journal of Pediatrics

Original Article
Does the Relationship between Prenatal Care and Birth Weight Vary by Oral Clefts? Evidence Using South American and United States Samples

https://doi.org/10.1016/j.jpeds.2012.06.040Get rights and content

Objective

To evaluate if the association between prenatal care use and birth weight (BW) varies for infants with cleft lip and/or cleft palate (CL/P), classified into isolated and non-isolated forms, compared with unaffected infants.

Study design

The study employed 2 datasets. The first included a multi-country sample of 2405 infants with CL/P and 24 046 infants without CL/P born in 1996-2007 in South America. The second was a sample of 2122 infants with CL/P and 297 415 without CL/P from the United States 2004 natality dataset. Separate analyses were performed for the South American and United States samples. The association between prenatal care and BW was evaluated separately for isolated CL/P, non-isolated CL/P, and unaffected infants using regression models adjusting for several background characteristics.

Results

Prenatal care was associated with improved BW for all infant groups, with greater BW increases for infants with CL/P particularly non-isolated forms. In the South American sample, BW increased by 108, 69, and 40 g on average per prenatal visit for infants with non-isolated CL/P, infants with isolated CL/P, and unaffected infants, respectively. In the United States sample, BW increased by 51, 21, and 16 g on average per prenatal visit for these infant groups, respectively.

Conclusions

Prenatal care was associated with larger BW increases for pregnancies complicated with CL/P, particularly non-isolated forms, compared with unaffected pregnancies. Given that reduced BW is a well-recognized comorbidity of CL/P, the findings highlight the importance of prenatal care for at-risk pregnancies as a tertiary-prevention intervention to reduce the health burden of CL/P.

Section snippets

Methods

We separately analyzed 2 samples in this study. The first sample included 921 infants with non-isolated CL/P, 1484 infants with isolated CL/P, and 24 046 unaffected infants born between 1996 and 2007 in 111 hospitals in South America (Argentina, Bolivia, Brazil, Chile, Ecuador, Uruguay, and Venezuela). The non-isolated group included infants with CL/P who had other birth defects, while the isolated group included infants with only CL/P and no other birth defects. The infants were enrolled

Results

Tables I and II describe the study variables for the ECLAMC and natality samples, respectively. The average BW of non-isolated, isolated, and unaffected infants was 2452, 3094, and 3216 g, respectively, in the ECLAMC sample and 2684, 3202, and 3259 g, respectively, in the natality sample. The difference in BW mean between each cleft group and the unaffected infants was significant (P < .0001 for all comparisons based on a t test). The average number of prenatal visits was 6.2 among affected

Discussion

The study finds that the association between prenatal care and BW varies by the presence of CL/P, with potentially larger benefits to BW for pregnancies affected with CL/P compared with unaffected pregnancies. Furthermore, the association generally is stronger for non-isolated than isolated CL/P forms. Given that infants with CL/P particularly non-isolated forms have significantly lower BW than unaffected infants, the study findings suggest that improving the access of pregnant women at-risk

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  • Supported by National Institutes of Health/National Institute of Dental and Craniofacial Research grant (1R03 DE018394). The authors declare no conflicts of interest.

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