COVID-19 related risk factors and their association with non-syndromic orofacial clefts in five Arab countries: a case-control study

Heba Jafar Sabbagh; Rana A Alamoudi; Mohammad Zeinalddin; Taimoor Al Bulushi; Ola B Al-Batayneh; Mamdouh A AboulHassan; Mohamed Koraitim; Maryam Quritum; Buthaina Almuqbali; Sultan Musaad Alghamdi; Shaimaa Mohsen Refahee; Lateefa Alkharafi; Fatemah Fahad Taqi; Bader Albassam; Mariam Ayed; Alia Embaireeg; Raqiya Alnahdi; Mona Talal AlSharif; Fatma Dawood Abdulhameed; Aziza Johar Aljohar; Najla Sulaiman Alrejaye; Manal Ibrahim Almalik; P S Viswapurna; Tamara Al Halasa; Maha El Tantawi

doi:10.1186/s12903-023-02934-y

COVID-19 related risk factors and their association with non-syndromic orofacial clefts in five Arab countries: a case-control study

BMC Oral Health. 2023 Apr 28;23(1):246. doi: 10.1186/s12903-023-02934-y.

Authors

Heba Jafar Sabbagh¹, Rana A Alamoudi¹, Mohammad Zeinalddin², Taimoor Al Bulushi³, Ola B Al-Batayneh⁴, Mamdouh A AboulHassan⁵, Mohamed Koraitim⁶, Maryam Quritum⁷, Buthaina Almuqbali⁸, Sultan Musaad Alghamdi⁹, Shaimaa Mohsen Refahee¹⁰, Lateefa Alkharafi¹¹, Fatemah Fahad Taqi¹², Bader Albassam¹², Mariam Ayed¹³, Alia Embaireeg¹³, Raqiya Alnahdi¹⁴, Mona Talal AlSharif¹⁵, Fatma Dawood Abdulhameed¹⁶, Aziza Johar Aljohar¹⁷, Najla Sulaiman Alrejaye¹⁸, Manal Ibrahim Almalik¹⁹, P S Viswapurna¹⁴, Tamara Al Halasa⁴, Maha El Tantawi²⁰

Affiliations

¹ Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.
² Private Practice, Muscat, Oman.
³ Plastic and Craniofacial Surgery, Khoula Hospital, Muscat, Oman.
⁴ Preventive Dentistry Department, Jordan University of Science & Technology, Irbid, 22110, Jordan.
⁵ Pediatric Plastic Surgery Department, Cairo University, Cairo, Egypt.
⁶ Maxillofacial and Plastic Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
⁷ Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, 21527, Egypt.
⁸ Ministry of Health, Khoula Hospital, Muscat, Oman.
⁹ Ministry of Health, Bisha, 67711, Saudi Arabia.
¹⁰ Oral and Maxilofacial Surgery, Faculty of Dentistry, Fayoum University, Faiyum, Egypt.
¹¹ Cleft and Craniofacial Unit, Ministry of Health, Kuwait, Kuwait.
¹² Department of General Dentistry, Ministry of Health, Kuwait, Kuwait.
¹³ Neonatal Department, Maternity Hospital-Kuwait, Kuwait, Kuwait.
¹⁴ Oman Dental College, Muscat, Oman.
¹⁵ Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.
¹⁶ Pediatric Surgery Department, King Salman Medical City, Maternity and Children's Hospital, Madinah, Saudi Arabia.
¹⁷ Department of Dentistry, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
¹⁸ Department of Dentistry, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
¹⁹ Dental Department, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia.
²⁰ Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, 21527, Egypt. maha.tantawy@alexu.edu.eg.

Abstract

Background: The environmental etiology of non-syndromic orofacial clefts (NSOFCs) is still under research. The aim of this case-control study is to assess COVID-19 associated factors that may be related to the risk of NSOFC in five Arab countries. These factors include COVID-19 infection, COVID-19 symptoms, family member or friends infected with COVID-19, stress, smoking, socioeconomic status and fear of COVID-19.

Methods: The study took place in governmental hospitals in five Arab countries from November 2020 to November 2021. Controls are matched in the month of delivery and site of recruitment. A clinical examination was carried out using LASHAL classification. Maternal exposure to medication, illnesses, supplementation, COVID-19 infection during their pregestation and 1st trimester periods were evaluated using a validated questionnaire. Maternal exposure to stress was assessed using the Life Events scale, fear of covid-19 scale, family member or friend affected with covid-19 infection, pregnancy planning and threatened abortion.

Results: The study recruited 1135 infants (386 NSOFC and 749 controls). Living in urban areas, maternal exposure to medications 3-months pregestation, maternal exposure to any of the prenatal life events and maternal fear of COVID-19 significantly increased the risk of having a child with NSOFC. On the other hand, mothers exposed to supplementation 3-months pregestation, mothers suspected of having COVID-19 infection, family members or friends testing positive with COVID-19 significantly decreased the risk of having a child with NSOFC.

Conclusions: This study suggests that NSOFC may be associated with maternal exposure to lifetime stress and COVID-19 fear in particular, with no direct effect of the COVID-19 infection itself. This highlights the importance of providing psychological support for expecting mothers during stressful events that affect populations such as the COVID-19 pandemic, in addition to the usual antenatal care.

Keywords: COVID-19; Etiology; Fear; Life events; Non-syndromic orofacial cleft; Risk factors; Stress.

MeSH terms

COVID-19* / epidemiology
Case-Control Studies
Child
Cleft Lip* / epidemiology
Cleft Palate* / epidemiology
Egypt / epidemiology
Female
Humans
Infant
Middle East / epidemiology
Mothers
Pandemics
Pregnancy
Risk Factors