ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Maternal Smoking Increases The Risk For Craniocynostosis And Oral Clefts
Clinical Question Does maternal smoking during pregnancy cause Craniocynostosis and Oral Clefts?
Clinical Bottom Line Maternal smoking during pregnancy leads to a 33% increased risk of Craniocynostosis and 28-34% increased risk of oral clefts.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21747128Hackshaw/2011173,687 malformed cases. 11.7 million control casesSystematic Review
Key resultsThe Odds Ratio for craniocynostosis in infants, exposed to maternal smoking during pregnancy, is 1.33 (95% CI 1.03-1.73, P=0.03) with evidence of a dose-response relationship. The Pooled Odds Ratio for Cleft Lip and Cleft Palate is 1.28 (95% CI 1.20-1.36, p<0.00001) with evidence of a dose-response relationship.
#2) 15112010Little/200424 Case-control and Cohort studiesMeta-anlaysis of case control and cohort studies
Key resultsThe Odds Ratio for cleft Lip with or without cleft palate in infants, exposed to maternal smoking during pregnancy, is 1.34 (95% CI 1.25-1.44). The Odds Ratio for Cleft Palate alone is 1.22 (95% CI 1.10-1.35). Both with evidence of a dose-response relationship.
Evidence Search (pregnancy AND smoking AND (craniosynostosis OR cleft)) OR ("Pregnancy"[Mesh] AND "Smoking"[Mesh] AND ("Craniosynostoses"[Mesh] OR "Cleft Lip"[Mesh] OR "Cleft Palate"[Mesh]))
Comments on
The Evidence
The systematic review and meta-analysis are typically the highest levels of evidence however, these consist of case control/cohort studies. Randomized control studies will most likely never be available so these lower level experiments will suffice. The systematic review had a large sample. The meta analysis also used a large number of studies from which to do its analysis. Both studies show evidence that the risk of these defects increased with increasing cigarette consumption.
Applicability The findings of these studies are highly applicable. Despite the evidence against maternal smoking during pregnancy, a high percentage of women continue to smoke during pregnancy (14-17% in western society). These defects are very expensive and difficult to treat and manage, and the psychological effects are un-measurable. The associated risk is significant enough to push for more advertising against this dangerous practice.
Specialty/Discipline (Public Health) (Oral Surgery) (Orthodontics) (Pediatric Dentistry) (Basic Science)
Keywords Maternal Smoking, Craniocynostosis, Oral Clefts, Birth Defects, Tobacco
ID# 2162
Date of submission: 10/10/2011spacer
E-mail pratta@livemail.uthscsa.edu
Author Allen Pratt, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Peter T. Gakunga, BDS, MS, PhD
Faculty mentor/Co-author e-mail GAKUNGA@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Thomas Adams and Priscilla Leary (San Antonio, Texas) on 11/28/2017
A Pub-Med search on this topic in November 2017, found a meta-analysis by Xuan et al. 2016(PMID 27727103.) which came to similar conclusions as the original bottom line for this CAT. The conclusions further confirmed a risk between smoking and cleft defects, but couldn't confirm if the risk increased depending on dose.
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