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Updated: Mar 7, 2026

Cigarette Smoke Exposure in Mice using a Whole-Body Inhalation System
Published on: October 22, 2020
Interaction between smoking and body mass index and risk of oral clefts
George L Wehby1, Lina M Moreno Uribe2, Allen J Wilcox3
1Department of Health Management and Policy, University of Iowa, Iowa City; Department of Economics, University of Iowa, Iowa City; Department of Preventive & Community Dentistry, University of Iowa, Iowa City; Public Policy Center, University of Iowa, Iowa City.
Purpose:
To examine maternal smoking and body mass index (BMI) interactions in contributing to risk of oral clefts.
Methods:
We studied 4935 cases and 10,557 controls from six population-based studies and estimated a pooled logistic regression of individual-level data, controlling for study fixed effects and individual-level risk factors.
Results:
We found a significant negative smoking-BMI interaction, with cleft risk with smoking generally declining with higher BMI. For all clefts combined, the odds ratio for smoking was 1.61 (95% confidence interval [CI]: 1.39-1.86) at BMI 17 (underweight), 1.47 (95% CI: 1.34-1.62) at BMI 22 (normal weight), 1.35 (95% CI: 1.22-1.48) at BMI 27 (overweight), 1.21 (95% CI: 1.04-1.41) at BMI 33 (obese), and 1.13 (95% CI: 0.92-1.38) at BMI 37 (very obese). A negative interaction was also observed for isolated clefts and across cleft types but was more pronounced for cleft lip only and cleft palate only.
Conclusions:
Our findings suggest that the risk of oral clefts associated with maternal smoking is largest among underweight mothers, although the smoking-BMI interaction is strongest for cleft lip only and cleft palate only. BMI was not protective for the effects of smoking; a clinically relevant increase in smoking-related cleft risk was still present among heavier women.
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