The impact of maternal stress on non-syndromic clefts: a retrospective case-control study

To assess the effect of COVID-19 related maternal psychological stress (MS) in the first trimester of pregnancy on non-syndromic orofacial-clefts (NSOFCs).

This retrospective case-control cross-sectional study included infants who were born during the COVID-19 pandemic. Sample size was determined based on differences in MS and their effect on clefts etiology. Infants were divided into two groups: cases (with NSOFCs) and controls (healthy); two controls were selected for each case, matched by gender and residence. Data was collected from mothers through phone-based questionnaires which consisted of three parts: demographics, risk factors, and maternal stress using the Life Events Questionnaire (LEQ) and Fear of COVID-19 Scale (FCV-19S). Descriptive statistics, correlations and logistic regression were done, level of significance was set at (P ≤ 0.05).

The final sample included 192 infants: (64 cases, 128 controls), mostly females, born full-term, with normal weight (55.2%, 72.9%, and 62.5%, respectively). Mothers ages were 19-41 years. Prevalence of NSOFCs was 1.41 birth per 1000 live births. The LEQ showed that changing residence (P = 0.012) and overall stress (P = 0.019) were significant factors for mothers in both groups. Regression analysis showed that low gestational age of the infant (P = 0.009), lack of folic acid intake during the first trimester (P = 0.037), parental consanguinity (P = 0.019) and maternal stress due to COVID-19 pandemic (P = 0.039) were risk factors for NSOFCs.

Despite limitations of reliance on self-reported MS, this study suggests that maternal stress is a risk factor for NSOFCs. More studies need to be conducted addressing MS during prenatal and perinatal periods.