Comparative study of individuals born with orofacial clefts in the United States and Brazil

BackgroundIn Brazil, little attention has been focused on gestational complications related to orofacial cleft. The objective was to characterize the burden of orofacial clefts in Brazil by comparing the prevalence, risk factors, and birth health conditions of children born with clefts in Brazil and the United States.MethodsThis was a population-based cross-sectional study conducted using national data from 13,297 to 8853 individuals born with orofacial cleft in Brazil and the United States, respectively, between 2017 and 2021. Risk factors (maternal ethnicity, maternal age, infant sex, and plurality) and birth health conditions (number of prenatal care appointments, delivery method, Apgar score at 5 minutes, gestational age, and birthweight) were gathered from national data in both countries. The prevalence of clefts in both countries and prevalence ratios were calculated.ResultsThe prevalence of clefts was 7.1/10,000 in the United States and 6.2/10,000 in Brazil. Newborns with clefts in Brazil were significantly more likely to have a cleft palate (PR = 1.32, p = 0.000), be premature (PR = 1.37, p = 0.000), be born by cesarean section (PR = 1.00, p = 0.000), and have low birth weight (PR = 1.49, p = 0.000). Their mothers tended to be older (PR = 1.09, p = 0.001), non-white (PR = 0.48, p = 0.000), and had fewer than 10 prenatal care appointments (PR = 2.14, p = 0.000), compared to the United States cohort.ConclusionThe frequency of risk factors and adverse outcomes associated with being born with clefts was higher in the Brazilian cohort, suggesting that social determinants of health play a significant role in increasing individuals' susceptibility to risk factors for clefts and poor birth health conditions.