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Maternal Smoking and Preterm Birth Among Infants With Orofacial Clefts

Peichun Han1, Renata H Benjamin1, Katherine L Ludorf1

  • 1Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.

The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association
|July 27, 2026
PubMed

Insights

Maternal heavy smoking during pregnancy, especially in the second trimester, is linked to preterm birth (PTB) in infants with orofacial clefts (OFCs). This highlights the need for smoking cessation programs for expectant mothers to reduce PTB risks.

Area of Science:

  • Reproductive Health
  • Pediatric Health
  • Birth Defect Research

Background:

  • Orofacial clefts (OFCs) are common birth defects.
  • Maternal smoking is a known risk factor for adverse pregnancy outcomes.
  • The specific impact of smoking on preterm birth (PTB) in infants with OFCs requires further investigation.

Purpose of the Study:

  • To assess the association between maternal cigarette smoking and PTB in infants diagnosed with OFCs.
  • To examine smoking's impact across different OFC types (cleft lip with/without cleft palate, cleft palate only) and pregnancy timepoints.

Main Methods:

  • A population-based retrospective cohort study utilizing data from the National Birth Defects Prevention Study and the Birth Defects Study To Evaluate Pregnancy exposures.
  • Analysis included 5618 liveborn infants with OFCs.
  • Poisson regression was used to calculate adjusted relative risks (aRRs) for PTB (<37 weeks) associated with maternal smoking (any vs. none, and intensity) at various pregnancy stages.

Main Results:

  • 14.5% of infants with OFCs experienced preterm birth.
  • Heavy maternal smoking (≥15 cigarettes/day) in the second trimester was significantly associated with PTB in infants with cleft palate only (aRR: 1.89) and extremely-to-very PTB (<32 weeks) in infants with any OFC (aRR: 3.37).
  • Associations were generally stronger for cleft palate only compared to cleft lip with/without cleft palate.

Conclusions:

  • Heavy maternal smoking during the second trimester may elevate the risk of severe preterm birth in infants with OFCs.
  • The findings underscore the critical importance of maternal smoking cessation or reduction during pregnancy to mitigate PTB risks in this vulnerable population.
  • Further research may refine understanding of smoking intensity and timing effects on specific OFC subtypes and PTB.

Keywords:
cleft lipcleft lip and palatecleft palateepidemiologymaternal factorsretrospective studies

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