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The etiologies are complicated, involving with genetic, epigenetic, and environmental factors. Studies have found that maternal diabetes and metabolic syndrome are associated with a higher risk of OFCs in offspring. Metabolic syndrome is a clustering of several disease risk factors, including hyperglycemia, dyslipidemia, obesity, and hypertension. Metabolic disease during pregnancy can increase risk of adverse outcomes and significantly influence fetal development, including orofacial formation and fusion. An altered metabolic state may contribute to developmental disorders or congenital defects including OFCs, potentially through epigenetic modulations, such as histone modification, DNA methylation, and noncoding RNA expression to alter activities of critical morphogenetic signaling or related developmental genes. This review summarizes the currently available evidence and underlying mechanisms of how the maternal metabolic syndrome is associated with OFCs in mostly human and some animal studies. It may provide a better understanding of the interactions between intrauterine metabolic status and fetal orofacial development which might be applied toward prevention and treatments of OFCs.<\/jats:p>","DOI":"10.1002\/bdr2.2226","type":"journal-article","created":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T08:29:34Z","timestamp":1690446574000},"page":"1835-1850","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Epigenetic implications in maternal diabetes and metabolic syndrome\u2010associated risk of orofacial clefts"],"prefix":"10.1002","volume":"115","author":[{"given":"Bo","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Biochemistry and Molecular Medicine University of California at Davis, School of Medicine  Sacramento California USA"},{"name":"Institute for Pediatric Regenerative Medicine of Shriners Hospitals for Children University of California at Davis, School of Medicine  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