{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T04:45:13Z","timestamp":1790397913968,"version":"4.1.0"},"reference-count":68,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2015,8,25]],"date-time":"2015-08-25T00:00:00Z","timestamp":1440460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Institutional funds from Keck School of Medicine of USC"},{"name":"Operation Smile International"},{"DOI":"10.13039\/100014165","name":"Sorenson Legacy Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100014165","id-type":"DOI","asserted-by":"crossref"}]},{"name":"California Community Adelaide Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Several lifestyle and environmental exposures have been suspected as risk factors for oral clefts, although few have been convincingly demonstrated. Studies across global diverse populations could offer additional insight given varying types and levels of exposures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed an international case\u2013control study in the Democratic Republic of the Congo (133 cases, 301 controls), Vietnam (75 cases, 158 controls), the Philippines (102 cases, 152 controls), and Honduras (120 cases, 143 controls). Mothers were recruited from hospitals and their exposures were collected from interviewer\u2010administered questionnaires. We used logistic regression modeling to estimate odds ratios (OR) and 95% confidence intervals (CI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Family history of clefts was strongly associated with increased risk (maternal: OR = 4.7; 95% CI, 3.0\u20137.2; paternal: OR = 10.5; 95% CI, 5.9\u201318.8; siblings: OR = 5.3; 95% CI, 1.4\u201319.9). Advanced maternal age (5 year OR = 1.2; 95% CI, 1.0\u20131.3), pregestational hypertension (OR = 2.6; 95% CI, 1.3\u20135.1), and gestational seizures (OR = 2.9; 95% CI, 1.1\u20137.4) were statistically significant risk factors. Lower maternal (secondary school OR = 1.6; 95% CI, 1.2\u20132.2; primary school OR = 2.4, 95% CI, 1.6\u20132.8) and paternal education (OR = 1.9; 95% CI, 1.4\u20132.5; and OR = 1.8; 95% CI, 1.1\u20132.9, respectively) and paternal tobacco smoking (OR = 1.5, 95% CI, 1.1\u20131.9) were associated with an increased risk. No other significant associations between maternal and paternal factors were found; some environmental factors including rural residency, indoor cooking with wood, chemicals and water source appeared to be associated with an increased risk in adjusted models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our study represents one of the first international studies investigating risk factors for clefts among multiethnic underserved populations. Our findings suggest a multifactorial etiology including both maternal and paternal factors. Birth Defects Research (Part A) 103:863\u2013879, 2015. \u00a9 2015 The Authors Birth Defects Research Part A: Clinical and Molecular Teratology Published by Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdra.23417","type":"journal-article","created":{"date-parts":[[2015,8,25]],"date-time":"2015-08-25T14:12:21Z","timestamp":1440511941000},"page":"863-879","source":"Crossref","is-referenced-by-count":51,"title":["Parental risk factors for oral clefts among Central Africans, Southeast Asians, and Central Americans"],"prefix":"10.1002","volume":"103","author":[{"given":"Jane C.","family":"Figueiredo","sequence":"first","affiliation":[{"name":"Department of Preventive Medicine Keck School of Medicine, University of Southern California Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Ly","sequence":"additional","affiliation":[{"name":"Division of Plastic &amp; Maxillofacial Surgery Children's Hospital Los Angeles Los Angeles California"},{"name":"Department of Community Health Sciences and California Center for Population Research UCLA Fielding School of Public Health Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen S.","family":"Magee","sequence":"additional","affiliation":[{"name":"Operation Smile, Inc Norfolk Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugonna","family":"Ihenacho","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine Keck School of Medicine, University of Southern California Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James W.","family":"Baurley","sequence":"additional","affiliation":[{"name":"BioRealm LLC Los Angeles California"},{"name":"Bioinformatics and Data Science Research Center, Bina Nusantara University Jakarta Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro A.","family":"Sanchez\u2010Lara","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Pathology &amp; 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