{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T09:27:59Z","timestamp":1784366879786,"version":"3.55.0"},"reference-count":60,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["T32CA094880"],"award-info":[{"award-number":["T32CA094880"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000072","name":"National Institute of Dental and Craniofacial Research","doi-asserted-by":"publisher","award":["R90DE23059"],"award-info":[{"award-number":["R90DE23059"]}],"id":[{"id":"10.13039\/100000072","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Paediatric Perinatal Epid"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Orofacial clefts (OFC) have multifactorial aetiology. Established risk factors explain a small proportion of cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate OFC risk by maternal rural residence and race\/ethnicity, and test whether these associations changed after US\u2010mandated folic acid fortification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This population\u2010based case\u2010control study included all non\u2010syndromic OFC cases among Washington State singleton livebirths between 1989\u20102014 and birth year\u2010matched controls. Data sources included birth certificates and hospital records. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for OFC by maternal rural\u2010urban residence (adjusted for maternal race\/ethnicity) and by maternal race\/ethnicity. We evaluated additive and multiplicative effect measure modification by time of folic acid fortification (before vs. after). Probabilistic quantitative bias analysis accounted for potential differential case ascertainment for infants born to Black mothers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The overall non\u2010syndromic OFC birth prevalence was 1.0 per 1000 livebirths (n\u00a0=\u00a02136 cases). Among controls (n\u00a0=\u00a025\u00a0826), 76% of mothers were urban residents and 72% were of White race\/ethnicity. OFC risk was slightly higher for infants born to rural than to urban mothers, adjusting for race\/ethnicity (OR 1.12, 95% CI 1.01, 1.25). The association was similar before and after US\u2010mandated folic acid fortification. Compared with infants born to White mothers, OFC risk was higher for American Indian mothers (OR 1.73, 95% CI 1.35, 2.23) and lower for Black (OR 0.62, 95% CI 0.48, 0.81), Hispanic (OR 0.75, 95% CI 0.64, 0.87), and Asian\/Pacific Islander (API) mothers (OR 0.87, 95% CI 0.74, 1.02). Bias analysis suggests the observed difference for Black mothers may be explained by selection bias. Post\u2010fortification, the association of OFC with maternal API race\/ethnicity decreased and with maternal Black race\/ethnicity increased relative to maternal White race\/ethnicity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Infants born to rural mothers and to American Indian mothers in Washington State during 1989\u20102014 were at higher OFC risk before and after US\u2010mandated folic acid fortification.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ppe.12727","type":"journal-article","created":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T17:47:18Z","timestamp":1606844838000},"page":"292-301","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Risk of non\u2010syndromic orofacial clefts by maternal rural\u2010urban residence and race\/ethnicity: A population\u2010based case\u2010control study in Washington State 1989\u20102014"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6224-273X","authenticated-orcid":false,"given":"Flavia P.","family":"Kapos","sequence":"first","affiliation":[{"name":"Department of Epidemiology School of Public Health University of Washington Seattle WA USA"},{"name":"Department of Oral Health Sciences School of Dentistry University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2752-9743","authenticated-orcid":false,"given":"Lauren A.","family":"White","sequence":"additional","affiliation":[{"name":"Department of Epidemiology School of Public Health University of Washington Seattle WA USA"},{"name":"School of Social Work University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9916-1634","authenticated-orcid":false,"given":"Kelsey A.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Nutritional Sciences Program School of Public Health University of Washington Seattle WA USA"},{"name":"Cancer Prevention Program Division of Public Health Sciences Fred Hutchinson Cancer Research Center Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen E.","family":"Hawes","sequence":"additional","affiliation":[{"name":"Department of Epidemiology School of Public Health University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline R.","family":"Starr","sequence":"additional","affiliation":[{"name":"The Forsyth Institute Cambridge MA USA"},{"name":"Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston MA 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