{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:32:59Z","timestamp":1777523579171,"version":"3.51.4"},"reference-count":31,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000883","name":"University of Bristol","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000883","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000303","name":"Inspire Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000303","id-type":"DOI","asserted-by":"publisher"}]},{"name":"European Joint Programming Initiative","award":["MRC MR\/S036520\/1"],"award-info":[{"award-number":["MRC MR\/S036520\/1"]}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MC_UU_00011\/5"],"award-info":[{"award-number":["MC_UU_00011\/5"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/S009310\/1"],"award-info":[{"award-number":["MR\/S009310\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess whether women who experience stressful life events during the periconceptional period are at higher risk of giving birth to a baby with an orofacial cleft (OFC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis of studies reporting the proportion of babies born with OFC to mothers exposed and unexposed to population-level or personal-level stressful life events during the periconceptional period. Six electronic databases were searched from inception to August 2020. Risk of bias was assessed using the Newcastle-Ottawa scale. Odds ratios (ORs) for the odds of OFC in babies of exposed mothers relative to unexposed controls were extracted and\/or calculated. Random effects meta-analysis was undertaken, stratified by cleft subtype.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 12 eligible studies, 8 examined experience of personal events and 4 examined population-level events. Studies demonstrated low-moderate risk of bias and there was indication of publication bias. There was some evidence that personal stressful life events were associated with greater odds of cleft lip and\/or palate (six studies, OR 1.63, 95% confidence interval (CI) 1.16, 2.30,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001) and cleft palate only (six studies, OR 1.45, 95% CI 1.02, 2.06,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.04). Population-level events were associated with higher odds of OFC in studies that did not specify subtype (three studies, OR 1.64, 95% CI 1.19, 2.25,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002), but subtype stratified analyses were underpowered. Heterogeneity was high.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Limited evidence indicated a weak positive association between maternal stressful life events during the periconceptional period and risk of OFC in the offspring, but further studies with greater consistency in research design are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656211045553","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T10:13:39Z","timestamp":1641896019000},"page":"1253-1263","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Maternal Stressful Life Events During the Periconceptional Period and Orofacial Clefts: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0045-7276","authenticated-orcid":false,"given":"Christina","family":"Tran","sequence":"first","affiliation":[{"name":"Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew A.","family":"Crawford","sequence":"additional","affiliation":[{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0730-4897","authenticated-orcid":false,"given":"Alexander","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clare E.","family":"French","sequence":"additional","affiliation":[{"name":"NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK"},{"name":"Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1575-453X","authenticated-orcid":false,"given":"Yvonne","family":"Wren","sequence":"additional","affiliation":[{"name":"Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7144-9700","authenticated-orcid":false,"given":"Jonathan","family":"Sandy","sequence":"additional","affiliation":[{"name":"Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gemma","family":"Sharp","sequence":"additional","affiliation":[{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"},{"name":"MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1597\/08-003.1"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12682"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1980.tb00618.x"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ppe.12123"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-200001000-00008"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ede.0000259986.85239.87"},{"key":"e_1_3_2_8_1","unstructured":"Centre for Disease Control. 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