{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T10:11:19Z","timestamp":1780654279372,"version":"3.54.1"},"reference-count":37,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether temporal changes in prenatal detection and North Carolina abortion rates are associated with live-birth cleft palate (CP\u2009\u00b1\u2009L) severity phenotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study linking patient-level clinical data to annual state abortion rates. Analyses included Pearson correlation, multivariable logistic, and interrupted time-series modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Single-center craniofacial program, with linkage to annual statewide abortion rates as a population-level contextual variable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients, Participants<\/jats:title>\n                    <jats:p>554 patients undergoing primary palatoplasty (1999 to 2021).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>None.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measure(S)<\/jats:title>\n                    <jats:p>Primary outcomes: annual Veau classification distribution. Secondary outcomes: prenatal diagnosis rates and genetic syndrome or sequence rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From 2004 to 2021, the proportion of Veau I cases increased from 18.2% to 25.0% (slope \u03b2=\u2009+\u20090.0074 proportion-units\/year;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.051), the proportion of Veau III cases declined significantly (slope \u03b2= \u22120.0085 proportion-units\/year;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.011), and the proportion of Veau IV cases trended downward non-significantly. Higher abortion rates correlated with greater Veau III proportions (r\u2009=\u20090.63,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.005). Logistic regression demonstrated that each 1-SD increase in abortion rate raised severe-cleft odds by 26% (odds ratio (OR) 1.26; 95% CI 1.05-1.51;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.014), prenatal diagnosis (OR 13.13;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001) and presence of genetic syndrome or sequence (OR 0.36;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001) were also significant. Cleft severity decreased prior to 2010 (\u03b2\u2009=\u2009\u20130.11 units\/year;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.036) and then plateaued. Prenatal diagnosis rates increased sevenfold during the study period.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Enhanced prenatal detection and abortion rate shifts had minimal impact on live-birth CL\/P trends. The paradoxical association between higher abortion rates and severe clefts suggests that reproductive decision-making is influenced by multifactorial factors beyond detection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656261454794","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T08:03:15Z","timestamp":1780473795000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends in Cleft Palate Incidence in the Era of Prenatal Ultrasonography and Early Detection"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5680-0513","authenticated-orcid":false,"given":"Grace Anne","family":"Longfellow","sequence":"first","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Idorenyin E.","family":"Ndem","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pragna N.","family":"Shetty","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina N.","family":"Kapsalis","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina R.","family":"Mehta","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minakshi","family":"Pillai","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeyhan","family":"Wood","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Calder","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"e_1_3_3_2_2","volume-title":"Global registry and database on craniofacial anomalies report of a WHO registry meeting on craniofacial anomalies","author":"Mossey PA","year":"2001","unstructured":"Mossey PA, Castilla EE. 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