{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T03:56:04Z","timestamp":1790654164317,"version":"4.1.0"},"reference-count":42,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"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>Despite advances in surgical management of cleft lip and\/or palate (CL\/P), prevention remains the most cost-effective strategy, especially in low-resource settings where access to care is limited. Identifying maternal factors is essential for guiding targeted interventions. This study identifies context-specific maternal factors associated with CL\/P to inform public and global health strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective chart review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Ecuador, El Salvador, Lebanon, and Peru.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients\/Participants<\/jats:title>\n                    <jats:p>Non-syndromic patients with CL\/P treated by Global Smile Foundation from 2010 to 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Maternal variables included age at delivery, education, family history of cleft, smoking and smoke exposure, alcohol consumption, folic acid and multivitamin use, pre-pregnancy body mass index (BMI), gestational weight gain, and consanguinity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measure(s)<\/jats:title>\n                    <jats:p>Maternal factors associated with CL\/P.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1068 charts were reviewed. CL\/P was most common among mothers aged (n\u2009=\u2009285) 25-29 years (27.7%), followed by 15-20 years (20.4%). Most had completed secondary school (42.5%, n\u2009=\u2009308), and 71.9% reported no family history of cleft (n\u2009=\u2009966). Prenatal exposures included active smoking (2.9%, n\u2009=\u20091068), alcohol use (1.9%, n\u2009=\u20091068), and coffee consumption (43.3% reporting 1-2 cups\/day, n\u2009=\u2009201). Folic acid and multivitamin use were reported in 70.5% (n\u2009=\u2009207) and 45.3% (n\u2009=\u2009245), respectively. Passive smoke exposure (n\u2009=\u2009201) was primarily from cooking smoke (34.8%) and cigarettes (23.4%). Mean pre-pregnancy BMI (n\u2009=\u2009107) was 26.3\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      with 10.7\u2005kg gestational weight gain (n\u2009=\u2009115). Consanguinity (n\u2009=\u2009797) was reported in 10.7% of cases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Variations in maternal factors reflect inequities in preventive care and health education, emphasizing the need to prioritize antenatal services, supplementation, and culturally appropriate education.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656261491500","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:29:16Z","timestamp":1790353756000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal Factors and Cleft Lip\/Palate in Four Low-Resource Settings: Prevention and Interventions"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0626-720X","authenticated-orcid":false,"given":"Dana","family":"Andari","sequence":"first","affiliation":[{"name":"Global Smile Foundation, Norwood, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9467-2531","authenticated-orcid":false,"given":"Roland K.","family":"Assaf","sequence":"additional","affiliation":[{"name":"Global Smile Foundation, Norwood, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1355-1372","authenticated-orcid":false,"given":"Ivana A.","family":"Garrido","sequence":"additional","affiliation":[{"name":"Department of Spacemed, Charit\u00e9 - Universit\u00e4tsmedizin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joy","family":"Keriakos","sequence":"additional","affiliation":[{"name":"American University of Beirut Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Vides","sequence":"additional","affiliation":[{"name":"Dr. Luis Edmundo V\u00e1squez Faculty of Health Sciences, University of Dr. Jos\u00e9 Mat\u00edas Delgado, San Salvador, El Salvador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bel\u00e9n","family":"Intriago","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Esp\u00edritu Santo, Samborond\u00f3n, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5081-5400","authenticated-orcid":false,"given":"Tamara","family":"Rodriguez-Rugel","sequence":"additional","affiliation":[{"name":"Global Smile Foundation, Norwood, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlyn Ella","family":"Wan","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons in Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Bleynat","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons in Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2976-265X","authenticated-orcid":false,"given":"Amal","family":"Halwani","sequence":"additional","affiliation":[{"name":"Global Smile Foundation, Norwood, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4557-8203","authenticated-orcid":false,"given":"Beyhan","family":"Annan","sequence":"additional","affiliation":[{"name":"Global Smile Foundation, Norwood, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1062-9403","authenticated-orcid":false,"given":"Marie","family":"Nader","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Connecticut Children's Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3654-7262","authenticated-orcid":false,"given":"Usama S.","family":"Hamdan","sequence":"additional","affiliation":[{"name":"Global Smile Foundation, Norwood, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2013.00053"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221111028"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23417"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/children11070819"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-79346-7"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656211018952"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2018.05.006"},{"issue":"93","key":"e_1_3_2_9_2","first-page":"189","article-title":"Maternal risk factors associated with the development of cleft lip and cleft palate in Mexico: A case-control study","volume":"29","author":"Angulo-Castro E","year":"2017","unstructured":"Angulo-Castro E, Acosta-Alfaro LF, Guadron-Llanos AM, Canizalez-Rom\u00e1n A, Gonzalez-Ibarra F, Osuna-Ram\u00edrez I, Murillo-Llanes J, . Maternal risk factors associated with the development of cleft lip and cleft palate in Mexico: A case-control study. Iran J Otorhinolaryngol. 2017;29(93):189-195.","journal-title":"Iran J Otorhinolaryngol"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.30476\/DENTJODS.2019.77620.0"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000008636"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-1774334"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.65293\/jbkcd.v2i01.35"},{"issue":"33","key":"e_1_3_2_14_2","first-page":"736","article-title":"Association of parental consanguinity with severity of cleft lip and palate","volume":"14","author":"Doshi S","year":"2025","unstructured":"Doshi S, Krishna V, Murugesan K. Association of parental consanguinity with severity of cleft lip and palate. J Neonatal Surg. 2025;14(33S):736-739.","journal-title":"J Neonatal Surg"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-016-1018-5"},{"issue":"1","key":"e_1_3_2_16_2","first-page":"49","article-title":"Utilization of maternal health-care services in Peru: The role of women\u2019s education","volume":"2","author":"IT Elo","year":"1992","unstructured":"IT Elo. Utilization of maternal health-care services in Peru: The role of women\u2019s education. Health Transit Rev. 1992;2(1):49-69.","journal-title":"Health Transit Rev"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-021-03299-w"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","unstructured":"\u015eenol D G\u00f6l I Ozkan S. The effect of health literacy levels of pregnant women on receiving prenatal care: A cross-sectional descriptive study. 10\/25 2019;12:1717-1724. doi:10.2016\/03)","DOI":"10.2016\/03)"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.15852"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wombi.2020.01.010"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2020.11.034"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-11138-1"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.ede.0000158745.84019.c2"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(09)60695-4"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.26719\/2025.31.7.471"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1597\/06-246.1"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.sdentj.2011.11.001"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2019.06.005"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000008294"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1086\/510518"},{"issue":"3","key":"e_1_3_2_31_2","first-page":"551","article-title":"Orofacial clefts, parental cigarette smoking, and transforming growth factor-alpha gene variants","volume":"58","author":"Shaw GM","year":"1996","unstructured":"Shaw GM, Wasserman CR, Lammer EJ, O'Malley CD, Murray JC, Basart AM, Tolarova MM. Orofacial clefts, parental cigarette smoking, and transforming growth factor-alpha gene variants. Am J Hum Genet. 1996;58(3):551-561.","journal-title":"Am J Hum Genet"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.3390\/children9121846"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1601-0825.2011.01810.x"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwn186"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1111\/ppe.12131"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwm146"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.10.020410"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1111\/odi.15079"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39079.618287.0B"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23214"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1601-0825.2009.01587.x"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.5468\/ogs.2019.62.6.454"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1017\/s136898000800298x"}],"container-title":["The Cleft Palate Craniofacial Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656261491500","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10556656261491500","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656261491500","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T03:16:59Z","timestamp":1790651819000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10556656261491500"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":42,"alternative-id":["10.1177\/10556656261491500"],"URL":"https:\/\/doi.org\/10.1177\/10556656261491500","relation":{},"ISSN":["1055-6656","1545-1569"],"issn-type":[{"value":"1055-6656","type":"print"},{"value":"1545-1569","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]},"article-number":"10556656261491500"}}