{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:02:07Z","timestamp":1789387327259,"version":"build-2803163510"},"reference-count":46,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2016,7,1]],"date-time":"2016-07-01T00:00:00Z","timestamp":1467331200000},"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"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Nonsyndromic orofacial cleft (NSOFC) etiology is multifactorial and heterogeneous. This study aimed to identify environmental risk factors related to NSOFC in the Western Region of Saudi Arabia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A case-control study carried out in seven hospitals in two main cities (Jeddah and Maddina) over 2 years on parents of 112 infants with NSOFC (infants were also examined) and 138 infant controls, matched for age (\u226418 months), gender, and location, completed a questionnaire on 3-month pregestation and first trimester events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was significantly increased NSOFC risk with twin pregnancies ( P = .01, odds ratio [OR] = 9.5, 95% confidence interval [CI]: 1.15 to 78.4), maternal antibiotic use ( P = .021, OR = 2.71, 95% CI: 1.11 to 6.62), antiemetic medication ( P = .005, OR = 2.85, 95% CI: 1.3 to 6), severe morning sickness ( P = .006, OR = 3.6, 95% CI: 1.34 to 9.65), illness ( P = .009, OR = 2.19, 95% CI: 1.17 to 4.08), common cold\/flu ( P = .003, OR = 3.32, 95% CI: 1.48 to 7.58), Jorak smoking ( P = .004, OR = 14.07, 95% CI: 1.55 to 128.1), and passive smoking ( P = .05, OR = 2.05, 95% CI: 1.05 to 4.01). Reduced NSOFC risk was found with calcium supplementation ( P = .02, OR = 0.32, 95% CI: 0.11 to 0.88), incense use ( P = .03, OR = 0.58, 95% CI: 0.34 to 0.98), and maternal drinking water, with Zamzam water (which contains a high concentration of minerals) showing a significant protective effect compared with tap water ( P = .01, 95% CI: 0.06 to 0.6) and bottled water ( P = .02, 95% CI: 0.03 to 0.57).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Twin births, maternal antibiotic use, antiemetic medication, severe morning sickness, common cold\/flu, Jorak smoking, and passive smoking were associated with infants born with NSOFC. Calcium supplementation, incense use, and Zamzam water reduced the risk of NSOFC, raising the possibility of community preventive programs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1597\/14-136","type":"journal-article","created":{"date-parts":[[2015,9,24]],"date-time":"2015-09-24T11:56:33Z","timestamp":1443095793000},"page":"435-443","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":35,"title":["Environmental Risk Factors in the Etiology of Nonsyndromic Orofacial Clefts in the Western Region of Saudi Arabia"],"prefix":"10.1177","volume":"53","author":[{"given":"Heba J.","family":"Sabbagh","sequence":"first","affiliation":[{"name":"King Abdulaziz University, Jeddah, Saudi Arabia, and University of Dundee, Scotland, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najlaa M.","family":"Alamoudi","sequence":"additional","affiliation":[{"name":"Pediatric Dentistry, Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatma Dawood","family":"Abdulhameed","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Maddina Maternity and Children's Hospital, Maddina, Saudi Arabia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola P. T.","family":"Innes","sequence":"additional","affiliation":[{"name":"Paediatric Dentistry, University of Dundee Dental School, Dundee, Scotland, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jumana Y.","family":"Al-Aama","sequence":"additional","affiliation":[{"name":"Genetic Medicine Department, Faculty of Medicine, Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University Hospital, Jeddah, Saudi Arabia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarig","family":"Hummaida","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Maternity and Children Hospital, Maddina, Saudi Arabia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manal","family":"Almalik","sequence":"additional","affiliation":[{"name":"Pediatric Dental Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douaa A.","family":"El Derwi","sequence":"additional","affiliation":[{"name":"Pediatric Dental Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia, and Public Health and Community Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Mossey","sequence":"additional","affiliation":[{"name":"Craniofacial Development, Associate Dean of Research, and Director of WHO Collaborating Centre, University of Dundee Dental School, Dundee, Scotland, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2016,7,1]]},"reference":[{"key":"bibr1-14-136","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0544.2002.02203.x"},{"key":"bibr2-14-136","doi-asserted-by":"publisher","DOI":"10.1080\/10934529.2011.609109"},{"key":"bibr3-14-136","volume-title":"The Association Between Orofacial Clefts and Consanguinity in Saudi Arabia.","author":"Al-Sahafi Y.A.","year":"2010"},{"key":"bibr4-14-136","unstructured":"Al ZuhairN., KhounganianR. 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