{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T23:41:38Z","timestamp":1785195698343,"version":"3.55.0"},"reference-count":40,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:00:00Z","timestamp":1750723200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research and Scientific Development Support Foundation of Maranh\u00e3o (FAPEMA)","award":["001"],"award-info":[{"award-number":["001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>This study aimed to identify spatial clustering and maternal and birth-related factors associated with the incidence of orofacial clefts in Brazil from 2001 to 2022. A nationwide ecological study was conducted in Brazil using data from 2001 to 2022 obtained from the Brazilian Live Birth Information System (SINASC). The municipality was used as the spatial unit of analysis. Variables included maternal age and education, newborn sex, gestational age, birth weight, and skin color\/ethnicity. Univariate and bivariate global and local Moran\u2019s I indices were used to assess spatial autocorrelation. A total of 234 municipalities (4.2%) formed high\u2013high spatial clusters, primarily in the South and Southeast, while 431 municipalities (7.7%) formed low\u2013low clusters, mostly in the Northeast (Moran\u2019s I = 0.121, 95% CI: 0.107 to 0.135). High\u2013high clusters had a lower median proportion of adolescent mothers (\u226419 years: 17.4%) and a higher proportion of mothers aged \u2265 35 years (12.9%) compared to low\u2013low clusters (23.5% and 8.7%, respectively; p &lt; 0.001). High\u2013high clusters also had fewer mothers with less than seven years of education (31.0% vs. 45.9%, p &lt; 0.001) and higher rates of preterm births and low birth weight (p &lt; 0.001). The proportion of White newborns was higher in high\u2013high clusters than in low\u2013low clusters (82.8% vs. 13.6%, p &lt; 0.001). These findings suggest that orofacial cleft incidence in Brazil is spatially associated with maternal sociodemographic characteristics, perinatal outcomes, and newborn race\/ethnicity.<\/jats:p>","DOI":"10.3390\/ijerph22070995","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T12:05:40Z","timestamp":1750766740000},"page":"995","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Nationwide Spatial Patterns and Maternal and Birth-Related Factors Associated with Orofacial Clefts in Brazil"],"prefix":"10.3390","volume":"22","author":[{"given":"Luis Gustavo Souza","family":"Santos","sequence":"first","affiliation":[{"name":"Dentistry Graduate Program, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65085-580, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6785-7864","authenticated-orcid":false,"given":"Vandilson","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Dentistry Graduate Program, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65085-580, Brazil"},{"name":"Department of Morphology, Federal University of Maranh\u00e3o, S\u00e3o Luis 65085-580, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessilene Ribeiro","family":"Rocha","sequence":"additional","affiliation":[{"name":"Dentistry Graduate Program, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65085-580, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3943-6496","authenticated-orcid":false,"given":"Mila Roselaine Lima","family":"de Assun\u00e7\u00e3o","sequence":"additional","affiliation":[{"name":"Dentistry Graduate Program, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65085-580, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6401-1513","authenticated-orcid":false,"given":"Marcio Vin\u00edcius Campos","family":"Borges","sequence":"additional","affiliation":[{"name":"Dentistry Graduate Program, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65085-580, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Carmen","family":"Fontoura Nogueira da Cruz","sequence":"additional","affiliation":[{"name":"Dentistry Graduate Program, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65085-580, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1111\/odi.14174","article-title":"Revisiting the embryogenesis of lip and palate development","volume":"28","author":"Hammond","year":"2022","journal-title":"Oral Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"108373","DOI":"10.1016\/j.mrrev.2021.108373","article-title":"Orofacial clefts embryology, classification, epidemiology, and genetics","volume":"787","author":"Nasreddine","year":"2021","journal-title":"Mutat. 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