COVID-19 related risk factors and their association with non-syndromic orofacial clefts in five Arab countries: a case-control study

Heba Jafar Sabbagh 1, Rana A Alamoudi 1, Mohammad Zeinalddin 2, Taimoor Al Bulushi 3, Ola B Al-Batayneh 4, Mamdouh A AboulHassan 5, Mohamed Koraitim 6, Maryam Quritum 7, Buthaina Almuqbali 8, Sultan Musaad Alghamdi 9, Shaimaa Mohsen Refahee 10, Lateefa Alkharafi 11, Fatemah Fahad Taqi 12, Bader Albassam 12, Mariam Ayed 13, Alia Embaireeg 13, Raqiya Alnahdi 14, Mona Talal AlSharif 15, Fatma Dawood Abdulhameed 16, Aziza Johar Aljohar 17, Najla Sulaiman Alrejaye 18, Manal Ibrahim Almalik 19, P S Viswapurna 14, Tamara Al Halasa 4, Maha El Tantawi 20

Affiliations

doi: 10.1186/s12903-023-02934-y

Abstract

Background: The environmental etiology of non-syndromic orofacial clefts (NSOFCs) is still under research. The aim of this case-control study is to assess COVID-19 associated factors that may be related to the risk of NSOFC in five Arab countries. These factors include COVID-19 infection, COVID-19 symptoms, family member or friends infected with COVID-19, stress, smoking, socioeconomic status and fear of COVID-19.

Methods: The study took place in governmental hospitals in five Arab countries from November 2020 to November 2021. Controls are matched in the month of delivery and site of recruitment. A clinical examination was carried out using LASHAL classification. Maternal exposure to medication, illnesses, supplementation, COVID-19 infection during their pregestation and 1st trimester periods were evaluated using a validated questionnaire. Maternal exposure to stress was assessed using the Life Events scale, fear of covid-19 scale, family member or friend affected with covid-19 infection, pregnancy planning and threatened abortion.

Results: The study recruited 1135 infants (386 NSOFC and 749 controls). Living in urban areas, maternal exposure to medications 3-months pregestation, maternal exposure to any of the prenatal life events and maternal fear of COVID-19 significantly increased the risk of having a child with NSOFC. On the other hand, mothers exposed to supplementation 3-months pregestation, mothers suspected of having COVID-19 infection, family members or friends testing positive with COVID-19 significantly decreased the risk of having a child with NSOFC.

Conclusions: This study suggests that NSOFC may be associated with maternal exposure to lifetime stress and COVID-19 fear in particular, with no direct effect of the COVID-19 infection itself. This highlights the importance of providing psychological support for expecting mothers during stressful events that affect populations such as the COVID-19 pandemic, in addition to the usual antenatal care.

Keywords: COVID-19; Etiology; Fear; Life events; Non-syndromic orofacial cleft; Risk factors; Stress.

Conflict of interest statement

The authors declare no competing interests.

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