‘Smok­ing dur­ing preg­nancy raises risk of cleft lip in ba­bies’

AIIMS study says al­co­hol con­sump­tion is also detri­men­tal

The Hindu - - LIFE - Press Trust of In­dia

Smok­ing, al­co­hol con­sump­tion, in­hal­ing smoke from chulha, over-med­i­ca­tion and ra­di­a­tion ex­po­sure dur­ing the first few weeks of preg­nancy, along with nu­tri­tional de­fi­cien­cies, may lead to con­gen­i­tal de­for­mi­ties of the face — such as cleft lip and palate anom­aly, ac­cord­ing to a study by AIIMS.

Cleft lip or cleft palate is a con­di­tion when the two sides of the lip, de­vel­op­ing in an un­born baby, do not com­pletely fuse to­gether. It af­fects speech and chew­ing habit of a child and leads to ab­nor­mal ar­range­ment of teeth, poor jaw re­la­tions and fa­cial aes­thetic.

Cleft lip and palate anom­aly con­sti­tute nearly onethird of all con­gen­i­tal mal­for­ma­tions of the cran­io­fa­cial re­gion with an av­er­age world­wide in­ci­dence of 1 in 700.

Its in­ci­dence in Asian pop­u­la­tion is re­ported to be around 1.7 per 1,000 live births or higher.

In In­dia, even though a na­tional epi­demi­o­log­i­cal data is not avail­able, many stud­ies from dif­fer­ent parts of the coun­try have re­ported a vari­a­tion in the in­ci­dence of cleft anom­aly.

Based on rough es­ti­mates, it is sug­gested that ap­prox­i­mately 35,000 new­born cleft pa­tients are added ev­ery year to the In­dian pop­u­la­tion.

Com­pre­hen­sive pro­to­col

The study, ini­ti­ated by Cen­tre for Den­tal Ed­u­ca­tion and Re­search (CDER) at All In­dia In­sti­tute of Med­i­cal Sciences since 2010, was con­ducted in three phases: pre-pilot, pilot and multi-cen­tric.

The pre-pilot phase was con­ducted be­tween 2010 and 2012. It aimed at de­vel­op­ing com­pre­hen­sive pro­to­cols for record­ing the his­tory, in­ves­ti­ga­tions on den­tal anom­alies, hear­ing de­fects and eval­u­a­tion of speech-re­lated prob­lems in pa­tients with cleft palate.

“The idea was to have a uni­for­mity in the pro­ce­dure of col­lect­ing the pa­tients’ records,” said O.P. Khar­banda, chief of CDER and prin­ci­pal in­ves­ti­ga­tor of the project.

Dur­ing the pilot phase (2012-2014), data of 164 cases with cleft lip and palate anom­aly were recorded from three high-vol­ume cleft care cen­tres in Delhi and Na­tional Cap­i­tal Re­gion, in­volv­ing two pub­lic funded hos­pi­tals — AIIMS and Saf­dar­jung — and one pri­vate hospi­tal — Medanta-The Medic­ity in Gur­gaon.

“It re­vealed that pa­tients suf­fer­ing from this de­for­mity re­quire treat­ment, with an im­me­di­ate need to de­vise strate­gies to im­prove the de­liv­ery of qual­ity care,” Mr. Khar­banda said.

Cur­rently, the multi-cen­tric phase is un­der way in New Delhi, Hy­der­abad, Luc­know and Guwa­hati.

Mul­ti­ple fac­tors

“In our study, we also eval­u­ated a few risk fac­tors, in­clud­ing ma­ter­nal smok­ing and al­co­hol con­sump­tion, in­take of drugs dur­ing the first trimester of preg­nancy and ex­po­sure to smoke dur­ing the same time by the use of chulha at home or due to pas­sive smok­ing.

“We also took into ac­count the his­tory of drug in­take and ra­di­a­tion ex­po­sure in the first trimester of preg­nancy. It was con­cluded that all these risk fac­tors may be re­lated to in­creased in­ci­dence of cleft in the prog­eny,” Mr. Khar­banda said.

The govern­ment’s Rashtriya Bal Swasthya Karyakram has iden­ti­fied cleft lip and palate as one of the vis­i­ble de­for­mi­ties which are recorded un­der the pro­gramme.

A web-based record­ing sys­tem, “IndiCleft” tool, has been de­vel­oped with the help of The Na­tional In­for­mat­ics Cen­tre. B

al­ram Bhar­gava, di­rec­tor gen­eral of ICMR, will launch the “IndiCleft” tool on Fe­bru­ary 14.


Risk fac­tors: A web-based tool, IndiCleft, will soon record pat­terns of con­gen­i­tal birth de­fects.

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