DUDAK-DAMAK YARIKLARINDA HAVA KİRLETİCİLERİNİN ETKİSİ

Abstract

Cleft lip and palate (CLP) are among the most common congenital anomalies, representing a significant public health issue due to their financial burden and psychological impact. It is believed that both environmental and genetic factors play a role in the etiology of CLP. This study aimed to examine the relationship between preconception health risks of parents, risks during the first trimester of pregnancy, air pollutant levels during the same period, and the likelihood of CLP development. In this case-control study, 127 patients diagnosed with CLP and 271 control group participants were included. Patients were divided into two groups: those with (CLP-Pa) and without (CLP-Na) a family history of CLP, considering etiological differences. The weekly average levels of pollutants during the 12 weeks prior to pregnancy and the first trimester were calculated. The study showed that high PM and O₃ exposure in both the three months before pregnancy and the first trimester increased the risk of CLP. Exposure to NO₂, NOₓ, and NO was lower in the control group. Advanced analyses did not find a significant association between nitric oxides, SO₂, and CLP occurrence. For CO, a negative association was observed in the CLP-Na group during the pre-pregnancy period. The use of folic acid and multivitamins during the three months before pregnancy and the first trimester was associated with a reduced risk of CLP development. Rates of premature birth and low birth weight were higher among patients. Mothers of infants diagnosed with CLP had higher numbers of total pregnancies and miscarriages. Paternal smoking during pregnancy was associated with CLP, while maternal smoking rates were similar between groups. Increased risk associated with alcohol consumption was not observed. There were no significant differences between the groups regarding the season of conception and birth weight. While the prevalence of diabetes during pregnancy did not change, insulin use was higher in mothers of CLP infants. A history of maternal obesity showed no difference in the CLP-Na group but was significantly higher in the CLP-Pa group. Paternal obesity was higher in both patient groups compared to the control group. In cases with gestational hypothyroidism, thyroid hormone therapy appeared to be associated with a reduced risk. Infections during the first trimester were not linked to increased risk. Proximity to agricultural fields and home gardening were more common in the CLP group. In conclusion, cleft lip and palate, a condition influenced by both genetic and environmental factors, have modifiable risk factors. Preventing air pollution, promoting the use of folic acid and multivitamins during pregnancy, preventing parental obesity, and avoiding smoking can contribute to reducing the disease burden. Further studies are needed to explore the risk-reducing effects of hypothyroidism treatment and the potential adverse effects of pesticides on CLP development.