Environmental Risk Factors in the Etiology of Nonsyndromic Orofacial Clefts in the Western Region of Saudi Arabia

Objectives: 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. Methods: 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 (<18 months), gender, and location, completed a questionnaire on 3-month pregestation and first trimester events. Results: 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). Conclusion: 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.