Alcohol and/or smoking teratogens induce development of oro-facial clefts

Objective: The purpose of this study was to evaluate maternal alcohol usage or smoking during the first trimester, affecting cleft expression in patients. The different cleft types were evaluated with and without a pregnancy history of smoking and alcohol use. Methods: Records of 3336 patients attending the university's cleft lip and palate clinic, between August 1983 and March 2010, were reviewed. The study group included cleft patients with syndromic and non-syndromic CL, CLA, CLAP, hP, hPsP, sP and COMBI clefts, with or without oblique or transverse facial clefts. The Microsoft Excel program was used to analyse the data. Results: Maternal alcohol usage and/or smoking were recorded after birth in 90 (2.7%) cleft patients. Comparing the total data base versus these possible teratogens: 65.4%:66.7% were White; 28.7%:22.2% Black; 2.6%:10.0% Coloured and 2.9%:1.1% Indian. There were more males (49 or 54.4%) than females (40 or 45.6%). When comparing the different cleft distribution of the total group (3336) with this group of patients (90) exposed to maternal alcohol usage and/or smoking, the following was noted: CL - 5.7%: 8.1%; CLA - 12.8%: 6.1%; CLAP - 40.2%: 43.4%; hP - 0.7%: 0%; hPsP - 16.5%: 17.2%; sP - 18.3%: 17.2%; Oblique - 1.6%: 1.0% and combinations of oro-facial clefts (COMBI) - 4.3%: 7.1%. With the COMBI (smoking – 10.9%) and hPsP (alcohol – 32.1%) these patients had a significant higher maternal exposure to these teratogens. Conclusion: Contra to the literature it appears that there is no increased in cleft formation with the use of maternal alcohol and/or smoking, as identified as one of the teratogens in the cleft formation. This is true for most of the different cleft categories, except for the COMBI and hPsP clefts, which had a significant high exposure to these possible maternal teratogens.