Passive smoking in the etiology of non-syndromic orofacial clefts

a systematic review and meta-analysis

Heba J. Sabbagh (Lead / Corresponding author), Mona Hassan Ahmed Hassan, Nicola P. T. Innes, Heba M. Elkodary, Julian Little, Peter A. Mossey

Research output: Contribution to journalArticle

25 Citations (Scopus)
70 Downloads (Pure)

Abstract

Background Studies have found a consistent positive association between maternal smoking and nonsyndromic orofacial clefts (NSOFC). However, no comprehensive assessment of the association between NSOFC and passive smoking has been undertaken. This systematic review and meta-analysis explores the relationship between maternal passive smoking and NSOFC, and compares the associations between passive and active smoking. Methods and Findings Search strategy, inclusion / exclusion criteria, and data extraction from studies reporting maternal passive smoking and NSOFC was implemented without language restrictions. Risks of bias in the identified studies were assessed and this information was used in sensitivity analyses to explain heterogeneity. Meta-analysis and meta-regression of the extracted data were performed. Egger's test was used to test for small study effects. Fourteen eligible articles were identified. Maternal passive smoking exposure was associated with a twofold increase in risk of NSOFC (odds ratio: 2.11, 95% confidence interval: 1.54-2.89); this was apparent for both cleft lip with and without palate (OR: 2.05, 95% CI: 1.27-3.3) and cleft palate (OR: 2.11, 95% CI: 1.23-3.62). There was substantial heterogeneity between studies. In the studies that provided data enabling crude and adjusted odd ratios to be compared, adjustment for potential confounders attenuated the magnitude of association to about a 1.5-fold increase in risk. Conclusion Overall, maternal passive smoking exposure results in a 1.5 fold increase in risk of NSOFC, similar to the magnitude of risk reported for active smoking, but there is marked heterogeneity between studies. This heterogeneity is not explained by differences in the distribution of cleft types, adjustment for covariates, broad geographic region, or study bias/quality. This thorough meta-analysis provides further evidence to minimize exposure to environmental tobacco smoke in policy making fora and in health promotion initiatives.

Original languageEnglish
Article numbere0116963
Pages (from-to)1-21
Number of pages21
JournalPLoS ONE
Volume10
Issue number3
DOIs
Publication statusPublished - 11 Mar 2015

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Tobacco Smoke Pollution
systematic review
meta-analysis
etiology
Meta-Analysis
Mothers
odds ratio
cleft palate
Smoking
Odds Ratio
health promotion
Tobacco
palate
smoke
lips
Palate
Smoke
Policy Making
Cleft Lip
Environmental Exposure

Cite this

Sabbagh, Heba J. ; Hassan, Mona Hassan Ahmed ; Innes, Nicola P. T. ; Elkodary, Heba M. ; Little, Julian ; Mossey, Peter A. / Passive smoking in the etiology of non-syndromic orofacial clefts : a systematic review and meta-analysis . In: PLoS ONE. 2015 ; Vol. 10, No. 3. pp. 1-21.
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title = "Passive smoking in the etiology of non-syndromic orofacial clefts: a systematic review and meta-analysis",
abstract = "Background Studies have found a consistent positive association between maternal smoking and nonsyndromic orofacial clefts (NSOFC). However, no comprehensive assessment of the association between NSOFC and passive smoking has been undertaken. This systematic review and meta-analysis explores the relationship between maternal passive smoking and NSOFC, and compares the associations between passive and active smoking. Methods and Findings Search strategy, inclusion / exclusion criteria, and data extraction from studies reporting maternal passive smoking and NSOFC was implemented without language restrictions. Risks of bias in the identified studies were assessed and this information was used in sensitivity analyses to explain heterogeneity. Meta-analysis and meta-regression of the extracted data were performed. Egger's test was used to test for small study effects. Fourteen eligible articles were identified. Maternal passive smoking exposure was associated with a twofold increase in risk of NSOFC (odds ratio: 2.11, 95{\%} confidence interval: 1.54-2.89); this was apparent for both cleft lip with and without palate (OR: 2.05, 95{\%} CI: 1.27-3.3) and cleft palate (OR: 2.11, 95{\%} CI: 1.23-3.62). There was substantial heterogeneity between studies. In the studies that provided data enabling crude and adjusted odd ratios to be compared, adjustment for potential confounders attenuated the magnitude of association to about a 1.5-fold increase in risk. Conclusion Overall, maternal passive smoking exposure results in a 1.5 fold increase in risk of NSOFC, similar to the magnitude of risk reported for active smoking, but there is marked heterogeneity between studies. This heterogeneity is not explained by differences in the distribution of cleft types, adjustment for covariates, broad geographic region, or study bias/quality. This thorough meta-analysis provides further evidence to minimize exposure to environmental tobacco smoke in policy making fora and in health promotion initiatives.",
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Passive smoking in the etiology of non-syndromic orofacial clefts : a systematic review and meta-analysis . / Sabbagh, Heba J. (Lead / Corresponding author); Hassan, Mona Hassan Ahmed; Innes, Nicola P. T.; Elkodary, Heba M.; Little, Julian; Mossey, Peter A.

In: PLoS ONE, Vol. 10, No. 3, e0116963, 11.03.2015, p. 1-21.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Passive smoking in the etiology of non-syndromic orofacial clefts

T2 - a systematic review and meta-analysis

AU - Sabbagh, Heba J.

AU - Hassan, Mona Hassan Ahmed

AU - Innes, Nicola P. T.

AU - Elkodary, Heba M.

AU - Little, Julian

AU - Mossey, Peter A.

N1 - Funding: none.

PY - 2015/3/11

Y1 - 2015/3/11

N2 - Background Studies have found a consistent positive association between maternal smoking and nonsyndromic orofacial clefts (NSOFC). However, no comprehensive assessment of the association between NSOFC and passive smoking has been undertaken. This systematic review and meta-analysis explores the relationship between maternal passive smoking and NSOFC, and compares the associations between passive and active smoking. Methods and Findings Search strategy, inclusion / exclusion criteria, and data extraction from studies reporting maternal passive smoking and NSOFC was implemented without language restrictions. Risks of bias in the identified studies were assessed and this information was used in sensitivity analyses to explain heterogeneity. Meta-analysis and meta-regression of the extracted data were performed. Egger's test was used to test for small study effects. Fourteen eligible articles were identified. Maternal passive smoking exposure was associated with a twofold increase in risk of NSOFC (odds ratio: 2.11, 95% confidence interval: 1.54-2.89); this was apparent for both cleft lip with and without palate (OR: 2.05, 95% CI: 1.27-3.3) and cleft palate (OR: 2.11, 95% CI: 1.23-3.62). There was substantial heterogeneity between studies. In the studies that provided data enabling crude and adjusted odd ratios to be compared, adjustment for potential confounders attenuated the magnitude of association to about a 1.5-fold increase in risk. Conclusion Overall, maternal passive smoking exposure results in a 1.5 fold increase in risk of NSOFC, similar to the magnitude of risk reported for active smoking, but there is marked heterogeneity between studies. This heterogeneity is not explained by differences in the distribution of cleft types, adjustment for covariates, broad geographic region, or study bias/quality. This thorough meta-analysis provides further evidence to minimize exposure to environmental tobacco smoke in policy making fora and in health promotion initiatives.

AB - Background Studies have found a consistent positive association between maternal smoking and nonsyndromic orofacial clefts (NSOFC). However, no comprehensive assessment of the association between NSOFC and passive smoking has been undertaken. This systematic review and meta-analysis explores the relationship between maternal passive smoking and NSOFC, and compares the associations between passive and active smoking. Methods and Findings Search strategy, inclusion / exclusion criteria, and data extraction from studies reporting maternal passive smoking and NSOFC was implemented without language restrictions. Risks of bias in the identified studies were assessed and this information was used in sensitivity analyses to explain heterogeneity. Meta-analysis and meta-regression of the extracted data were performed. Egger's test was used to test for small study effects. Fourteen eligible articles were identified. Maternal passive smoking exposure was associated with a twofold increase in risk of NSOFC (odds ratio: 2.11, 95% confidence interval: 1.54-2.89); this was apparent for both cleft lip with and without palate (OR: 2.05, 95% CI: 1.27-3.3) and cleft palate (OR: 2.11, 95% CI: 1.23-3.62). There was substantial heterogeneity between studies. In the studies that provided data enabling crude and adjusted odd ratios to be compared, adjustment for potential confounders attenuated the magnitude of association to about a 1.5-fold increase in risk. Conclusion Overall, maternal passive smoking exposure results in a 1.5 fold increase in risk of NSOFC, similar to the magnitude of risk reported for active smoking, but there is marked heterogeneity between studies. This heterogeneity is not explained by differences in the distribution of cleft types, adjustment for covariates, broad geographic region, or study bias/quality. This thorough meta-analysis provides further evidence to minimize exposure to environmental tobacco smoke in policy making fora and in health promotion initiatives.

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DO - 10.1371/journal.pone.0116963

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JF - PLoS ONE

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