ANNALS OF IBADAN POSTGRADUATE MEDICINE
C.E. Nwaze1, O. Adebayo2, A.M. Adeoye3,4 and V. Akinmoladun5
There is a complex interplay between orofacial clefts (OFCs) or cleft of the lip and palate and cardiovascular risk factors and cardiac diseases. The presence of maternal cardiovascular risk factors serves as a potent predisposing factor to the development of OFCs during foetal development in addition to the fact that various congenital anomalies are associated with OFCs either in syndromic or non-syndrome relationship. This article narratively explores this complex interplay, which is not uncommon.
Keywords: Cleft lip and palate, Cardiovascular diseases, Obesity, Hypertension, Natal, Prenatal
Dr. O. Adebayo
Department of Medicine,
University College Hospital, Ibadan.
Cardiovascular diseases (CVDs) are on the rise globally and cause one-third of deaths worldwide, with 80% of such mortality in developing countries.1 The burden of CVD is primarily driven by dyslipidemia, hypertension, obesity, diabetes, physical inactivity, poor diet, and smoking.1 The CVDs burden is anticipated to burgeon in the coming years.2 Orofacial clefts (OFCs) or cleft lip and palate defects are the commonest congenital malformation of the head & neck and one of the most frequent congenital disabilities globally.3,4 The disorder is of enormous medical, surgical, or cosmetic importance in addition to the colossal health care cost. They can occur as syndromic or non-syndromic forms with the latter being the more common.3, 4
The estimated prevalence of OFCs in Nigeria is about 0.5:1000 live births.5-7 It occurs in about 1 in 700 live births globally while it accounted for 3,800 deaths globally in 2017 or 3.8 per 100,000 person death from the Global Burden of Disease (GBD) 2017 estimates.8,9 Furthermore, the highest prevalence at birth of OFCs is among the native American and Asian (1 in 500 live births), while the lowest prevalence is among the populations of African descent, with approximately 1 in 2,500 live births.10
The usual male: female ratio was 2:1 in the various OFC variants such as cleft lip and/or cleft lip and palate.9 The Nigerian craniofacial anomalies study, Nigeria CRAN, showed a male: female ratio of 1.19:1 of all OFCs.7 Furthermore, cardiovascular anomalies are commonly associated with OFCs and these associated cardiovascular defects may require lifelong follow up after corrective surgery for OFCs.11 Cardiovascular diseases or cardiovascular risk factors and oro-facial defects interplay may be a casual relation or a mere association.
Pre-conceptional, as well as conceptional maternal cardiovascular risk factors (CRFs) may predispose to the development of cleft palate in the offspring. Such increased causality or the CRFs interlink with OFCs may be the strong link to the possibility of reversal of the epidemiological burden for OFCs or just the continuous presence of cases as CVDs/CRFs are on the increase. The key CRFs linked to OFCs includes alcohol use, obesity and smoking with obesity and smoking each having 6% population attributable risk factors.11 Cardiovascular conditions in the form of congenital heart diseases usually present alongside this condition in newborns.
Cleft lip and/or cleft palate may arise in isolation or association with a syndrome and CRFs, and Congenital heart diseases(CHDs) are associated with both syndromic and non-syndromic OFCs although commoner in the former.4,12