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Original Investigation
November 2016

Health Status Among Adults Born With an Oral Cleft in Norway

Author Affiliations
  • 1Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
  • 2Department of Pediatrics, Haukeland University Hospital, Helse-Bergen, Bergen, Norway
  • 3Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
  • 4Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
  • 5Norwegian Registry of Cleft Lip and Palate, Helse-Bergen, Bergen, Norway
  • 6Department of Plastic Surgery, Haukeland University Hospital, Helse-Bergen, Bergen, Norway
  • 7Norwegian Institute of Public Health, Bergen, Norway
JAMA Pediatr. 2016;170(11):1063-1070. doi:10.1001/jamapediatrics.2016.1925
Key Points

Question  What is the association between isolated oral clefts and the risk of adverse health outcomes in the future?

Findings  In this registry-based cohort study, little excess morbidity or mortality was found among children born with an isolated cleft lip with or without cleft palate. Children born with cleft palate only had increased mortality and increased morbidity across a range of conditions.

Meaning  Children born with isolated cleft lip defects have a low risk of adverse health outcomes, whereas children with isolated cleft palate should just be monitored more closely by caretakers.

Abstract

Importance  Parents regularly express concern about long-term health outcomes for children who are born with an oral cleft.

Objective  To assess whether oral clefts affect the health and ability to work of young adults.

Design, Setting, and Participants  A population-based cohort study was conducted on all individuals born in Norway between calendar years 1967 and 1992 (n = 1 490 401). All patients treated for clefts in Norway during the study period were invited to participate (n = 2860). This study used population-based, long-term follow-up data from national registries to focus on the future health outcomes of individuals with cleft and no additional chronic medical conditions or congenital anomalies. A total of 523 individuals were excluded from the study cohort because they declined participation, could not be reached by mail, or had birth defects other than clefts. The final cohort, consisting of 2337 cases with isolated clefts and 1 413 819 unaffected individuals, was followed up until December 31, 2010, using compulsory national registries and clinical data. Data analysis was conducted from February 13, 2014, to April 18, 2016.

Exposures  Oral clefts.

Main Outcomes and Measures  Death, intellectual disability, schizophrenia, mood affective disorders, anxiety disorders, autism spectrum disorders, attention deficit/hyperactivity disorder, severe learning disability, cerebral palsy, epilepsy, muscle or skeletal disorders, trauma, and episodes of reduced health.

Results  Of 2860 individuals born with an oral cleft, 2337 were included in the analysis; of these, 1401 were male (59.9%). Mean (SD) age in 2010 was 30.6 (7.7) years. Compared with unaffected individuals, no increased risks were found regarding morbidity or mortality among persons with isolated cleft lip only. Among individuals with isolated cleft lip and cleft palate, increased risks of intellectual disability (relative risk [RR], 2.2; 95% CI, 1.2-4.1) and cerebral palsy (RR, 2.6; 95% CI, 1.1-6.2) were found. Individuals with isolated cleft palate (ie, without cleft lip) had increased mortality (hazard ratio, 3.4; 95% CI, 2.1-5.7) in addition to an increased risk of intellectual disability (RR, 11.5; 95% CI, 8.5-15.6), anxiety disorders (RR, 2.9; 95% CI, 1.3-6.5), autism spectrum disorders (RR, 6.6; 95% CI, 2.8-15.7), severe learning disabilities (RR, 10.6; 95% CI, 5.5-20.2), cerebral palsy (RR, 4.8; 95% CI, 2.3-10.0), epilepsy (RR, 4.9; 95% CI, 2.2-10.8), and muscle or skeletal disorders (RR, 2.7; 95% CI, 1.4-5.4).

Conclusions and Relevance  Young adults who were born with isolated cleft lip only did not differ significantly from unaffected individuals in their risk of health problems. However, individuals with isolated cleft palate had increased health risks and mortality. This information should be provided to genetic counselors, parents of children with clefts, and health care workers involved in the treatment or follow-up of these children.

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