Bader Albassam

Cleft lip with or without palate (CL/P) rank among the most prevalent congenital anomalies globally. This study aimed to report the phenotypic patterns of CL/P across seven Middle Eastern and Asian countries, reflecting two different economic levels. A cross-sectional, multicountry-study was carried out in seven Middle Eastern and Asian countries (high income: Saudi Arabia, Kuwait, Oman, UAE; lower-middle income: Egypt, Pakistan, Jordan) at major government and university cleft care referral centers. Cleft phenotypes were classified using the LASHAL system, and severity was categorized into seven grades, ranging from unilateral incomplete CL (mild) to bilateral complete CLP (severe). There were 836 CL/P patients; out of them, 337(40.3%) were CL, 499(59.7%) were CLP and 160 (19.1%) diagnosed with associated anomalies. A subgroup analysis demonstrated a significant relationship between country economic level and CL/P severity (P < 0.001), with lower-middle-income countries showing higher rates of unilateral-incomplete-CL and high-income countries presenting more bilateral-complete-CLP. Associated anomalies occurred significantly more among unilateral complete CL cases (P = 0.036). Regression analysis found that low-to-moderate income countries significantly decreased the adjusted odds ratio (AOR) of CLP compared to CL phenotypes (AOR: 0.494, P = 0.032), and having mild compared to severe CL/P (AOR = 0.431, P = 0.029). This multicenter study revealed that the socioeconomic level influences both cleft type and severity. Collaborative research focusing on genetic, environmental, and healthcare access factors is recommended to better explain the socioeconomic variations observed and guide targeted prevention and policy strategies.

Background Little is known about factors associated with the severity of cleft lip with or without cleft palate (CL/P) especially during the COVID-19 pandemic with its dramatic changes. Objectives The aim of this multi-national study is to measure the association between CL/P severity, COVID-19 infection, and fear of COVID-19 in five Arab countries. Methods This cross-sectional study took place in major governmental hospitals in five Arab countries from November 2020 to April 2023. Participants were infants born with CL/P and their mothers who were in their 1st trimester during the COVID-19 pandemic. Clinical examination was carried out, and CL/P cases were grouped according to phenotype: cleft lip and palate (CLP) versus cleft lip (CL), cleft extension (incomplete versus complete), and site (unilateral versus bilateral) to assess severity. Information on maternal COVID-19 infection and fear of COVID-19 were gathered. Results The study recruited 273 CL/P infants. Maternal COVID-19 infection during one-month pre-gestation and 1st trimester was significantly associated with higher odds of CL/P severity (AOR = 2.707; P = 0.002) than mothers without the COVID-19 infection. Using supplements during pregnancy showed a protective effect (AOR = 0.573; P = 0.065). Conclusion Mothers infected with COVID-19 before and during pregnancy had more than twofold higher odds of having an infant with a more severe CL/P phenotype.

Objectives Risk factors for non-syndromic orofacial cleft (NSOFCs) include genetic profile and environmental exposure to medication and illnesses during pregnancy. We assessed the association between the COVID-19 vaccination and the incidence of NSOFC across five Middle Eastern countries. Materials and methods This multi-country, hospital-based, case-control study included infants with NSOFCs whose first 3 intrauterine months coincided with the time when pregnant women were allowed to receive COVID-19 vaccination in the countries participating in the study. Newborns with NSOFCs were examined for cleft type and their parents were interviewed for maternal exposures and COVID-19 vaccination. Controls were newborns matched to cases in gender and setting. Results The study recruited 977 (348 children with NSOFCs and 629 controls). Maternal use of nicotine (Adjusted Odds Ratio (AOR): 2.437; P = 0.044) and family history of NSOFC (AOR: 11.059; P < 0.001) increased significantly the AOR of having a child with NSOFC. On the other hand, COVID-19 vaccine administration to pregnant mothers have significantly decreased the AOR of having a child with NSOFC (AOR: 0.337; P = 0.006). Conclusion This study suggests that COVID-19 vaccination is not related to NSOFC and might protect against having a child affected with such a congenital anomaly. Clinical relevance The finding of this study is important for healthcare providers for considering COVID-19 vaccination for pregnant woman. Clear communication and education about the potential risks and benefits would be crucial for informed decision-making. The study’s results would directly impact pregnant individuals, as they would need accurate information to make informed decisions about their health and the health of their infants.

Background: The environmental etiology of non-syndromic orofacial clefts (NSOFCs) is still under research. The aim of this case-control study is to assess COVID-19 associated factors that may be related to the risk of NSOFC in five Arab countries. These factors include COVID-19 infection, COVID-19 symptoms, family member or friends infected with COVID-19, stress, smoking, socioeconomic status and fear of COVID-19. Methods: The study took place in governmental hospitals in five Arab countries from November 2020 to November 2021. Controls are matched in the month of delivery and site of recruitment. A clinical examination was carried out using LASHAL classification. Maternal exposure to medication, illnesses, supplementation, COVID-19 infection during their pregestation and 1st trimester periods were evaluated using a validated questionnaire. Maternal exposure to stress was assessed using the Life Events scale, fear of covid-19 scale, family member or friend affected with covid-19 infection, pregnancy planning and threatened abortion. Results: The study recruited 1135 infants (386 NSOFC and 749 controls). Living in urban areas, maternal exposure to medications 3-months pregestation, maternal exposure to any of the prenatal life events and maternal fear of COVID-19 significantly increased the risk of having a child with NSOFC. On the other hand, mothers exposed to supplementation 3-months pregestation, mothers suspected of having COVID-19 infection, family members or friends testing positive with COVID-19 significantly decreased the risk of having a child with NSOFC. Conclusions: This study suggests that NSOFC may be associated with maternal exposure to lifetime stress and COVID-19 fear in particular, with no direct effect of the COVID-19 infection itself. This highlights the importance of providing psychological support for expecting mothers during stressful events that affect populations such as the COVID-19 pandemic, in addition to the usual antenatal care.