Researcher speaks on cleft palate risk in pregnant mothers

Anisha Hall Hoppe, Dental Tribune International

Mon. 22. July 2024

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Last month, Dental Tribune International (DTI) covered a new study on how lipid metabolism and maternal weight influence orofacial cleft (OFC) risk in infants, based on research done in Thailand. The study indicated that mothers outside normal weight ranges and those with low levels of high-density lipoprotein cholesterol (HDL-C) are more likely to have infants with OFC. DTI spoke with one of the researchers, Dr Waranuch Pitiphat of Khon Kaen University in Thailand, about the results.

Dr Pitiphat, you noted a dearth of research on the association between metabolic syndrome and OFC. Was that your primary motivation for investigating the link between maternal metabolic status and the risk of OFC in infants?
Yes, the limited number of studies exploring this connection was a primary motivation for our investigation. We recognised a gap in understanding how maternal metabolic status could influence the risk of OFC in infants. Given the rising prevalence of metabolic disorders such as obesity and dyslipidaemia, it is imperative to examine their potential impact on congenital anomalies like OFC. Our study aimed to provide insights that could guide preventive strategies and enhance prenatal care recommendations.

What were the most surprising findings from your research? Were there any results that contradicted your initial hypotheses?
One of the most surprising findings was the significant association between low maternal HDL-C levels and an increased risk of OFC. This was unexpected, as the primary focus was on the more commonly discussed metabolic factors like obesity and overall lipid levels. The persistence of this association even after adjusting for passive smoking and other confounding factors was particularly noteworthy. Additionally, while we hypothesised a link between obesity and OFC, the finding that both underweight and overweight or obese maternal body mass index were significantly associated with increased OFC risk was surprising and highlighted the importance of maintaining a healthy weight across the spectrum.

Could you elaborate on the potential mechanisms behind the association between maternal obesity and the risk of OFC and how these might influence prenatal care recommendations?
The potential mechanisms behind the association may involve several factors. Obesity is often accompanied by chronic inflammation, insulin resistance and dysregulated lipid metabolism, which can adversely affect placental function and foetal development. Specifically, altered placental vascular function due to obesity-related dyslipidaemia could lead to inadequate provision of oxygen and nutrients to the developing foetus, contributing to congenital anomalies like OFC.

In terms of prenatal care recommendations, our findings underscore the importance of monitoring and managing maternal weight and metabolic health before and during pregnancy. Healthcare providers should emphasise healthy eating, regular physical activity and, possibly, lipid-lowering strategies to maintain optimal body weight and enhance HDL-C levels. Tailored interventions aimed at achieving and maintaining a healthy metabolic status could potentially reduce the risk of OFC.

Considering the role of maternal nutrition highlighted in your study, how could dental clinicians better advise pregnant patients in order to potentially reduce the risk of OFC?
Dental clinicians can play a crucial role in advising pregnant patients on nutrition and lifestyle modifications to potentially reduce the risk of OFC and other adverse pregnancy outcomes. They should encourage patients to adopt a balanced diet rich in essential nutrients, including folic acid and omega-3 fatty acids, which are vital for foetal development. Clinicians can also educate patients about the importance of maintaining a healthy weight through regular physical activity and avoiding excessive intake of high-fat and high-sugar foods. Additionally, they can provide resources and referrals to nutritionists or dietitians for personalised dietary planning. By integrating these preventive measures into routine dental visits, clinicians can contribute to improving overall maternal and foetal health outcomes.

Is there anything else you would like our readers to know about this or any other ongoing research you are working on?
Beyond the scope of this study, we are continuing to explore various factors that could influence the risk of OFC. Our most recent work focuses on the association between maternal micronutrient biomarkers, such as vitamin B₁₂ and homocysteine, and the risk of OFC. This research aims to understand how specific maternal nutrient levels might protect against or contribute to the risk of these congenital anomalies. Although the findings have not yet been published, they underscore the potential significance of maternal nutrition in prenatal health and may lead to targeted nutritional interventions to reduce the risk of OFC. We are excited about the potential implications of this research for improving maternal and foetal health outcomes.

Editorial note:

The study, titled “Maternal metabolic status and orofacial cleft risk: A case-control study in Thailand”, was published online on 12 April 2024 in the International Dental Journal, ahead of inclusion in an issue.

Topics:

Public Health Dentistry

Tags:

Cleft lip Cleft palate Pregnancy

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