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Nutritional Epidemiology

Maternal Nutritional Status and the Risk for Orofacial Cleft Offspring in Humans^1,2

Ingrid P. C. Krapels^*,, Iris A. L. M. van Rooij^*, Marga C. Ocké, Clive E. West^**,,3, Chantal M.A.M. van der Horst and Régine P. M. Steegers-Theunissen^*,#,4

Departments of ^* Epidemiology and Biostatistics, Orthodontics and Oral Biology and ^** Department of Gastroenterology, University Medical Center Nijmegen, Nijmegen, The Netherlands; Department of Chronic Disease Epidemiology, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Department of Human Nutrition, Wageningen University, Wageningen, The Netherlands; Department of Plastic and Reconstructive Surgery, Academic Medical Center Amsterdam, The Netherlands; and ^# Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands

⁴To whom correspondence should be addressed. E-mail: R.Steegers{at}epib.umcn.nl.

Periconceptional folate and folic acid intake prevents orofacial clefts (OFC) in the offspring. It has been suggested that other nutrients also play a role. We investigated the preconceptional intake of macronutrients (protein, fat, carbohydrate, fiber, and cholesterol), vitamins (vitamin A, retinol, ß-carotene, ascorbic acid, and -tocopherol), minerals (calcium, phosphorus, iron, magnesium, and zinc) and food groups in mothers of OFC children and controls. At 14 mo after the index pregnancy, 206 mothers of a child with a nonsyndromic OFC and 203 control mothers completed a FFQ on current food intake and a general questionnaire. After exclusion of pregnant and lactating mothers, mothers who reported a change in diet compared with the preconceptional period, and those for whom periconceptional folic acid supplement use was unclear, 182 OFC mothers and 173 control mothers were evaluated. Macronutrient, vitamin, mineral, and food group intakes were compared. After adjustment for energy, quintiles of dietary nutrient intake and odds ratios with 95% CI were calculated. The preconceptional intake of all macronutrients, vitamins, minerals, and food groups with the exception of milk (products), potatoes, pies/cookies were lower in OFC mothers than in controls. The energy-adjusted intakes of vegetable protein, fiber, ß-carotene, ascorbic acid, -tocopherol, iron, and magnesium were significantly lower in cases compared with controls. Increasing intakes of vegetable protein, fiber, ascorbic acid, iron, and magnesium decreased OFC risk. In conclusion, a higher preconceptional intake of nutrients predominantly present in fruits and vegetables reduces the risk of offspring affected by OFC.

KEY WORDS: • ascorbic acid • cleft • iron • magnesium • nutrition

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