Impacto del Ácido Fólico en la Incidencia de Fisuras Labiopalatinas de la Población Occidente de la Región Metropolitana, Chile / Impact of Folic Acid on the Incidence of Cleft Lip and Palate of the Western Population of the Metropolitan Region, Chile

RESUMEN: La fisura labiopalatina ha tenido una alta frecuencia en la población chilena. A partir del 2000 se inició el programa de fortificación de la harina con ácido fólico a fin de disminuir los defectos del tubo neural. El objetivo de este estudio fue determinar el impacto que presenta la incorporación del ácido fólico en la incidencia de fisuras labiopalatinas de la población del área occidente de la Región Metropolitana. Se recopiló información a partir de las fichas clínicas de la Fundación Gantz seleccionando a los recién nacidos entre 1990 y 2009, correspondientes a las comunas del Servicio de Salud Occidente de la Región Metropolitana. Desde el 2000 hasta el 2004 se observó una disminución importante en las tasas de fisura labiopalatina, con una tasa de 0,88 fisurados por 1000 recién nacidos vivos. Posteriormente se observó un incremento a partir del 2005 hasta el 2009 llegando a una tasa de 1,52 fisurados por 1000 recién nacidos vivos. En conclusión, el efecto protector del ácido fólico se evidencia en la disminución de las tasas de los recién nacidos con fisuras durante los primeros años de su implementación. Sin embargo, posteriormente se observó un aumento de dichas tasas, lo cual podría deberse al incumplimiento de la norma.

ABSTRACT: Cleft lip and palate has had a high frequency in the Chilean population. From the year 2000 a flour fortification program with folic acid was initiated in order to reduce the defects of the neural tube. The objective of this study was to determine the impact of the incorporation of folic acid in the incidence of cleft lip and palate of the population of the western area of the Metropolitan Region. Information was collected from clinical records of the Gantz Foundation, selecting newborns from 1990 to 2009, corresponding to the districts of the western sector of the Metropolitan Region. From 2000 to 2004 there was a significant decrease in cleft lip and palate rates, with a rate of 0.88 cases per 1000 live births. Subsequently, an increase was observed from 2005 to 2009, reaching a rate of 1.52 cases per 1000 live births. In conclusion, the protective effect of folic acid is evidenced in the reduction of the rates of newborns with cleft palate during the first years of its implementation. However, an increase in these rates was subsequently observed, which could be due to noncompliance with the standard.

Fisuras labio-palatinas y fortificación de la harina con ácido fólico en Chile: an exploratory study / Cleft lip/palate and flour fortification with folic acid in Chile

Background: The effect of food fortification with folic acid on the incidence of lip-palate fissures (FLP) is under discussion. Aim: To calculate the rate of hospital discharges due to cleft lip and palate (CLP) and explore whether they decreased after the start of folic acid fortification in Chile. Material and Methods: The hospital discharge databases published by the Chilean Ministry of Health were analyzed. The trends of discharge rates due to CLP of children of less than one year of life (ICD-10 Q350-379 code) and live births (lb) were calculated from 1986 to 2012. Variables such as incidence of rubella, poverty rate, obesity in pregnant women, and percentage of women who smoked or drank alcohol in the last month were included. The relative risk (RR) of CLP pre-fortification (1986-1999) and post-fortification (2000-2010) was calculated. Mixed and Prais-Winsten models were used to adjust other variables. Results: The hospital discharge rate due to CLP decreased from 1.88 x 1,000 lb during 1986-1996 to 1.68 x 1,000 lb (RR = 1.09 (95% CI 1.05-1.14, p < 0.001). Prais-Winsten and Mixed models, determined that folic acid fortification is the variable explaining this decrease. During 2004-2011, hospital discharge rates for cleft lip decreased but there was an increase in the figures for cleft lip and palate. Conclusions: The 9% decrease in hospital discharge rates for CLP is concomitant with wheat folic acid fortification.

Risk factors and the prevention of oral clefts

This article presents general aspects of risk factors and particularities of the management of individuals with oral clefts (OCs). A practical manual of prevention and management of this congenital defect was prepared based on a review of the literature and using data from Brazilian multicenter studies. Since OCs require efforts from all levels of healthcare, the data herein presented permits appropriate follow-up for affected individuals and their families. Also, the recognition of risk factors is crucial for planning and implementing preventive measures at the individual and population levels.

Folic acid in cleft lip, alveolus and palate prevention: Awareness among dental professionals.

Objectives : To determine the awareness amongst dental students, practitioners and maxillofacial surgeons the role of folic acid in the prevention of CLAP and its clinical use. Materials and Methods : Questionnaire based study involving a sample base of 1100, comprising of dental students, practitioners and specialist maxillofacial surgeons. Results : hundred percent of the sample population were aware of CLAP disorders, of which 9.5 % believed that CLAP could be prevented. 3.8 % of the population were able to correlate folic acid to CLAP while a negligible 0.03 % could provide the dosage. Conclusion : Educating healthcare providers and, in turn, the prospective parents on benefits folic acid would not only help in reducing the incidence of CLAP but also significantly influence the economics of the patients afflicted with CLAP disorders.

Epidemiology of orofacial clefts in Africa: methodological challenges in ascertainment

BACKGROUND:To carry out a systematic review of the birth prevalence of cleft lip with or without cleft palate (CLP) and cleft palate (CP) in Africa based on available published data.METHOD:Using the Cochrane search strategy and the following keywords words "cleft palate", "prevalence", "incidence", "cleft lip" and "Africa" to screen Ovid Medline {1966 to March 2007), Cinahl {1982-March 2007}, PubMed, Scopus, and Web-Google. All identified published, prospective and retrospective studies on the birth prevalence of CLP and CP in Africa were included. The dates, location, sources, number of births (live births, still births, number of cleft cases, prevalence rates, sex ratio, cleft types, and clefts with associated anomalies were extracted.RESULTS: Ascertainment of cases was through the hospitals. Overall there were 57 CL/P, 56 CL and 36 CP reported from all the studies. From seven studies combined, 21 males and 20 females had CL, 10 males and 22 females with CP and 26 males and 24 females with CL/P. There were 3 cases with CL/P, 2 with CP and 2 with CL from the three studies that reported clefts with associated anomalies.CONCLUSION: For an improved ascertainment of cleft cases, there is a need to set up a birth defects surveillance system in the form of a national birth registry. Future studies should then aim to include the entire population in geographically defined regions. Reliable data on incidence is an essential pre-requisite for studies into aetiology and prevention

Dados epidemiológicos de portadores de fissuras labiopalatinas de uma instituição especializada de Londrina, Estado do Paraná / Epidemiologic data of cleft lip and palate bearers from a specialized institution of Londrina, Parana State

O objetivo deste estudo foi descrever as características de uma população de377 fissurados atendidos por uma instituição de Londrina, Estado do Paraná. Paratanto, foi avaliada a prevalência das fissuras em relação ao gênero, ao hábito maternode fumar até o 3º mês de gestação, à história familiar de fissuras, à classificaçãosocioeconômica e às faixas etárias materna e paterna nas quais os fissurados foram concebidos. A fissura de maior prevalência foi a transforame (59,9 por cento), a razão entre os gêneros foi de 1,5 masculino:1,0 feminino, 92,6 por cento da população pertencia à classe econômica baixa e as idades maternas e paternas foram respectivamente 25,5 ± 7,0 e 29,8 ± 8,9 anos. Os resultados de X² para a associação entre as variáveis e os tipos de fissura foram positivos em relação ao gênero (X² 0,05;2=20,6) e à idade paterna no período da concepção (X² 0,05;8=26,3)

Recurrencia familiar del labio leporino con o sin fisura velopalatina de origen no sindrómico en poblaciones de Chile / Familial recurence of non syndromic cleft lip with or without cleft palate in Chilean populations

Background: The presence of major genes in the susceptibility of non syndromic cleft lip with or without cleft palate (CL/P) in Chile has been postulated, considering the high prevalence and familial aggregation of this condition. Aim: To study the familial recurrence of CL/P in Chile. Patients and methods: The recurrence risk of CL/P was studied in 217 extended pedigrees where 33 (15.2 percent) were multiplex (21 male and 12 female propositi). These multiplex extended pedigrees (with more than one affected individual) represented 75 nuclear pedigrees, constituted by 840 males and 803 females and are the basic information of this study. Results: A significantly higher frequency of affected males (4.15 percent) than affected females (2.27 percent) was observed, independent of the difference in number of propositi by sex. Even though no differences were observed between families where both parents were unaffected, compared to those with only one affected parent, a higher proportion of affected descendants was found when the affected propositi was the mother. In multiplex families, the recurrence risk, according to the genetic proximity to the proband, was 10.1, 3.6 and 3.3 percent respectively for first, second and third degree relatives. The figures were 1.5, 0.5 and 0.4 percent respectively, when adjusted to the 217 extended pedigrees. Considering that the risk for the general population in Chile is approximately 0.16 percent, it is 10.3, 3.2 and 2.6 times higher among affected families. Conclusions: The high heritability of CL/P and the risk encountered for the Chilean population supports the hypothesis of major genes involved in its susceptibility

Recomendaciones para el manejo de niños con fisuras labiales, maxilares y/o palatinas / Recomendations for management of children with cleft lip, cleft maxillary and cleft palate

La fisuras labiales, maxilares y/o palatinas constituyen una malformación de frecuencia considerable en nuestro medio. Su manejo y tratamiento compete a todo el equipo de salud. Un momento crítico ocurre durante los primeros días de vida, dado que en la mayoría de las oportunidades el parto coincide con el diagnóstico de la malformación. Se exponen algunas consideraciones respecto a la patología, su etiopatogenia y las conductas apropiadas durante los primeros meses de vida. Se indica la cronología del tratamiento quirúrgico ideal basado en las características morfofuncionales normales, nociones útiles para orientación del pediatra que controla al niño

Educaçäo dos pais versus saúde bucal de bebês fissurados / Education of parents versus oral health of cleft palate infants

O conhecimento sobre saúde bucal de pais de crianças portadoras de fissura de lábio e/ou palato com até 3 anos de idade foi avaliado através de um questionário. Verificou-se que essas informaçöes eram superficiais e estanques, sendo necessária uma abordagem com vistas à motivaçäo para a educaçäo sobre os cuidados odontológicos em fases precoces da vida, especialmente para bebês fissurados, em que o sucesso da reabilitaçäo relaciona-se diretamente a obtençäo e manutençäo da saúde bucal