Medication Exposure During Pregnancy And The Risk Of Orofacial Clefts: A Scoping Review
Medication Exposure During Pregnancy And The Risk Of Orofacial Clefts: A Scoping Review

Summary/Abstract: Orofacial clefts (OFCs), including cleft lip with or without cleft palate (CL/P) and isolated cleft palate (CP), are among the most common congenital malformations worldwide, affecting approximately 1 in 500 to 550 live births. Such malformations occur due to a failure in the fusion of the embryonic facial processes, a process that generally occurs between the 4th and 12th weeks of gestation. OFCs have a substantial impact on quality of life and can cause lifelong issues, including feeding problems, speech abnormalities, hearing loss, dental abnormalities, and psychosocial challenges; therefore, there is a need for studies to explore possible solutions to these issues. There are studies examining the use of medications in the periconceptional period; however, the findings from these studies are largely inconsistent. This review strives to find answers to possible contributing factors to increased risks of OFCs by evaluating the association of maternal medication use during pregnancy and increased risk of OFCs. In conducting this review, we searched the PubMed and Dimensions databases for published literature relevant to the study's focus. We further selected the studies included in our review based on the inclusion criteria we had developed before the study. We included a total of five studies in this review — three case-control studies and one cohort study — most of which were conducted by researchers in European countries and the USA. The five articles included in this study featured research data from congenital disability registries, hospital medical records, and information obtained through interviews with mothers. The medications evaluated in the studies included in this review include corticosteroids administered via various routes, antiepileptics (such as lamotrigine), and bronchodilators commonly used in the treatment of asthma. The exposure period considered in the studies was mainly four weeks before pregnancy and the end of the first trimester. Ultimately, the findings from this study showed that there is an association between medication use during pregnancy and the incidence of orofacial clefts in newborns. However, this association is dependent on the types or classes of medications. There are varying results from epidemiologic studies on the association between the maternal use of corticosteroids and the risk of orofacial clefts. However, administration during pregnancy should be with caution. However, antiepileptic drugs were found to be associated with an increased incidence of orofacial clefts, and maternal bronchodilators used in asthma management were linked to an increased risk of cleft lip only and cleft lip with cleft palate.

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