Maternal exposure to ozone and PM 2.5 and the prevalence of orofacial clefts in four U.S. states

Environ Res. 2017 Feb;153:35-40. doi: 10.1016/j.envres.2016.11.007. Epub 2016 Nov 23.


Background: While there is some evidence that maternal exposure to ambient air pollution is associated with orofacial clefts in offspring, the epidemiologic studies have been largely equivocal. We evaluated whether maternal exposure to elevated county-level ambient fine particulate matter with aerodynamic diameter ≤2.5µm (PM2.5) and ozone during early gestation was associated with a higher prevalence of orofacial clefts.

Methods: Birth data consisting of 4.7 million births from 2001 to 2007 were obtained from National Birth Defects Prevention Network for four states - Arizona, Florida, New York (excluding New York City), and Texas. The air pollution exposure assessment for gestational weeks 5-10 was based on county-level average concentrations of PM2.5 and ozone data generated using a Bayesian fusion model available through CDC's Environmental Public Health Tracking Network. Two outcomes were analyzed separately: cleft lip with or without cleft palate, cleft palate alone. In logistic regression analyses, we adjusted for factors that were suspected confounders or modifiers of the association between the prevalence of orofacial clefts and air pollution, i.e., infant sex, race-ethnicity, maternal education, smoking status during pregnancy, whether this was mother's first baby, maternal age.

Results: Each 10µg/m3 increase in PM2.5 concentration was significantly associated with cleft palate alone (OR =1.43, 95% CI: 1.11-1.86). There was no significant association between PM2.5 concentration and cleft lip with or without cleft palate. No associations were observed between ozone exposure and the two outcomes of orofacial clefts.

Conclusions: Our study suggests that PM2.5 significantly increased the risk of cleft palate alone, but did not change the incidence of cleft lip with or without palate. Ozone levels did not correlate with incidence of orofacial clefts.

Keywords: Air pollution; Cleft lip; Cleft palate; Ozone; PM(2.5).

MeSH terms

  • Adolescent
  • Adult
  • Arizona / epidemiology
  • Cleft Lip / epidemiology*
  • Cleft Lip / etiology
  • Cleft Palate / epidemiology*
  • Cleft Palate / etiology
  • Female
  • Florida / epidemiology
  • Humans
  • Infant, Newborn
  • Male
  • Maternal Exposure / adverse effects*
  • New York / epidemiology
  • Ozone / adverse effects
  • Ozone / analysis
  • Particulate Matter / adverse effects*
  • Particulate Matter / analysis
  • Regression Analysis
  • Retrospective Studies
  • Risk Factors
  • Texas / epidemiology
  • Young Adult


  • Particulate Matter
  • Ozone