Incidence of Cleft Pathology in Greater New Orleans before and after Hurricane Katrina

Abstract

Background

Reports after the 2005 Hurricane Katrina have documented an increase in stress reactions and environmental teratogens (arsenic, mold, alcohol).

Objective

To assess the incidence of cleft pathology before and after the hurricane, and the distribution of cleft cases by gender and race.

Methods

Retrospective chart review of cleft lip with or without cleft palate (CUP) and cleft palate (CP) cases registered with the Cleft and Craniofacial Team at Children's Hospital of New Orleans, the surgical center that treated cleft cases in Greater New Orleans between 2004 and 2007. Live birth data were obtained from the Louisiana State Center for Health Statistics.

Results

The incidence of cleft cases, beginning 9 months after the hurricane (i.e., June 1, 2006) was significantly higher compared with the period before the hurricane (0.80 versus 1.42; p = .008). Within racial group comparisons showed a higher incidence among African Americans versus whites (0.42 versus 1.22; p = .01). The distribution of CUP and CP cases by gender was significant (p = .05).

Conclusion

The increase in the incidence of cleft cases after the hurricane may be attributable to increased stress and teratogenic factors associated with the hurricane. The increase among African Americans may have been due to comparatively higher exposure to environmental risk factors. These findings warrant further investigation to replicate the results elsewhere in the Gulf to determine whether there is a causal relationship between environmental risk factors and increased cleft pathology.

Keywords

cleft lip Hurricane Katrina incidence palate teratogens

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References

Amidei

R.L.

, Hamman

R.F.

, Kassebaum

D.K.

, Marshall

J.A.

Birth prevalence of cleft lip and palate in Colorado by gender distribution, seasonality, race/ethnicity and geographic variation.

Spec Care Dentist. 1994; 14: 233–239.

Bailey

L.J.

, Johnson

M.C.

, Billet

Effects of carbon monoxide and hypoxia on cleft lip in A/J mice.

Cleft Palate Craniofac J. 1995; 32: 14–19.

Bernheim

, Georges

, Malevez

, DeMey

, Mansbach

Embryology and epidemiology of cleft lip and palate.

B-ENT. 2006; 2: 11–19.

Billings

, Billings

L.A.

, eds. Mold: The War Within. Knoxville, TN: Partners Publishing LLC; 2007.

Carmichael

S.L.

, Shaw

G.M.

, Yang

, Abrams

, Lammer

E.J.

Maternal stressful life events and risks of birth defects.

Epidemiology. 2007; 18: 356–361.

Cech

, Burau

K.D.

, Walston

Spatial distribution of orofacial cleft defect births in Harris County, Texas, 1990 to 1994, and historical evidence for the presence of low-level radioactivity in tap water.

South Med J. 2007; 100: 560–569.

Centers for Disease Control and Prevention. CDC public health analysis. Available at www.bt.cdc.gov/od/Katrina. Accessed October 7, 2005.

Cerda

, Dowd

, Tracy

, Goldmann

, McGonagle

, Stafford

, Galea

The impact of Hurricane Katrina on socioeconomic disparities in alcohol use. Paper presented at the Annual Conference of the Association of Americas; April 16–19, 2008; New Orleans, LA.

Chung

C.S.

, Myrianthopoulos

N.C.

Racial and parental factors in major congenital malformations.

Am J Hum Genet. 1968; 20: 44–60.

10.

Ciminello

F.S.

, Morin

R.J.

, Nguyen

T.J.

, Wolfe

S.A.

Cleft lip and palate: review.

Comp Ther. 2009; 35: 37–43.

11.

Daley WR, Centers for Disease Control and Prevention.

Assessment of health related needs after Hurricane Katrina and Rita: Orleans and Jefferson parishes, New Orleans area, Louisiana, October 17–22.

MMWR Morb Mortal Wkly Rep. 2006; 55: 38–41.

12.

Das

S.K.

, Runnels

R.S.

, Smith

J.C.

, Cohly

H.H.

Epidemiology of cleft lip and cleft palate in Mississippi.

South Med J. 1995; 88: 437–442.

13.

Dubey

, Solo-Gabriele

H.M.

, Townsendt

T.G.

Quantities of arsenic-treated wood in demolition debris generated by Hurricane Katrina.

Environ Sci Technol. 2007; 41: 1533–1536.

14.

Emanuel

, Culver

B.H.

, Erikson

, Guthrie

, Schuldberg

The further epidemiological differentiation of cleft lip and palate: a population study of clefts in King County, Washington, 1956–1965.

Teratology. 1973; 7: 271–282.

15.

FEMA report. Available at www.newser.com/story/19094/fema-to-move-families-tocins-in-trailers.html. Accessed February 14, 2008.

16.

Fields

, Huang

, Solomon

, Rotkin-Ellman

, Simms

Katrina's wake: arsenic-laced schools and playgrounds put New Orleans children at risk. Natural Resources Defense Council. Available at www.nrdc.org. Accessed August 2007.

17.

Fitzpatrick

D.R.

, Carr

I.M.

, Mclaren

, Leek

J.P.

, Wightman

, Williamson

, Gautier

, McGill

, Hayward

, Firth

. Identification of SATB2 as the cleft palate gene on 2q32–q33. Hum Mol Genet. 2003; 12: 2491–2501.

18.

Fogh-Anderson

Inheritance of Harelip and Cleft Palate. Copenhagen, Denmark: Nyt Nordisk Forlag; 1942.

19.

Fraser

F.C.

The genetics of cleft lip and cleft palate.

Am J Hum Genet. 1970; 22: 336–352.

20.

Galea

, Brewin

C.R.

, Gruber

, Jones

, King

D.W.

, King

L.A.

, McNally

R.J.

, Ursano

R.J.

, Petukhova

, Kessler

R.C.

Exposure to hurricane-related stressors and mental illness after Hurricane Katrina.

Arch Gen Psychiatry. 2007; 64: 1427–1434.

21.

Gonzales

B.S.

, Lopez

M.L.

, Rico

M.A.

, Garduno

Oral clefts: a retrospective study of prevalence and predisposal factors in the state of Mexico.

J Oral Science. 2008; 50: 123–129.

22.

Kessler

R.C.

, Galea

, Gruber

M.J.

, Sampson

N.A.

, Ursano

R.J.

, Wessely

Trends in mental illness and suicidality after Hurricane Katrina.

Mol Psychiatry. 2008; 13: 374–384.

23.

Khoury

M.J.

, Gomez-Farias

, Mulinaire

Does maternal cigarette smoking during pregnancy cause cleft lip and palate in the offspring?

Am J Dis Child. 1989; 143: 333–337.

24.

Kishore

, Theall

K.P.

, Robinson

, Pichon

, Schribner

, Roberson

, Johnson

Resource loss, coping, alcohol use, and posttraumatic stress symptoms among survivors of Hurricane Katrina: a cross sectional study.

Am J Disaster Med. 2008; 3: 345–347.

25.

Longo

L.D.

Some health consequences of maternal smoking: Issues without answers.

Birth Defects Orig Artie Ser. 1982; 18: 13–31.

26.

Merritt

Part 1. Understanding the embryology and genetics of cleft lip and palate.

Adv Neonatal Care. 2005; 5: 64–71.

27.

Mitchell

L.E.

Genetic epidemiology of birth defects: non-syndromic cleft lip and neural tube defects.

Epidemiol Rev. 1997; 19: 61–68.

28.

Murray

J.C.

Face facts: genes, environment, and clefts.

Am J Hum Genet. 1995; 57: 227–232.

29.

Rao

C.Y.

, Riggs

M.A.

, Chew

G.I.

, Muilenburg

M.I.

, Thome

P.S.

, Van Sickle

, Dunn

K.H.

, Brown

Characterization of airborne molds, endotoxins and glucans in homes in New Orleans after Hurricane Katrina and Rita.

Appl Environ Microbiol. 2007; 73: 1630–1634.

30.

Reddy

C.S.

, Reddy

R.V.

, Hayes

A.W.

, Ciegler

Teratogenicity of secalonic acid D in mice.

J Toxicol Environ Health. 1981; 7: 445–455.

31.

Rosenbaum

US health policy in the aftermath of Hurricane Katrina.

JAMA. 2006; 295: 437–440.

32.

Rotkin-Ellman

, Solomon

, Gonzales

C.R.

, Agwaramgbo

Arsenic contamination in New Orleans soil: temporal changes associated with flooding.

Environ Res. 2010; 110: 19–25.

33.

Shaw

G.M.

, Croen

L.A.

, Curry

C.J.

Isolated oral cleft malformations: associations with maternal and infant characteristics in a California population.

Teratology. 1991; 43: 225–228.

34.

Shaw

G.M.

, Lammer

E.J.

Maternal periconceptional alcohol consumption and risk for orofacial clefts.

J Pediatr. 1999; 134: 298–303.

35.

Shaw

G.M.

, Wasserman

C.R.

, Lammer

E.J.

, O'Malley

C.D.

, Murray

J.C.

, Basarat

A.M.

, Tolarova

M.M.

Orofacial clefts, parental cigarette smoking, and transforming growth factor-alfa gene variants.

Am J Hum Genet. 1996; 58: 551–561.

36.

Solomon

, Hjelmroos-Koski

, Rotkin-Eilman

, Hammond

Airborne mold and endotoxin concentration in New Orleans, Louisiana, after flooding, October thru November 2005.

Environ Health Perspect. 2006; 114: 381–386.

37.

Subra

Environmental and human health impacts of the 2005 Katrina and Rita Hurricane season. Presented at Church World Service Forum on Domestic Disasters Ministry, Princeton Theological Seminary; March 26, 2006; Princeton, NJ.

38.

Thrasher

J.D.

, Kilburn

K.H.

Embryo toxicity and teratogenicity of formaldehyde.

Arch Environ Health. 2001; 56: 300–311.

39.

Tolarova

M.M.

, Cervenka

Classification and birth prevalence of orofacial clefts.

Am J Med Genet. 1998; 75: 126–137.

40.

UCLA Center for Environmental Risk Reduction. Arsenic-induced embryopathy: a mechanistic approach, 1997. Available at http://www.cerr.ucla.edu/arsenic.htm. Accessed July 2001.

41.

Vallino-Napoli

L.D.

, Riley

M.M.

, Halliday

An epidemiologic study of isolated cleft lip, palate, or both in Victoria, Australia from 1983 to 2000.

Cleft Palate Craniofac J. 2004; 41: 185–194.

42.

Van Rooij

, Groenen

P.M.

, van Drongelen

M.V.

, Te Morsche

R.H.

, Peters

W.H.

, Steegers-Theunissen

R.P.

Orofacial clefts and spina bifida: N-acetyltransferase phenotype, maternal smoking, and medication use.

Teratology. 2002; 66: 260–266.

43.

Vanderas

A.P.

Incidence of cleft lip, cleft palate, and cleft lip and palate among races: a review.

Cleft Palate J. 1987; 24: 216–225.

44.

Wyszynski

D.F.

, Beaty

T.H.

, Maestri

N.E.

Genetics of non-syndromic oral clefts revisited.

Cleft Palate Craniofac J. 1996; 33: 406–417.