Association of Cleft Lip and Palate on Mother-to-Infant Bonding: a Cross-Sectional Study in the Japan Environment and Children's Study (JECS).
Abstract Background: Cleft lip and/or palate is among the most prevalent congenital birth defects, and negatively affects maternal psychological status and may consequently result in higher prevalence of child maltreatment. However, the association of cleft lip and/or palate childbirths with bonding disorders still remains unclear. We examined the association between cleft lip and/or palate childbirth and mother-to-infant bonding, using data from the Japan Environment and Children's Study, a nationwide birth cohort study. Methods: A cross-sectional study using the jecs-an-20180131 dataset was performed. A total of 104,065 foetuses in 15 regional centres in Japan were enrolled after obtaining informed written consent. The Mother-to-Infant Bonding Scale, a self-report scale consisting of 10 items, was used to evaluate maternal bonding at 1 year after childbirth. Finally, the participants consisted of 79,140 mother-infant pairs, of which 211 mothers with cleft lip and/or palate infants were included in our analyses. Multivariable logistic regression analysis using multiple imputation for missing data was performed to calculate the odds ratio and 95% confidence interval in the estimation of the association between bonding disorders and childbirth with cleft lip and/or palate. Results: No increased risk of bonding disorders was observed among all the mothers with cleft lip and/or palate childbirths (odds ratio [95% confidence interval]; 0.97 [0.63-1.48], p = 0.880), and advanced maternal age or multiple parity may adversely affect the associations between bonding disorders and cleft lip and/or palate childbirths, respectively. After stratification with a combination of maternal age and parity, a significant association of cleft lip and/or palate childbirth with bonding disorders was found only among advanced-age multiparae (odds ratio [95% confidence interval] = 2.51 [1.17-5.37], p = 0.018), but it was weakened after additional adjustment for maternal depression. Conclusions: Cleft lip and/or palate childbirth may increase the risk of bonding disorders among advanced-age multiparae, possibly through maternal depression. This finding provides valuable information for the provision of multidisciplinary cleft care.