Maternal Dietary Patterns, Food Security and Multivitamin Use as Determinants of Non-Syndromic Orofacial Clefts Risk in Ghana: A Case–Control Study

Abstract

Non-syndromic Orofacial clefts (NSOFCs) are among the most common congenital anomalies globally, yet evidence on maternal dietary and nutritional risk factors in sub-Saharan Africa is limited. A matched case–control study with 103 mothers of children with non-syndromic OFCs and 103 control mothers of unaffected children was conducted to assess dietary patterns, food security, and supplement use. Dietary intake was assessed using a food frequency questionnaire, and patterns were identified through principal component analysis. Household food security was measured using the USDA 18-item scale, and periconceptional multivitamin and folic acid use were recorded. Logistic regression models examined the associations. Three major dietary patterns emerged: Sweet and Energy-Dense, Staple Plant-Based, and Animal Protein–Vegetable. Higher adherence to Sweet and Energy-Dense (Highest tertile, T3: OR = 22.27; 95% CI: 8.71–56.91, p < 0.001) and Staple Plant-Based (T3: OR = 4.07; 95% CI: 1.70–9.73, p = 0.002) was associated with increased OFC odds, while the Animal Protein–Vegetable pattern suggested a borderline protective association (T3: OR = 0.44; 95% CI: 0.19–1.03, p = 0.048). Severe food insecurity was more common among case-mothers (49.5%) than controls (39.8%). Periconceptional use of multivitamins and folic acid was low (<15%) in both groups. These findings highlight the importance of improving maternal diet quality and addressing food insecurity in resource-limited settings.