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.

1. Introduction

Orofacial clefts (OFCs), including cleft lip, with or without cleft palate, and isolated cleft palate, rank among the most prevalent congenital anomalies worldwide, affecting approximately 1 in every 700 live births [1]. These conditions not only contribute to infant morbidity and mortality but also impose long-term functional, psychosocial, and economic burdens on affected individuals and families [2]. While the etiology of OFCs is multifactorial, encompassing both genetic and environmental influences, increasing evidence points to maternal nutrition during the periconceptional period as a critical and potentially modifiable risk factor [3]. Orofacial clefts (OFCs) are commonly classified as either syndromic or non-syndromic. Syndromic clefts occur as part of a broader congenital or developmental syndrome, whereas non-syndromic clefts occur in isolation without additional structural or neurological abnormalities [4]. In this study, we focus exclusively on non-syndromic OFCs to minimize heterogeneity and improve the clarity of associations between maternal nutrition and cleft risk.

The periconceptional period, which spans from three months before conception through the first three months of pregnancy [5], is critical for reducing the risk of NSOFCs. Proper maternal nutrition during this time is essential, as nutritional deficiencies or imbalances can significantly increase the risk of congenital anomalies [6]. Therefore, addressing maternal nutrition during the periconceptional period is vital in preventing these birth defects.

Despite widespread recommendations of prenatal supplementation, the uptake of micronutrient supplements remains suboptimal in many low- and middle-income countries. Factors such as limited access to healthcare, low health literacy, cost constraints, and cultural perceptions contribute to the low coverage and adherence rates among women of reproductive age [7]. This inadequate uptake undermines the potential impact of nutrient-specific interventions designed to prevent birth defects and improve maternal and fetal outcomes. In the context of NSOFCs and other congenital anomalies with suspected nutritional aetiologies, the consistently low utilization of prenatal supplements in LMICs poses a critical barrier to primary prevention efforts and may limit the mass population-level benefits in existing public health strategies [8].

The traditional Ghanaian diet, primarily comprising starchy staples like maize, cassava, and plantains, frequently lacks adequate levels of key micronutrients, particularly when the intake of green leafy vegetables, legumes, and fish is insufficient [9,10]. The transition towards greater consumption of processed and fried foods in urban settings further exacerbates nutrient deficiencies, potentially deteriorating maternal health and increasing the risk of congenital defects [11]. Furthermore, food security, which directly affects dietary patterns and nutrient intake, plays a significant role in the nutritional well-being of pregnant women [12].

This study, therefore, aimed to examine the associations between maternal dietary patterns, household food security, and periconceptional supplement use with the risk of NSOFCs in Ghana. Understanding these relationships can help inform public health strategies focused on dietary improvement and targeted prenatal nutrition interventions in sub-Saharan Africa.

2. Results

2.1. Sociodemographic Characteristics

Table 1. Sociodemographic characteristics of case and control mothers.

Variable	Control (n = 103)	Case (n = 103)	χ2 (df)	p-Value
Education			7.12 (3)	0.068
No Formal Education	13 (12.6%)	17 (16.5%)
Primary	9 (8.7%)	21 (20.4%)
Secondary	56 (54.4%)	44 (42.7%)
Tertiary	25 (24.3%)	21 (20.4%)
Occupation			5.58 (2)	0.061
Unemployed	21 (20.4%)	20 (19.4%)
Trader/Entrepreneur	77 (74.8%)	68 (66.0%)
Formal Employee	5 (4.9%)	15 (14.6%)
Monthly Income			4.92 (3)	0.178
≤GHC 100	30 (29.1%)	28 (27.2%)
GHC 200–700	21 (20.4%)	12 (11.7%)
GHC 800–1500	36 (35.0%)	37 (35.9%)
≥GHC 1600	16 (15.5%)	26 (25.2%)
Marital Status			3.23 (2)	0.199
Single	35 (34.0%)	25 (24.3%)
Married	68 (66.0%)	77 (74.8%)
Widowed	0 (0.0%)	1 (1.0%)

Values are presented as frequencies and percentages. Chi-squared tests (χ²) were used to assess differences between cases and controls. p-values < 0.05 were considered statistically significant.

shows the sociodemographic characteristics of the study participants. The majority had secondary education (54.4% of controls; 42.7% of cases). A higher proportion of mothers with children with NSOFCs had primary education compared to controls (20.8% vs. 8.7%, p = 0.068). Occupation distribution differed slightly, with more formal employees among cases than controls (14.6% vs. 4.9%, p = 0.061). Monthly income levels showed no statistical difference (p = 0.178). Marital status was similar between groups (p = 0.199).

2.2. Household Food Security

The results on household food insecurity status among cases and controls are presented in

Table 2. Distribution of household food security levels among case and control mothers.

Food Security Level	Control (n = 103)	Case (n = 103)	χ2 (df)	p-Value	Unadjusted Fisher’s p-Value	Bonferroni Adjusted
Food Secure	34 (33.0%)	35 (34.0%)	5.69 (3)	0.128	1.000	1.00
Mildly Food Insecure	16 (15.5%)	6 (5.8%)			0.40	0.16
Moderately Food Insecure	12 (11.7%)	11 (10.7%)			1.00	1.00
Severely Food Insecure	41 (39.8%)	51 (49.5%)			0.207	0.83

Food security categories were derived from the 18-item Household Food Security Survey Module (HFSSM). Classification thresholds were based on standard scoring: 0–2 = Food Secure, 3–7 = Mild Food Insecurity, 8–12 = Moderate Food Insecurity, 13–18 = Severe Food Insecurity. p-value based on Pearson’s Chi-square test for independence. Pairwise comparisons were performed using Fisher’s exact test. Bonferroni correction was applied for four comparisons (adjusted α = 0.05/4 = 0.0125).

. Severe food insecurity was more common among the cases than the controls (49.5% vs. 39.8%, p = 0.128). Overall, a higher proportion of controls reported mild food insecurity (15.5%) compared to cases (5.8%). Although the unadjusted Fisher p-value for mildly food insecure (0.043) suggests a difference, this does not remain statistically significant after Bonferrroni correction (adjusted p = 0.1613; α = 0.0125)

2.3. Periconceptional Supplement Use

A comparison of periconceptional multivitamin and folic acid use among case and control mothers is shown in

Table 3. Comparison of periconception multivitamin and folic acid use among case and control mothers.

Variable	Control (n = 103)	Case (n = 103)	χ2 (df)	p-Value
Multivitamin Use Before Conception
Used	7 (6.8%)	4 (3.9%)	0.86 (1)	0.353
Did not use	96 (93.2%)	99 (96.1%)
Regular Folic Acid Before Conception
Used	11 (10.7%)	14 (13.6%)	0.41 (1)	0.522
Did not use	92 (89.3%)	89 (86.4%)

Periconception use was defined as regular intake during the 1 month prior to pregnancy recognition. Percentages reflect the proportion of mothers within each group (case or control) who reported regular use. Multivitamin use included any supplement containing multiple micronutrients. p-values were calculated using Pearson’s Chi-square test for categorical comparison. χ² tests compare proportions of use between groups.

. Although periconception use of multivitamins was generally low in the two groups, a smaller proportion of the cases used multivitamins before conception (3.9% vs. 6.8%, p = 0.353). There was no statistically significant difference between cases and controls for multivitamin use (X² = 0.86, p = 0.353) or regular folic acid use (X² = 0.41, p = 0.522).

2.4. Dietary Patterns

2.4.1. Case Mothers

Table 4. Factor loadings for dietary patterns derived from principal component analysis among case mothers.

Food Group	Pattern 1 (Sweetened and Caffeinated Beverages)	Pattern 2 (Starchy Plant-Based Foods)	Pattern 3 (Animal Protein and Vegetables)	Pattern 4 (High Energy Junk Foods)
Cereals and Grains	0.112	0.614	0.391	−0.006
Tubers and Plantain	0.031	0.854	−0.054	−0.001
Meat and Poultry	0.344	0.114	0.641	0.048
Vegetables	−0.082	0.092	0.65	0.331
Fruits and Fruit Juice	0.613	0.446	0.026	0.022
Milk and Milk Products	0.787	0.198	0.107	0.015
Fish and Seafood	0.006	0.136	0.66	−0.166
Sugared Snacks	0.598	0.225	0.012	0.21
Tea and Coffee	0.746	−0.222	0.285	−0.097
Sweets	0.689	0.11	−0.190	0.448
Nuts, Seeds, and Legumes	0.327	0.717	0.119	−0.145
Energy and Soft Drinks	0.159	−0.019	0.069	0.897
Fats, Oils, and Fat-Based	0.078	0.6	0.259	0.259
% Variance Explained	29.14%	13.49%	10.04%	8.57%
Total % Variance	61.24%

PCA was conducted using the Varimax rotation with Kaiser normalization. Pattern names were derived based on food groups with the highest absolute loadings per factor. Values in the table represent standardized correlation coefficients (factor loadings) between food groups and extracted patterns. The four dietary patterns extracted jointly explained 61.24% of the total variance in food group intake.

presents four major dietary patterns among case mothers, which explain 61.2% of the total variance. The Sweet and Caffeinated beverages pattern was characterized by milk and milk products, tea/coffee, fruits/fruit juices, as well as sweet and sugary drinks, which explained 29.15% of the total variance. The Starchy Plant-Based foods pattern characterized by plant-based foods dominated by tubers and plantain, nuts and legumes, cereal and grains, fats and oils, and explained 13.49% of the total variance. The Animal Protein and Vegetable pattern was characterized by fish and seafood, vegetables, with meat and poultry, altogether explaining 10.04% of the total variance. The High-Energy Junk foods pattern was characterized by energy and, soft drinks, and sweets, explaining 8.57% of the total variance.

2.4.2. Control Mothers

Table 5. Factor loadings for dietary patterns identified through PCA among control mothers.

Food Group	Pattern 1 (Sweet and Caffeinated Foods)	Pattern 2 (Animal Protein and Dairy)	Pattern 3 (Staple Carbohydrates and Legumes)
Cereals and Grains	−0.009	−0.030	0.802
Tubers and Plantain	0.334	−0.208	0.654
Meat and Poultry	0.153	0.815	0.056
Vegetables	−0.114	0.444	0.454
Fruits and Fruit Juice	0.7	0.23	0.019
Milk and Milk Products	0.514	0.568	−0.253
Fish and Seafood	−0.204	0.728	0.083
Sugared Snacks	0.469	0.271	0.281
Tea and Coffee	0.683	−0.343	−0.026
Sweets	0.759	−0.120	0.102
Nuts, Seeds, and Legumes	0.504	0.11	0.324
Energy and Soft Drinks	0.758	−0.054	0.074
Fats, Oils, and Fat-Based	0.156	0.308	0.695
% Variance Explained	25.93%	16.82%	12.80%
Total % Variance	55.55%

Extraction method: principal component analysis with Varimax rotation and Kaiser normalization. The three extracted components explained 55.5% of the total variance in food group consumption among control mothers.

presents three distinct dietary patterns among control mothers, accounting for 55.55% of the total variance. The first pattern, Sweet and Caffeinated Foods, explains 25.93% of the total variance and is characterized by the high consumption of fruits and fruit juice, sweets, energy drinks, tea/coffee, and sugary snacks. The Animal Protein and Dairy pattern explains 16.82% of the total variance and is marked by high intakes of meat, fish, and milk products, suggesting a protein-rich, nutrient-dense diet with moderate dairy inclusion. The Staple Carbohydrate and Legumes pattern explains 12.80% of the variance and is dominated by cereals, tubers, legumes, and fat/oils.

2.5. Association Between Dietary Pattern Tertiles and NSOFC Risk

Associations between maternal dietary pattern tertiles and NSOFC risk were examined using multivariable binary logistic regression in SPSS version 25, adjusting for food security score, periconceptional multivitamin use, and folic acid intake (

Table 6. Association between tertiles of dietary patterns and non-syndromic orofacial cleft risk.

Dietary Patterns	OR	95% CI	p-Value
Sweet and Energy-Dense
Tertile 1	Ref
Tertile 2	6.916	2.835–16.868	<0.0001 *
Tertile 3	22.266	8.711–56.909	<0.0001 *
Staple-Plant-Based
Tertile 1	Ref
Tertile 2	0.941	0.419–2.113	0.882
Tertile 3	4.067	1.7–9.726	0.002 *
Animal Protein–Vegetable
Tertile 1	Ref
Tertile 2	0.850	0.354–2.042	0.717
Tertile 3	0.438	0.186–1.028	0.048 *

Model adjusted for food security, multivitamin use, and regular folic acid intake during the periconceptional period. Ref = reference category (lowest tertile of intake). * shows statistical significance.

). For Sweet and Energy-Dense pattern, OFC odds increase with adherence: Tertile 2, moderate intake (OR = 6.92; 95% CI: 2.84–16.87; p < 0.0001) and Tertile 3, highest intake (OR = 22.27; 95% CI: 8.71–56.91; p < 0.0001) versus Tertile 1. For the Staple Plant-Based pattern, only Tertile 3 showed a significant increase (OR = 4.07; 95% CI: 1.70–9.73; p < 0.002), while Tertile 2 was non-significant (OR = 0.94; p = 0.882). Tertile 3 in the Animal Protein–Vegetable pattern indicated lower odds (OR = 0.44; 95% CI: 0.19–1.03; p < 0.048) and Tertile 2 with no significant association (OR = 0.85; p = 0.717).

3. Discussion

This study explored maternal dietary patterns, micronutrient supplementations, and household food security status in relation to the risk of NSOFCs in Ghanaian newborns. Findings highlight multiple nutritional and socioeconomic disparities between case and control participants, highlighting how broader contextual factors may shape prenatal health outcomes. The socio-demographic profile of mothers revealed no statistically significant differences between case and control groups.

Food security levels were broadly similar across groups, with high proportions of severe food insecurity in both. However, a larger proportion of case mothers were food secure (34%) compared to control mothers (33%), and mild food insecurity was twice as prevalent among controls; these variations were not statistically significant after Bonferroni correction. This suggests that food insecurity is widespread in this population but may intersect with other risk factors to influence NSOFCs’ predisposition. However, severe food insecurity was more common in case households (49.5%), raising the possibility of dietary deprivation during the critical periconceptional window. Emerging evidence supports the link between maternal food insecurity and elevated risk of birth defects [13]. Food insecurity may lead to inadequate intake of key micronutrients such as folate, vitamin B12, and zinc that are essential for normal embryonic development, particularly during the early stages of orofacial formation. Studies in resource-limited settings have shown that mothers experiencing chronic or severe food insecurity are more likely to have compromised dietary diversity, lower overall nutrient density, and reduced access to supplements, all of which may contribute to increased susceptibility to NSOFCs [14].

The analysis of periconceptional supplement use showed low uptake of both multivitamins and folic acid among all participants, with no significant differences between groups. Only 6.8% of control and 3.9% of case mothers reported using multivitamins prior to conception. Similarly, folic acid intake remains suboptimal (10.7% for controls, 13.6% for cases), far below the WHO-recommended levels for preventing neural tube defects (NTDs) and craniofacial anomalies. This widespread deficiency points to systemic barriers in preconception care and public awareness, consistent with other West African studies reporting limited micronutrient use during early pregnancy [15]. Interestingly, countries with mandatory folic acid fortification, such as Canada and the United States, have a dramatic reduction in the prevalence of Neural tube defects by approximately 46% in Canada [16] and around 30% in the US and other regions [17]. These findings, alongside evidence of ongoing birth defect rates in Ghana, suggest a persistently low folic acid intake in our study population [18], with reported NTD prevalences of 1.15 per 1000 births [19] and 4.7 per 1000 live births [18]. Despite the lack of statistical significance, the low coverage rates for supplements highlight a missed opportunity for primary prevention. Previous research supports that taking multivitamins, especially those containing folic acid, before conception significantly reduces the risk of NSOFCs [20,21]. Multivitamin use during pregnancy supports maternal health and can lead to better pregnancy outcomes by fulfilling various nutritional needs [22]. Ensuring consistent and adequate intake of multivitamins is crucial for optimal fetal development, both before conception and during pregnancy [6,23].

Empirical evidence suggests that maternal dietary patterns reflecting habitual combinations of foods play a critical role in shaping fetal development and may influence the risk of congenital anomalies such as NSOFCs [24]. In this study, principal component analysis (PCA) identified four distinct dietary patterns among case mothers: Sweetened and Caffeinated Beverages, Starchy Plant-Based Foods, Animal Protein–Vegetables, and High Energy Junk Foods, which together explained 61.2% of the variance in food group consumption. Among control mothers, three principal patterns emerged: Sweet and Caffeinated Foods, Animal Protein and Dairy, and Staple Carbohydrates and Legumes, accounting for 55.5% of the dietary variance. These patterns reflect broader trends reported in LMIC settings, where economic constraints often limit access to nutrient-rich foods, resulting in diets dominated by energy-dense, low-micronutrient options [25]. The prominence of sweets, sweetened beverages, and processed items in both groups highlights an ongoing nutrition transition and raises concern about the potential negative influence of poor diet quality during the periconceptional period. These types of foods generally lack the necessary nutrients for proper fetal development and can lead to excessive calorie intake without providing critical vitamins and minerals. As purported by [26], excessive sugar consumption has been associated with inflammation and oxidative stress, both of which can negatively affect fetal growth. Therefore, promoting a well-rounded diet for pregnant women, which includes a variety of nutrient-dense foods such as fruits, vegetables, whole grains, lean proteins, and nuts and seeds, is essential.

Multivariable binary logistic regression analysis of dietary tertiles offered compelling insights into NSOFC risk. Mothers in the highest tertile (T3) of the sweets pattern had 22-fold increased odds of giving birth to a child with NSOFC compared to those in the lowest tertile (T1), even after adjusting for supplement use in food security. This strong association suggests that high sugar and processed food intake during the periconceptional period may be an important nutritional risk factor that negatively affects pregnancy outcomes, possibly through hyperglycaemia-induced oxidative stress or micronutrient displacement [27]. Similarly, the highest tertile of the staple pattern, which was associated with four-fold increased odds of NSOFC, suggests that reliance on refined carbohydrates and starchy staples may contribute to inadequate micronutrient density. Diets high in carbohydrates, particularly from refined sources like sweets and sugary snacks, may increase the risk of NSOFCs and other congenital abnormalities. Research indicates that excessive intake of simple sugars and refined carbohydrates during pregnancy contributes to fluctuations in blood sugar levels, potentially increasing oxidative stress and inflammatory responses, which can interfere with normal fetal development [28]. Interestingly, the Animal Protein–Vegetable pattern showed a borderline protective effect (T3 OR = 0.438, p = 0.048), supporting hypotheses that diets rich in bioavailable micronutrients such as iron, zinc, and B12 may mitigate congenital birth defect risks [29]. Due to this borderline significance association, the results should be interpreted with caution. Taken together, these findings reinforce the need for holistic maternal nutrition strategies in Ghana, targeting not only food security but also dietary quality and supplementation. While food insecurity remains a structural barrier, our results suggest that even among food-insecure populations, specific dietary behaviors, particularly high sugar intake and low animal protein consumption, may elevate NSOFC risk. Policy efforts must transcend calorie sufficiency to emphasize diet diversity in nutrient adequacy, particularly in the critical periconceptional and early gestation windows.

This study provides robust evidence linking maternal dietary patterns, food security status, and periconceptional micronutrient use with the risk of NSOFCs in a Ghanaian population. Through a rigorous case–control design, application of principal component analysis to derive meaningful dietary profiles, and adjusted logistic regression models, the analysis offers insights into how specific eating patterns, particularly high consumption of sweets and starchy staples, may significantly elevate NSOFC risk. However, some limitations must be acknowledged. Dietary data were self-reported retrospectively, raising the potential for recall bias. The cross-sectional nature of dietary pattern assessment may not fully capture periconceptional intake variability over time. It is important to note that the relatively small sample size in this study may have limited our ability to detect modest but clinically meaningful associations. This reduced statistical power could partly be the reason why some observed differences did not reach statistical significance. Larger multi-center studies are therefore warranted to confirm these findings and to better explore the interaction between maternal food insecurity, nutritional deficiencies, and NSOFC risk. Despite these constraints, the study remains one of the few in sub-Saharan Africa to holistically assess maternal diet and its relation to NSOFC risk using data-driven methods. The findings call for more longitudinal and interventional research but already highlight key leverage points for policy and public health interventions.

4. Materials and Methods

4.1. Study Design and Site

This study employed a case–control study design to investigate potential nutritional risk factors associated with NSOFCs. Case–control studies are particularly useful for studying rare conditions like NSOFCs because they allow for a detailed comparison between affected individuals (cases) and those without the condition (controls), helping to pinpoint potential risk factors [30]. Data for the cases were collected from the National Cleft Care Center (NCCC) at Komfo Anokye Teaching Hospital (KATH), Kumasi, while control data were obtained from women attending the Child Welfare Clinic (CWC) at Ayeduase Health Centre, Kumasi, Ghana.

4.2. Study Population and Sampling

The study population comprised two groups: case-mothers and control-mothers. Case-mothers were drawn from the NCCC at KATH, where mothers from across Ghana bring their children diagnosed with NSOFCs for treatment. Control-mothers were selected from the Ayeduase Child Welfare Clinic (CWC) within the Oforikrom Municipality in Kumasi, which serves several communities. A total of 103 case-mothers and 103 control-mothers participated in the study. Purposive sampling was used to identify case-mothers, ensuring the inclusion of individuals whose children were affected by NSOFCs, a necessary approach for studying rare conditions where the population of interest must be deliberately targeted [31]. In contrast, convenience sampling was employed for control-mothers, allowing for the efficient recruitment of participants based on accessibility while ensuring demographic comparability with the case-mothers [32]. For the mothers, no specific exclusion criteria were applied. All mothers who consented to the study, regardless of previous medical history. This approach was chosen because the study’s primary sampling framework was based on children’s eligibility rather than maternal health characteristics.

4.3. Sample Size

The study included 103 case-mothers and 103 control-mothers. The sample size was determined using a 95% confidence interval and an adjusted margin of error of approximately 5.79%, based on a population size of 135 reported cases of NSOFCs per year at KATH. This calculation ensures sufficient power (80%) to detect significant differences between the groups, providing reliable and valid results.

To calculate the sample size, the formula for determining sample size for case–control studies was used:

$$ɳ={\displaystyle \frac{Z^{2}P(1-P)}{E^2}}$$

n is the sample size;

Z is the Z-value (1.96 for 95% confidence);

P is the estimated prevalence of the outcome (OFCs) in the population (0.1);

E is the margin of error (0.0579).

$$ɳ={\displaystyle \frac{{\left(1.96\right)}^2\times 0.1\times (1-0.1)}{{\left(0.0579\right)}^2}}=103$$

4.4. Eligibility Criteria

Eligibility criteria were strictly defined to ensure the reliability of the study results. Case-mothers were those with children diagnosed with nonsyndromic NSOFCs aged 12 months to five years. Control-mothers had children without NSOFCs or any birth abnormalities. Controls were matched with cases by the month of delivery and the sex of the child in a 1:1 ratio, enhancing the study’s internal validity by reducing potential confounding variables [33]. It was assumed that dietary intake patterns at the time of data collection would be similar to the diet in the periconceptional period. Hence, mothers who reported a change in dietary intake at the time of the interview compared to the periconceptional period were excluded. This was crucial in maintaining consistency in dietary assessment.

4.5. Data Collection

A total of 206 participants, consisting of 103 case-mothers and 103 control-mothers, were interviewed with pretested questionnaires. Information about socio-demographic factors, dietary intake, multivitamin and supplement use, and food security was gathered. A seven-day food frequency questionnaire was included to gain insights into dietary habits, asking participants how often they consumed various local foods [34]. Participants were also asked about their use of multivitamins and supplements, particularly focusing on the month before and during early pregnancy, to assess folic acid intake. For folic acid, mothers reported the standard dosage of 400 µg per tablet. Additionally, food insecurity was assessed using the USDA 18-item Household Food Security Survey Module (HFSSM). This thorough approach ensured that all necessary information was gathered to understand the participants’ nutritional status and other factors relevant to the study.

4.6. Data Analysis

Data was analyzed using SPSS v25. Descriptive statistics, including mean, standard deviation, frequencies, and percentages, were used to summarize demographic information. Differences between the case and control groups were assessed using Pearson’s chi-squared tests for categorical variables. Dietary patterns were derived separately for case and control mothers using principal component analysis (PCA) with Varimax rotation and Kaiser normalization, based on the reported frequency of consumption of food groups from the food frequency questionnaire. Associations between tertiles of dietary pattern scores and the odds of OFCs were examined using multivariable binary logistic regression, adjusting for food security score, periconceptional multivitamin use, and folic acid intake. Statistical significance was set at p < 0.05 for all analyses.

5. Conclusions

While the study provides valuable insights, they should be interpreted with caution due to certain limitations, including the relatively small sample size and lack of detailed medical histories of mothers. This study highlights the critical role of maternal nutrition, comprehensive dietary patterns, micronutrient supplementation, and food security in influencing the risk of OFC among newborns in Ghana. Although food insecurity was prevalent in both the case and control groups, specific dietary patterns predicted NSOFC occurrence than food availability and accessibility. Dietary patterns that were high in sweetened and energy-dense foods, as well as starchy staples, significantly increased the odds of NSOFCs. In contrast, the Animal protein and Vegetable pattern offered protective benefits against NSOFC. This study also observed low intake of multivitamins and folic acid among both groups, despite their known roles and benefits in periconceptional nutrition care. The findings of this study highlight the need for integrated maternal nutrition to fill gaps in preconception care. Further, public health efforts should prioritize education, fortification strategies, and access to diverse, nutrient-rich foods to reduce the burden of congenital anomalies such as NSOFC. Further, strengthened public health strategies, integrating folic acid supplementation into routine maternal health programs, improving awareness campaigns, and enhancing national fortification initiatives could collectively reduce the risk of NSOFC.