How to prevent cleft lip and palate during pregnancy

During early pregnancy, the growing baby develops the skull and face from either side, meeting in the middle eventually. When this process is interrupted at any stage, a split or break may appear on the face and is called a cleft. It affects the lip, hard palate and soft palate.

Cleft lip and cleft palate are among the most common birth defects. They can occur on their own or together. The exact cause is often not known, but there are certain things that can be done during pregnancy to reduce the risk of having a baby with a cleft. Lets dive into what these things are.

📝 What is a cleft lip & palate?

A cleft is a gap created when the different parts of a baby’s face don’t fully join together in the womb. It is a condition which someone is born with.

Cleft lip

A cleft lip is a gap in the upper lip. It can affect one side or both sides of the lip or the middle. This can range from a small notch to a total separation of the upper lip, which can extend up to the nose.

A cleft palate is a gap in the roof of the mouth. It can affect some or all of the soft palate (the back portion of the roof of the mouth) and may extend into some or all of the hard palate (the bony front portion of the roof of the mouth). Clefts of the lip and palate can occur separately or together.

Cleft lips and palates occur during early pregnancy. Around the fifth or sixth weeks of pregnancy, the lips join, and around the seventh or eighth week the palate joins. This joining process may fail completely or stop at any point, resulting in a cleft.

📝 What is the main cause of cleft lip and palate?

The exact reason why this happens to some babies is often unclear, but here are some possible risk factors:

Genes

Having a family history of cleft lip or palate increases the chance of your child having this condition. A healthcare professional may refer you to a genetic counsellor who can help figure out your risk of having children in the future with cleft lip and cleft palate.

Genetic syndromes

Cleft lip or palate are found in more than 400 syndromes, including Pierre Robin and Down syndromes. Approximately 30 percent of cleft defects are associated with a genetic syndrome.

Environmental factors

There are things that can happen just before or during pregnancy that can increase the risk of cleft lip or cleft palate:

• Taking medication. Certain medications such as anti seizure drugs for epilepsy, some acne treatment and methotrexate, a drug commonly used for treating cancer, arthritis and psoriasis can increase the risk of cleft lip and palate
• Smoking during pregnancy
• Having a folic acid deficiency during pregnancy
• Exposure to certain chemicals during pregnancy
• Drinking alcohol during pregnancy
• Not getting enough nutrients during pregnancy
• Having diabetes before pregnancy
• Obesity during pregnancy
• Having certain infections during pregnancy, such as rubella (German measles)

📝 What kind of complications occur with cleft lip and palate?

• Ear infections and hearing loss. Ear infections are often due to problems with the tube that connects the middle ear and the throat. A fluid build up in the ears (glue ear) can also lead to hearing problems
• Feeding difficulties. Feeding difficulties occur more with cleft palate abnormalities. The infant may be unable to suck properly because the roof of the mouth is not fully formed
• Speech problems. Muscle function may be reduced due to the opening of the roof of the mouth and the lip, leading to a delay in a child’s speech. Speech therapy may be recommended
• Dental problems. The abnormalities around the mouth may lead to teeth not developing normally, oral health problems and orthodontic treatment may be required

📝 Can cleft lip and cleft palate be prevented or avoided during pregnancy?

There are steps you can take to lower your risk of having a baby with a birth defect:

Take folic acid

Folic acid is a vitamin that every cell in your body needs for healthy growth and development. It is also known as vitamin B9 and is present is various foods such as:

• Dark leafy vegetables
• Lentils and beans
• Oranges and orange juice
• Wholegrain foods
• Chicken, shellfish and liver
• Fortified foods with added folic acid, including some brands of breakfast cereals

It is already commonly known that folic acid is a prenatal vitamin that reduces the risk of neural tube defects, such as spina bifida, during the first trimester of pregnancy.

A study published in the British Medical Journal found that women who take folic acid supplementation of 400 micrograms or more per day reduced the risk by one third, for a baby developing cleft lip with or without cleft palate. This shows how important a mother’s nutrition is during pregnancy. It is clearly an environmental factor that can affect the health of a growing baby.

Taking a folic acid supplement is the best way to get the recommend amount of 400 micrograms, which is ten times more folate needed than a non-pregnant woman. It’s unlikely that you would be able to have this much through diet alone.

Lose weight before pregnancy

It is ideal to get to a healthy weight before you get pregnant. Discuss with your health care provider about the right weight for you. Being overweight or obese during pregnancy can cause problems for you and your baby. Talk to your doctor about how much weight to gain during pregnancy.

Stop smoking

Smoking during pregnancy increases the risk of having a baby with health problems at birth. It can cause early labour, premature births, low birth weight and birth defects such as cleft lip and other health problems. Quitting smoking, even if you’re already pregnant, can make a big difference in your baby’s life.

Stop drinking alcohol

Drinking alcohol during pregnancy makes it more likely to have a premature birth, birth defects and fetal alcohol spectrum disorders. Alcohol passes directly from your body to your baby’s and can cause serious health problems for your baby.

Get your diabetes under control

If you have diabetes plan your pregnancy, as it is important to get your diabetes under control 3 to 6 months before you get pregnant. Managing diabetes when pregnant requires extra attention and care. You’ll need extra prenatal care check-ups so your provider can make sure you and your baby are doing well.

Untreated or uncontrolled diabetes increases your risk for pregnancy complications, like high blood pressure, depression, preterm birth, birth defects and pregnancy loss.

Discuss your anti-seizure medication with your healthcare provider

Pregnant mothers with epilepsy have an increased risk of babies with a cleft lips and palate. Discuss the possibility of reducing the number of medicines or your dose with your doctor.

Discuss ultrasound scans and detecting cleft lip and palate

At the 18th to 20th week of pregnancy cleft lip and palate may sometimes be detected using an ultrasound scan. If detected, parents are counselled regarding the condition and the family may also be referred for genetic counselling and other tests.

Also, families with a history of cleft palates should seek genetic counselling to determine their risks for giving birth to a child with a cleft palate.

🩺 Diagnosis

A cleft lip may be picked up during pregnancy during a routine prenatal ultrasound. After the birth of the baby it will generally be visible during a baby’s first examination. However some types of cleft palate aren’t easily visible and might not be diagnosed until later in life.

After diagnosis the paediatrician will explain your child’s condition, discuss the treatments they need and answer any questions you have. The paediatrician will work together with an otolaryngologist, plastic surgeon, oral surgeon, speech therapist, paediatric dentist, orthodontist, audiologist, nutritionist, and psychologist/social worker to put in place a treatment plan.

🏥 Treatment

Surgery

Surgery can treat both cleft lip and cleft palate, but as every cleft is unique treatment depends on the extent of the cleft, the child’s age and any health conditions.

Cleft lip surgery usually occurs in the first few months of life. It is recommended within the first 12 months of life.

Cleft palate surgery is recommended within the first 18 months of life. This is a more complicated surgery and it is done when the baby is slightly older and can tolerate the surgery. Many children will need additional surgical procedures as they get older.

📝 Conclusion

The causes of cleft lip and palate are not clear, but are likely to be a combination of genetic and environmental factors. There are steps a woman can take to reduce the risk of having a baby with a birth defect like cleft lip and palate, such as taking folic acid supplements, stopping smoking, giving up alcohol and maintaining a healthy weight.

The majority of children treated for cleft lip or palate will not have any other serious medical problems. Treatment can usually improve the appearance of the face and any problems with feeding and speech.

Sources

• Cleft lip and palate – NHS
• Cleft Lip/Cleft Palate | Birth Defects | CDC
• Cleft lip and cleft palate – Symptoms and causes – Mayo Clinic
• Folic Acid May Prevent Cleft Lip and Palate | National Institutes of Health (NIH)