Family Factors Affect Child’s Odds for Cleft Palate

Economic status appears linked to increased risk of being born with a cleft palate or lip, new research suggests, building on past evidence that it can also result in delayed care and poorer outcomes.

Cleft palate and cleft lip are the terms that describe openings or splits in the roof of the mouth and lip, conditions present at birth.

“We looked at whether factors of poverty are associated with risk of having a cleft lip or palate in the first place,” said study co-author Dr. Jordan Swanson, a reconstructive and oral surgeon at the Children’s Hospital of Philadelphia.

His team analyzed data from a U.S. birth database of roughly 6.25 million births in 2016 and 2017. Of these, close to 3,000 (about 0.05%) were affected by cleft lip with/without cleft palate and 1,180 (0.02%), with cleft palate only.

To gauge economic status, researchers looked at the mother’s education, family use of a U.S. federal nutrition program, and insurance (Medicaid or private). They also accounted for such variables as prenatal care, the mother’s weight, use of tobacco and health, as well as the baby’s size and other characteristics.

Certain benchmarks were significantly linked with the risk of cleft lip/cleft palate.

Maternal education was a protective factor, with a 27% lower risk of cleft lip for babies born to college-educated moms, while federal food assistance was linked to a 25% increased risk of cleft palate. Medicaid coverage was unrelated to the risk of either.

The risk of cleft lip jumped 14% in women who postponed prenatal care to the second trimester of pregnancy and 23% for those who waited until the third trimester.

The timing of prenatal care was unrelated to the risk of cleft palate.

The study also confirmed some known risk factors for cleft palate or lip. Notably, male sex, first-trimester smoking, and maternal gestational diabetes were all linked to an increased risk of cleft lip. Smoking and maternal infections before pregnancy were associated with an increased risk of cleft palate, while female sex was a protective factor against it.

Most risk factors for cleft palate did not overlap with those for cleft lip, supporting the theory that they have different causes.

As to why economic factors may affect risks, the team theorized that moms with more education might be better informed about, and have better access to prenatal care and adequate nutrition during pregnancy. The nutritional support provided to women enrolled in the federal nutrition program might avoid the risk of “environmentally determined” cleft lip, but not “genetically determined” cleft palate, they said.

The findings appear in the January issue of Plastic and Reconstructive Surgery.

The researchers said they hoped their findings would help to clarify the relationship between economic status and clefts, and lead to better public health policies to address them, researchers said.

“Such understandings and partnerships among researchers, health professionals, policymakers, social agencies and local communities will allow us, as a society, to inch towards greater health parity,” study co-author Dr. Giap Vu, of Children’s Hospital of Philadelphia, said in a journal news release.

More information

The U.S. Centers for Disease Control and Prevention has more on cleft lip and cleft palate.

SOURCE: Plastic and Reconstructive Surgery, news release, Dec. 27, 2021