By Dr Ananya Mandal, MD
In most cases cleft lip and palate is an inherited condition. There is really nothing parents can do in such cases to prevent cleft lip and palate from forming in their babies.
However, there are steps a woman can take to reduce the risk of having a baby with a birth defect like cleft lip and palate.
Cleft lip and palate like other deformities forms during the first three months of pregnancy. This is the time when the tissues of the face come together from either side to fuse in the middle.
Preconception and Prenatal Care
Folic acid is a B vitamin that is thought to play a role in the development of the fetal brain and spinal cord especially during the first trimester of pregnancy. Folic acid in fact is needed even before a woman is aware of her pregnancy.
Thus all women who may conceive even unplanned are advised to take 400 micrograms of folic acid per day in dietary supplements or foods that are fortified with folic acid.
The Department of Health recommends all women take a daily supplement of 0.4mg of folic acid before they conceive and for the first 12 weeks of pregnancy.
A recently reported study of 11,000 babies born in Ireland showed that mothers who did not take folic acid in the first three months of pregnancy were four times more at risk of giving birth to babies with cleft lip and palates compared to mothers who did take the supplements.
Folic acid is an essential vitamin found in meat, fresh fruit and vegetables. It is added to many breakfast cereals, of which one standard serving gives a quarter of the Daily Recommended Allowance (DRA). (3)
Ultrasound scans and detecting cleft lip and palate
Cleft lip and palate may sometimes be detected using ultrasound scans during pregnancy. This is usually done at the anatomy scan at 18th to 20th week of pregnancy.
While some cleft lips and palates occur without other defects, they may also be part of other genetic defects and syndromes. Early diagnosis of these syndromes may be made.
Parents are counselled regarding the condition of their baby. The family may also be referred for genetic counselling and other tests.
Genetic counselling can identify high-risk families. The cleft palate and lip management team prepares the parents for initial management of their baby after birth.
Smoking and passive exposure
Pregnant mothers are advised to avoid smoking and passive exposure to smoke during pregnancy. They are advised a healthy lifestyle and avoid smoking and drinking alcohol.
Anti-seizure drugs and cleft lip and palate
Pregnant mothers with epilepsy need to anti-seizure drugs. These also raise the risk of cleft lips and palates. Combining two or more anticonvulsants increases the risk even more.
Under medical supervision it may be possible to reduce the number of medicines and the risk.
A seizure in the mother during pregnancy brought about by uncontrolled epilepsy may also be highly risky for the baby.
Reduction and changing the dose of the drugs thus needs careful supervision and mothers should not stop taking their regular medication without advise from their physicians. (1-5)
Edited by April Cashin-Garbutt, BA Hons (Cantab)