By Staci Gulbin, MS, MEd, RD
Staci Gulbin is a registered dietitian with BumpVitamins.com. Staci is also a freelance writer, health editor, the founder of LighttrackNutrition.com, and the author of The High-Protein Bariatric Cookbook.
Staci has graduate degrees in Biology, Human Nutrition, and Nutrition Education from New York University and Columbia University, respectively. She has treated thousands of patients across many wellness arenas such as weight management, fitness, long-term care, rehab, and bariatric nutrition.
Cleft lip and Cleft palate
Non-profit organizations like Smile Train and March of Dimes, work hard to provide care and raise awareness around birth defects like Cleft Palate and Cleft Lip. Through organizations like these, doctors provide free services to correct a child’s cleft lip or palate, through surgical reconstruction. But did you know that many of these cases could be easily prevented by the mother through proper nutrition during pregnancy? How much do you really know about cleft palate and cleft lip? Are you taking the necessary steps to minimize these risks for your child?
Cleft Lip and Cleft Palate affect thousands of newborns every year in the U.S. (1). These birth defects have a lasting impact on the child, as well as the family. Although not life-threatening, even mild cases can leave a child feeling self-conscious about their appearance and facial features. In severe cases, these defects can sometimes make it hard for children to breathe or eat properly, which can negatively affect their nutritional status, growth, and overall health.
What are cleft lip and cleft palate? How are they different?
Cleft lip occurs when a baby’s upper lip doesn’t seal completely, while cleft palate refers to the roof of a baby’s mouth not forming correctly (1,2). These conditions can leave an opening, or a split in the baby’s lip or palate, which can not only affect physical appearance but in some cases, it can also affect the function of the lips and mouth. Depending on the size of the openings, cleft lip and cleft palate can have a dramatic impact on dental health, as well as making eating, breathing, and speaking quite difficult (2,3).
What causes cleft lip and cleft palate?
Cleft lip and cleft palate can have one of four major causes including (1,2):
- An inherited gene from one or both parents
- Family history of cleft lip or cleft palate
- A genetic syndrome such as Down syndrome or Waardenburg syndrome, for example
- Health and environmental issues such as a mother’s:
○ Poor health during pregnancy (for example, mothers with diabetes, obesity, or infections like rubella)
○ Regular smoking or drinking alcohol o history of taking certain anti-epileptic medicines
○ Poor nutritional status such as low folate levels
A baby’s lips take form around 4 to 7 weeks into pregnancy and the palate forms between 6 and 9 weeks of pregnancy (1). Therefore, it is important for the mother to make lifestyle changes to prevent birth defects early on. Steps like quitting smoking, abstaining from alcohol, eating a healthier diet, and taking a dietary supplement can greatly lower the chances of birth defects and should be taken prior to conception if possible.
What is the treatment for cleft lip and cleft palate?
Surgery can repair cleft lip and cleft palate. This type of treatment plan usually involves an array of medical specialists including (2):
- an otolaryngologist (ear, nose, and throat or ENT doctor)
- a plastic surgeon
- an oral surgeon
- a speech pathologist
- a pediatric dentist
- an orthodontist
- an audiologist
- a pediatrician
- a nutritionist
- a psychologist/social worker
Surgery can close the lip and palate and should be done early in life. Ideally, cleft lip surgery should be done before 12 months of age, and cleft palate surgery prior to 18 months of age (3). With appropriate treatment, children born with cleft lip and cleft palate can live a normal and healthy life.
How could nutrition impact cleft lip and cleft palate risk?
In addition to the other major causes listed above, a lack of folic acid in the mother’s diet can increase their baby’s risk of developing a cleft lip or cleft palate (1). Research shows that those mothers who take folic acid during the first three months of pregnancy have a significantly lower risk of their baby developing cleft lip or cleft palate, as compared to those who do not (4). Folic acid is not only helpful to reduce the risk of cleft lip and cleft palate but can also reduce the risk of neural tube defects like spina bifida (1).
What is folic acid and how much folic acid should I consume?
Folic acid is the fully oxidized form of folate (or vitamin B9), and is the form found in fortified food products and dietary supplements (5). Folate is vital for healthy red blood cell function which delivers oxygen to the body’s cells and tissues (6). Without it, cell growth and function can suffer, and birth defects like cleft lip, cleft palate, and NTDs are more likely. All women of childbearing age or expecting should consume 400 to 800 micrograms of folic acid daily (6,7).
How can I consume folic acid?
You can consume folic acid in a dietary supplement form that you can purchase over the counter or receive by a doctor. Folic acid is found in prenatal vitamins that also contain other important nutrients required by women of childbearing age, to have the healthiest pregnancy possible. If you do consume folic acid in a supplement form, be sure you use the following tips to choose a safe and effective supplement (8).
- Look on the label for third-party testing: Testing of a supplement by a third party can ensure purity and potency of a supplement product.
- Find brands that are certified by the National Sanitation Foundation (NSF): Products with NSF certification ensure that what is on the label is in the product and it ensures that no unsafe levels of contaminants are in the product.
- Look for Good Manufacturing Practices (GMP) registration on the label: Products with GMP registration can help ensure the company processing the supplement follows safety standards.
You can also find folic acid in the form of foods such as leafy green vegetables like spinach, kale, and broccoli, as well as foods like nuts, beans, and oranges (9). Fortified rice, pasta, bread, and cereals are also good sources of folic acid (7,9).
Final facts about cleft lip and cleft palate
The majority of cleft lip and cleft palate birth defects are preventable with proper nutrition. Therefore, it’s important to expand awareness of these conditions and how to prevent them. You can read about the latest information about cleft lip and cleft palate, or make donations to help fund research and surgical needs of those less fortunate on trusted websites like MarchofDimes.org and SmileTrain.org.
- March of Dimes (last reviewed January 2017) “Cleft Lip and Cleft Palate.”
- National Institute of Dental and Craniofacial Research (last reviewed July 2018) “Cleft Lip & Palate.”
- Centers for Disease Control (last reviewed December 5, 2019) “Cleft Lip/Cleft Palate.”
- Kelly, D., O’Dowd, T., and Reulbach, U. (July 2012) “Use of folic acid supplements and risk of cleft lip and palate in infants: a population-based cohort study.” The British Journal of General Practice: The Journal of the Royal College of General Practitioners, 62(600): e466-72.
- National Institutes of Health Office of Dietary Supplements (last updated March 11, 2020) “Folate.”
- Mayo Clinic (October 24, 2017) “Folate (folic acid).”
- Centers for Disease Control (last reviewed April 11, 2018) “Folic acid.”
- The Public Health and Safety Organization (accessed March 11, 2020) “Selecting Dietary and Nutritional Supplements.”
- Office of Women’s Health (last updated April 1, 2019) “Folic acid.”
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
Tell your doctor, pharmacist, and other healthcare providers about any dietary supplements and medicines you take. They can tell you if those dietary supplements might interact or interfere with your prescription or over-the-counter medicines or if the medicines might interfere with how your body absorbs, uses, or breaks down nutrients.