Mothers' lack of folic acid linked to cleft palate in babies

THE RISK of having a child with cleft lip or palate is more than four times higher if mothers do not take folic acid in the first three months of pregnancy, researchers at Trinity College Dublin have established.

Lack of folic acid early in pregnancy is known to cause neural tube defects such as spina bifida, but this is the first study to show a strong association between maternal folic acid intake and the risk of a baby developing an orofacial cleft deformity.

Using data generated from more than 11,000 babies representing the nine-month-old infant cohort of the Growing Up in Ireland Study, Dervla Kelly and colleagues from the department of public health and primary care at Trinity set out to assess the effect of folic acid supplements in preventing cleft lip and cleft palate.

Their results show that a mother’s intake of folic acid during the first three months of pregnancy was significantly associated with cleft lip and palate.

According to the study, to be published in the July issue of the British Journal of General Practice, the rate of cleft lip and palate in infants was 6.8 per 1,000 nine-month-olds among women who did not take folic acid, and 1.5 per 1000 nine-month-olds in those who did take folic acid supplements. More than a third of women did not take a folic acid supplement before becoming pregnant while a minority of women (6.7 per cent) did not take folic acid during the first 12 weeks of pregnancy.

Current recommendations state that women planning pregnancy should use a folic acid supplement of 400mg per day from at least four weeks before, to 12 weeks after conception. It is estimated that more than 70 per cent of neural tube defects can be prevented by maternal folic acid supplementation.

A cleft lip is a separation in the upper lip while a cleft palate is an opening in the roof of the mouth. Clefts result from incomplete development of the lip and/or palate in the early weeks of pregnancy.

Even when repaired, the condition can lead to complications such as persistent ear infections, speech impairments, facial deformities and dental problems. Treatment involves plastic surgery, beginning approximately three months after birth.

“This study supports the hypothesis of a further significant role of a daily folic acid supplement of 0.4mg taken four weeks before conception and in the first 12 weeks of pregnancy in the prevention of cleft lip and palate,” Prof Tom O’Dowd of the TCD department of general practice and a senior author of the research, said. “By women taking this simple, cheap and safe supplement we can reduce the numbers affected by this disfiguring condition.”