Cleft Palate and Weight Increase in Mothers
A report published in the June issue of the American Journal of Epidemiology provides some statistics regarding the relationship between second children born with cleft palates or cleft lips and substantial weight gain by the mother between the two births. The study was conducted utilizing medical information on over 220,000 Swedish women who had their first two pregnancies between 1992 and 2004.
The data was analyzed by a Dr. Villamor of the Harvard School of Public Health and colleagues who assisted in the process. Findings indicated that the women in the study who had substantial weight gain between their first two births were more likely to give birth to a child with cleft palate. The study showed no evidence of an increase in cleft lip for children born to mothers with similar weight gain.
Specifically, the report used the Body Mass Index (BMI) statistic for comparative purposes. BMI provides an educated guess at the amount of body fat in a person based on weight, height, gender and age. Women who had a BMI increase of 3 or more units between pregnancies were the group that showed an increase in children born with cleft deformities. For women between five feet two inches and five feet five inches this appears to be a minimum weight increase of seventeen to twenty two pounds – between pregnancies, not during the prenatal period.
A cleft palate or cleft lip is the most common of birth deformities, occurring in one of every 700 – 1000 births. While there are no identified causes affiliated with this occurrence, overall statistics suggest that the condition occurs more often among Asian, Hispanic and Native American children. African American children are the least susceptible to cleft deformities. The Mayo Clinic lists no definitive causal relationship for parental behavior and a newborn’s cleft lip or palate; their general statement is that…“Exposure in early pregnancy to cigarette smoke, alcohol or illicit drugs may put a baby at higher risk of developing a cleft.”
A fact sheet from the March of Dimes Foundation says that, “The causes of these birth defects are not well understood. Studies suggest that a number of genes, as well as environmental factors, such as drugs (including several different anti-seizure drugs) and maternal smoking, may contribute. Other environmental factors that are suspected of playing a role include infections, maternal alcohol use and deficiency of the B vitamin folic acid.”
Suggesting that weight gain between pregnancies can be isolated as a cause of cleft palate in newborns begs the question of whether or not there were patterns of drug use, smoking, alcohol use or any of the other likely catalysts for this birth defect in the women studied by Dr. Villamor. In his words, “although the mechanisms to explain this association are still uncertain, this finding contributes additional evidence to the importance of keeping a healthy weight throughout life.”
It is important that mothers who give birth to a child with cleft palate or cleft lip be aware of the remarkable advances in plastic surgery that allow for reconstruction of a child’s palate and lip early in life. However the American Society of Plastic Surgeons recommends that a child with a cleft deformity be treated by a team that includes an ear nose and throat specialist; a dentist; a speech therapist; a hearing specialist; and other specialists such as a psychologist as necessary.
Repair of a cleft palate is more complicated than repair of a cleft lip and may require multiple surgical procedures. Children born with this impairment often have hearing problems, always have a speaking problem, may have extra teeth or teeth out of place, and will be faced with the psychological burden of being the different kid on the playground. Plastic surgery is an important part of the treatment, but only one of the critical components.
