Taking folic acid at start of pregnancy seems to lower risk of cleft lip and palate

BMJ 2012; 345 doi: (Published 05 July 2012) Cite this as: BMJ 2012;345:e4614
  1. Muiris Houston
  1. 1Galway

The risk of having a cleft lip or palate seems to be more than four times higher if mothers do not take folic acid in the first three months of pregnancy, a study shows.1

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

Using data generated from over 11 000 babies representing the 9 month old infant cohort of the Growing Up in Ireland Study, Ms Dervla Kelly and colleagues from the Department of Public Health and Primary Care at Trinity College Dublin 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, the rate of cleft lip and palate in infants was 6.8 per 1000 9 month old babies of women who did not take folic acid and 1.5 per 1000 9 month olds of women who did take folic acid supplements. “The OR (logistic regression) of not having folic acid during the first three months of pregnancy for cleft lip was 4.36-fold higher (95% CI=1.55 to 12.30, P=0.005) when compared with participants who had a folate intake during the first trimester,” the article said

More than a third of women did not take a folic acid supplement before becoming pregnant whereas a minority of women (6.7%) did not take folic acid during the first 12 weeks of pregnancy.

A cleft lip and palate occurs in about one in 700 live births. Cleft lip, with or without cleft palate, is most frequent in boys and isolated cleft palate is most common in girls. Even when surgically repaired, cleft anomalies can lead to longlasting complications such as persistent ear infections, speech impairments, facial deformities, and dental problems.

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

O’ Dowd acknowledged that there are several challenges to be overcome. It is estimated that up to half of pregnancies in Ireland are unplanned, thereby denying these women the opportunity to take supplements pre-conceptually. In addition, for those planning pregnancy, it is not unusual for a baby to reach six weeks’ gestation before the pregnancy is confirmed.

The research findings are expected to reignite a debate about fortifying bread with folic acid in Ireland. The merits of a “whole population” public health intervention in order to achieve a health gain for a proportion of the populace has proved contentious in the past.


Cite this as: BMJ 2012;345:e4614