Answer Man: Can cleft palate and lip be prevented?

News-DemocratDecember 10, 2013 

Why are so many babies born with cleft palate and lip? Isn't there a pill or vitamin expecting mothers can take to prevent it? -- Grace Conner, formerly of Belleville

Considering your question, here's a too-obvious but interesting trivia fact: What do King Tut, Tad Lincoln, comic Cheech Marin and actor Stacy Keach have in common?

That's right, they all were born or are believed to have been born with a cleft palate and/or lip. Estimates are that the deformities occur about once in every 700 U.S. births. That adds up to roughly 7,000 babies every year, making it the nation's most common birth defect, according to the Centers for Disease Control and Prevention.

And, unfortunately, your power of observation is keen. While the media has done more to bring it to the nation's attention, researchers have noted an increase in occurrence since at least the mid-1960s, according to a study in the Archives of Disease in Childhood.

If you're unfamiliar with them, cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth (the palate) or both.

During normal fetal development, we all start life with both a cleft lip and palate. Then, sometime between the sixth and 15th weeks of pregnancy, these splits -- or clefts -- close in most cases.

But for reasons both known and hypothesized, these divided tissues fail to fuse in tens of thousands of babies worldwide. In addition to the obvious physical deformity, the defect can cause speech problems as President Lincoln's last son reportedly experienced. It also can cause breathing and feeding difficulties, ear infections and dental problems.

Wouldn't it be fantastic if we could hand women a simple pill to prevent it? In the past few years, for example, researchers have found that a small daily dose of folic acid produces a dramatic 70 percent reduction in the incidence of spina bifida -- a failure of the neural tube to close.

But while there are clues, researchers have yet to uncover the precise smoking gun or guns that lead to cleft lip and palate. As a result, there is no magic bullet doctors can offer to prevent the defect, only broad recommendations.

Most certainly, there is a genetic component, Lisa Gist Walker at the Cleft Palate Foundation in Chapel Hill, N.C., told me. For one thing, people born with clefts have a greater chance of producing children with clefts. They occur more often in certain groups, including Asian, Hispanic, Eskimos and Native Americans. Blacks are least likely to have a cleft, according to the Mayo Clinic.

But pinpointing one or two genes responsible for the defect likely will be impossible, according to the American Academy of Otolaryngology -- Head and Neck Surgery. A full 30 percent of all clefts are part of more than 400 syndromes, including Down, Waardenburg and Pierre Robin.

Nevertheless, doctors think there are sensible precautions women can take to lessen the likelihood. Studies show they seem to occur more often in women who smoke, have diabetes or are obese. Researchers also are looking at the effectiveness of folic acid.

Women also might want to discuss any drugs they're taking with their doctor. In 1992, the American Dental Society associated congenital malformations with an increased use of "teratogens" -- which include a wide range of drugs from blood-thinners and cancer drugs to seizure medications, some antidepressants and cocaine.

Decades ago, babies with severe clefts would die in infancy because they were unable to feed properly from either a breast or a standard bottle. Even today, some women report having abortions after ultrasound tests revealed the deformity. In the United Kingdom, a government report found seven women in 2010 saying they had an abortion specifically because their fetus had a cleft lip and palate.

That should no longer occur, Walker stresses. With surgery, therapy and other treatments, a child born with a cleft today can have a long, healthy life. Keach, for example, has won a Golden Globe winner and is the honorary chair of the Cleft Palate Foundation. He often has hid his residual surgical scars with his trademark mustache.

Care, however, is expensive. The National Institute of Dental and Craniofacial Research estimates the lifetime cost of treating the children born each year with clefts will be at least $700 million.

For more information, go to the Cleft Palate Foundation site at www.cleftline.org, where you'll find a raft of related links. If you'd like to help, consider giving to such groups as the foundation or www.smiletrain.org.

Today's trivia

From what is Richard Anthony Marin's nickname of "Cheech" derived?

Answer to Tuesday's trivia: If you want to do some serious time travel back into the nation's history, you need go no farther than Elfreth's Alley in Philadelphia. Dating to 1702, the cobblestone alleyway boasts 32 Georgian and Federal-style houses built between 1728 and 1836 and bills itself as the country's oldest residential street. It is named for Jeremiah Elfreth, an 18th-century blacksmith and property owner. And if you go now, you can enjoy Deck the Alley, an annual holiday self-guided tour of 13 private homes.

Send your questions to Roger Schlueter, Belleville News-Democrat, 120 S. Illinois St., P.O. Box 427, Belleville, IL 62222-0427 or rschlueter@bnd.com or call 618-239-2465.

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