A 2026 hospital-based study of 544 children in Ethiopia found that maternal factors during pregnancy—particularly poor nutrition, lack of folic acid supplementation, alcohol consumption, and smoking exposure—significantly increase the risk of cleft lip and palate. According to Gram Research analysis, mothers who received adequate prenatal nutrition and vitamins had substantially lower rates of these birth defects, suggesting that improving maternal health before and during pregnancy could prevent many cases.
Researchers studied 544 children with birth defects in Ethiopia to understand what causes cleft lip and cleft palate—conditions where a baby’s mouth doesn’t fully form before birth. According to Gram Research analysis, the study found that what mothers eat, drink, and breathe during pregnancy plays a huge role. Mothers who didn’t get enough vitamins, especially folic acid, or who smoked or drank alcohol while pregnant had higher chances of having babies with these conditions. The good news? Many of these risk factors can be controlled, meaning better prenatal care and nutrition could prevent many cases.
Key Statistics
A 2026 cross-sectional study of 544 children at an Ethiopian hospital found that maternal inadequate nutrition, folic acid deficiency, and lack of multivitamin supplementation were significantly associated with increased risk of cleft lip and cleft palate.
Research from a 2026 Ethiopian hospital study involving 544 children showed that maternal alcohol consumption and both active and passive smoking during pregnancy were linked to higher rates of cleft conditions.
A 2026 analysis of 544 children in Ethiopia revealed that parental history of birth defects and certain maternal medical conditions during pregnancy were associated with cleft lip and palate, demonstrating the combined role of genetics and environment.
According to a 2026 study of 544 children, living in rural areas was associated with higher rates of cleft lip and palate, likely due to reduced access to prenatal care and nutritional resources.
The Quick Take
- What they studied: What factors during pregnancy increase the risk of babies being born with cleft lip or cleft palate (openings in the mouth and upper lip that don’t close properly)
- Who participated: 544 children with various birth defects and their parents at a children’s hospital in Ethiopia. Researchers compared children with cleft conditions to those with other birth defects to identify specific risk factors.
- Key finding: Mothers who lacked proper nutrition, didn’t take vitamins (especially folic acid), smoked, drank alcohol, or were exposed to secondhand smoke during pregnancy were significantly more likely to have babies with cleft lip or palate
- What it means for you: If you’re planning to become pregnant or are currently pregnant, getting proper nutrition, taking prenatal vitamins with folic acid, avoiding alcohol and smoking, and staying away from secondhand smoke are important steps to reduce risk. However, some cases still occur even with perfect prenatal care, as genetics also play a role.
The Research Details
This was a hospital-based cross-sectional study, which means researchers looked at a snapshot of 544 children with birth defects at one point in time and asked their parents about what happened during pregnancy. They compared children with cleft lip and palate to children with other birth defects to identify which pregnancy factors were specifically linked to cleft conditions.
The researchers used advanced statistical methods called Bayesian modeling to analyze the data. This approach is like having a smart computer system that learns from the information and gets better at predicting patterns. They looked at many different factors: what mothers ate, whether they took vitamins, if they smoked or drank, whether they lived in cities or rural areas, and if there was a family history of birth defects.
The study was particularly clever because it recognized that cleft lip and cleft palate often happen together in families, so the researchers used methods that could account for this connection rather than studying them separately.
This research approach matters because it identifies real-world factors that doctors and public health workers can actually change. By studying children who already have these conditions and comparing them to others, researchers can spot patterns that might prevent future cases. The use of advanced statistical methods helps ensure the findings are reliable and not just random chance.
The study’s strengths include a reasonably large sample size (544 children), a clear comparison group, and use of sophisticated statistical methods. However, because it’s a hospital-based study, it only includes families who went to this particular hospital, so results might not apply everywhere. The study relied on parents remembering details about pregnancy, which can sometimes be inaccurate. The research was conducted in Ethiopia, so findings may be most relevant to that population, though the basic biology of birth defects is similar worldwide.
What the Results Show
The research identified multiple maternal factors strongly linked to cleft lip and palate. Inadequate nutrition during pregnancy was one of the strongest risk factors—mothers who didn’t eat enough nutritious food were significantly more likely to have babies with these conditions. Lack of multivitamin supplementation, particularly folic acid (a B vitamin crucial for facial development), was strongly associated with increased risk.
Exposure to harmful substances was another major finding. Mothers who drank alcohol during pregnancy had higher rates of cleft conditions in their babies. Both active smoking (the mother smoking) and passive smoking (breathing secondhand smoke) increased risk. Interestingly, living in rural areas was also associated with higher rates, likely because rural areas often have less access to prenatal care and nutrition.
The study also found that family history matters—if parents had relatives with birth defects, their children were at higher risk. Certain medical conditions during pregnancy, like infections or uncontrolled diabetes, also increased the likelihood of cleft conditions. The research showed that cleft lip and cleft palate are closely related conditions that often share the same risk factors.
The study revealed that multiple risk factors often occur together. For example, mothers with poor nutrition were also more likely to lack vitamin supplementation and live in areas with less healthcare access. This clustering of risk factors means that improving one area—like nutrition—might help prevent cleft conditions through multiple pathways. The research also confirmed that these conditions are not simply inherited but result from a combination of genetic predisposition and environmental factors during pregnancy.
These findings align with decades of international research showing that folic acid deficiency and maternal nutrition are crucial for preventing cleft conditions. The study adds to existing knowledge by specifically documenting these patterns in an Ethiopian population and using advanced statistical methods to account for how cleft lip and palate are related. Previous studies have identified similar risk factors, but this research provides strong confirmation from a different geographic region.
The study has several important limitations. First, it only included children who came to one hospital, so results might not represent all children in Ethiopia or other countries. Second, the study asked parents to remember details about pregnancy from months or years earlier, and memory can be unreliable. Third, the study couldn’t prove that these factors directly caused the cleft conditions—only that they were associated with them. Fourth, the study couldn’t account for all possible genetic factors that might influence risk. Finally, because this is a hospital-based study in Ethiopia, the findings may not apply equally to other populations with different genetics, nutrition patterns, or healthcare access.
The Bottom Line
Women planning pregnancy or currently pregnant should: (1) Take prenatal vitamins containing folic acid as recommended by their doctor—this is a high-confidence recommendation backed by strong evidence; (2) Eat a balanced diet with plenty of fruits, vegetables, and protein; (3) Completely avoid alcohol during pregnancy; (4) Avoid smoking and secondhand smoke; (5) Get regular prenatal care to monitor health and catch any medical conditions early. These recommendations have moderate-to-high confidence based on this and previous research.
Women of childbearing age planning pregnancy, pregnant women, and healthcare providers should pay attention to these findings. Women with family histories of cleft conditions should be especially vigilant about prenatal care. Healthcare workers in developing countries with limited resources should prioritize prenatal nutrition and folic acid supplementation programs. Partners and family members should support pregnant women in avoiding harmful substances.
The critical period for preventing cleft conditions is during the first three months of pregnancy, when facial structures are forming. This means women should start taking folic acid and eating well before becoming pregnant, not after. If someone is already pregnant, it’s still important to start good nutrition and prenatal care immediately, as some benefit may still occur.
Frequently Asked Questions
What causes cleft lip and cleft palate in babies?
Cleft conditions result from a combination of genetic factors and environmental exposures during pregnancy. Research shows maternal nutrition deficiencies, folic acid lack, alcohol use, smoking, and certain medical conditions significantly increase risk. These conditions develop when facial structures fail to close properly during early pregnancy.
Can you prevent cleft lip and palate during pregnancy?
While you cannot eliminate all risk, research shows taking prenatal vitamins with folic acid, eating nutritious food, avoiding alcohol and smoking, and getting regular prenatal care substantially reduce risk. A 2026 study found mothers with adequate nutrition had significantly lower rates of these birth defects.
How much folic acid do pregnant women need to prevent cleft conditions?
Standard prenatal recommendations are 400-800 micrograms of folic acid daily, starting before pregnancy if possible. The 2026 Ethiopian study found folic acid deficiency was strongly linked to cleft conditions, supporting the importance of consistent supplementation throughout pregnancy.
Does family history mean my baby will definitely have a cleft?
No. A 2026 study found family history increases risk but doesn’t guarantee cleft conditions will occur. Many children with family histories are born without clefts, especially when mothers receive good prenatal care, proper nutrition, and avoid harmful substances during pregnancy.
Is cleft lip and cleft palate the same condition?
They are related but separate conditions. Cleft lip affects the upper lip, while cleft palate affects the roof of the mouth. A 2026 study found they share similar risk factors and often occur together, suggesting common underlying causes during early facial development.
Want to Apply This Research?
- Track daily prenatal vitamin intake (especially folic acid), daily nutrition quality (servings of fruits, vegetables, protein), and exposure to smoke or alcohol. Users could log these daily with simple yes/no or checkmark entries.
- Set daily reminders to take prenatal vitamins at the same time each day. Create a meal plan that includes folic acid-rich foods like leafy greens, beans, and fortified cereals. If pregnant or planning pregnancy, identify and avoid secondhand smoke exposure by noting locations to avoid.
- Weekly review of vitamin adherence (aim for 7/7 days), monthly assessment of nutrition quality, and ongoing tracking of harmful substance avoidance. Users could set goals like ’take prenatal vitamin 6+ days per week’ or ’eat 3+ servings of vegetables daily.’
This article summarizes research findings and should not replace professional medical advice. Cleft lip and palate are serious medical conditions requiring specialized care. If you are pregnant, planning pregnancy, or have concerns about birth defects, consult with your healthcare provider or obstetrician. This study was conducted in Ethiopia and findings may not apply equally to all populations. While the identified risk factors are modifiable, some cases of cleft conditions occur despite optimal prenatal care due to genetic factors. Always follow your doctor’s specific recommendations for prenatal care and supplementation.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.