Prenatal Knowledge of Cleft Lip/Palate Shows Little Advantage Over Birth Discovery

Many expectant parents look forward to routine ultrasounds as their first opportunity to “see” their baby. But the ultrasound can reveal that the fetus has unexpected medical conditions, such as a diagnosis of cleft lip and palate. Despite the emotional distress the diagnosis can bring, it can also offer the opportunity to prepare for the child’s future needs. However, a study has found little difference between mothers who were given a prenatal diagnosis of cleft lip and palate and those who discovered the problem at birth.

The authors of the study, which is reported in the September 2010 issue of The Cleft Palate - Craniofacial Journal, conducted interviews with 235 mothers of children aged 2 to 7 years with orofacial clefts. Of these children, 46% had been identified prenatally with cleft lip or cleft lip and palate. Overall, prenatal diagnosis is made in about 20% to 30% of pregnancies affected by an orofacial cleft.

Contrary to expectations, few advantages were found for having a prenatal diagnosis. Those with early knowledge of the condition did not report greater satisfaction with information, support, and treatment outcomes, although they had more time to learn and prepare. The two groups did not differ in number of surgeries, expectations for surgeries, complications of surgery, or the quality of care as rated by the mother.

Early planning for a child's condition could allow parents to seek information and counseling or find resources. An appropriate cleft care team - composed of at least a surgeon, dental professional, and speech professional - could be identified and contacted or organized. Many established cleft care teams hold prenatal consultations with parents expecting a baby with an orofacial cleft.

The one area of the study that did show a significant difference was feeding the newborn child. Infants born with orofacial clefts have unique feeding requirements, and feeding these infants can be difficult and anxiety-provoking for untrained providers and parents. Mothers who were given an early diagnosis reported more positively about providers’ help in making it easier for their infants to feed.

Not only can parents make necessary emotional and medical adjustments with an early diagnosis, but they can also make more practical adjustments. Changes in employment, health insurance, and child care plans may be in order.

The authors acknowledge other questions for which there are not yet answers: whether the early diagnosis might cause greater maternal anxiety, whether being given information about a problem that cannot be corrected prenatally is of any value, and whether the early diagnosis might encourage termination of a pregnancy that shows no other malformations.

Full text of the article, “Prenatal Diagnosis of Orofacial Clefts: Association With Maternal Satisfaction, Team Care, and Treatment Outcomes,” The Cleft Palate–Craniofacial Journal, Volume 47, Issue 4, July 2010, is available at http://www2.allenpress.com/pdf/cpcj-47-05-476-481.pdf.