Maternal Factors and Cleft Lip/Palate in Four Low-Resource Settings: Prevention and Interventions

Objective Despite advances in surgical management of cleft lip and/or palate (CL/P), prevention remains the most cost-effective strategy, especially in low-resource settings where access to care is limited. Identifying maternal factors is essential for guiding targeted interventions. This study identifies context-specific maternal factors associated with CL/P to inform public and global health strategies. Design Retrospective chart review. Setting Ecuador, El Salvador, Lebanon, and Peru. Patients/Participants Non-syndromic patients with CL/P treated by Global Smile Foundation from 2010 to 2024. Interventions Maternal variables included age at delivery, education, family history of cleft, smoking and smoke exposure, alcohol consumption, folic acid and multivitamin use, pre-pregnancy body mass index (BMI), gestational weight gain, and consanguinity. Main Outcome Measure(s) Maternal factors associated with CL/P. Results A total of 1068 charts were reviewed. CL/P was most common among mothers aged (n = 285) 25-29 years (27.7%), followed by 15-20 years (20.4%). Most had completed secondary school (42.5%, n = 308), and 71.9% reported no family history of cleft (n = 966). Prenatal exposures included active smoking (2.9%, n = 1068), alcohol use (1.9%, n = 1068), and coffee consumption (43.3% reporting 1-2 cups/day, n = 201). Folic acid and multivitamin use were reported in 70.5% (n = 207) and 45.3% (n = 245), respectively. Passive smoke exposure (n = 201) was primarily from cooking smoke (34.8%) and cigarettes (23.4%). Mean pre-pregnancy BMI (n = 107) was 26.3 kg/m 2 with 10.7 kg gestational weight gain (n = 115). Consanguinity (n = 797) was reported in 10.7% of cases. Conclusion Variations in maternal factors reflect inequities in preventive care and health education, emphasizing the need to prioritize antenatal services, supplementation, and culturally appropriate education.