What Causes a Cleft Palate During Pregnancy?
At a Glance
A cleft palate is not caused by anything a parent did wrong. It is a multifactorial condition resulting from a complex mix of genetics and environmental factors that prevent the roof of the mouth from fully fusing between weeks 8 and 12 of pregnancy.
In this answer
4 sections
If you have just learned that your baby has a cleft palate, one of the first questions you might ask is, “Did I do something wrong?” The direct answer is no. A cleft palate is almost never caused by a single action you took or didn’t take during your pregnancy [1][2][3]. Medical experts describe the causes of most clefts as multifactorial, meaning they happen due to a complex, unpredictable mix of many different genetic and environmental factors [1][2][3].
The Crucial Window of Development
A baby’s face and mouth form very early in pregnancy. The development of the primary palate (which includes the lip and front of the upper gum) happens between weeks 4 and 7 of gestation [4][5]. The secondary palate (the roof of the mouth, which is what is involved in an isolated cleft palate) forms a little later, between weeks 8 and 12 [4][6].
During this 8 to 12-week window, two pieces of tissue called palatal shelves grow vertically, flip to a horizontal position, and then fuse together in the middle to form the roof of the mouth [6]. This is a highly complex process controlled by dozens of different biological signals [7][6]. If anything subtly alters the timing or strength of these signals, the shelves may not fuse completely, resulting in a cleft [7][6].
The Genetic Blueprint
Genetics play a major role in how the palate forms. Many cases of cleft palate are non-syndromic, meaning they happen on their own without any other health problems [8]. These are linked to natural variations in several genes (like IRF6) that parents may unknowingly pass down [8][9].
Other times, a cleft palate is syndromic, meaning it is part of a broader genetic condition (such as Van der Woude syndrome) [10]. If there is a genetic component, it is simply part of your family’s DNA blueprint—not something caused by your actions during pregnancy.
Environmental Risk Factors
While no single factor causes a cleft palate, researchers have identified a few environmental factors that, when combined with a genetic predisposition, can slightly increase the risk during the first trimester. These include:
- Maternal Smoking: Smoking during early pregnancy is a well-established risk factor for oral clefts [11][12].
- Pre-gestational Diabetes: Having diabetes before becoming pregnant (pre-gestational diabetes) increases the risk, as early high blood sugar levels can impact organ and tissue development [13][14]. Gestational diabetes (which develops later in pregnancy) does not carry the same risk for cleft palate because the palate has usually already formed by the time the condition develops [15].
- Prenatal Vitamins: A lack of folic acid and multivitamins early in pregnancy can be a contributing factor [16][17]. However, missing a dose or starting vitamins late does not single-handedly cause a cleft. Many parents who take their vitamins perfectly still have babies with a cleft [18].
- Alcohol Consumption: Drinking alcohol during the first trimester can also interact with genetic factors to slightly increase the risk [19][16].
- Certain Medications: The use of specific anti-seizure medications, such as topiramate, during the first trimester has been linked to a higher risk of cleft lip and palate [20]. However, treating serious maternal conditions (like epilepsy) is medically essential. Mothers should never feel guilty for following their doctor’s advice to manage their own health during pregnancy.
Even when these risk factors are present, they only increase the chance of a cleft—they are not guarantees. Most parents who have these risk factors have babies without clefts, and many parents with no risk factors have babies with clefts [18].
Letting Go of Guilt
Parental guilt is normal, but it is misplaced. A cleft palate is the result of biology, genetics, and timing interacting in ways that modern medicine still doesn’t entirely understand [2][3].
Instead of focusing on those early weeks of pregnancy, you can channel your energy into actionable next steps. Consider asking for a referral to a genetic counselor, who can help you understand the exact causes and any future risks [3]. You will also want to begin building a multidisciplinary care team—often including a pediatric plastic surgeon, an ENT (ear, nose, and throat doctor), a speech therapist, and a feeding specialist to address immediate concerns like how to safely feed your baby [21].
Common questions in this guide
Is a cleft palate caused by something I did wrong during pregnancy?
When does a cleft palate develop during pregnancy?
Are there genetic factors that cause a cleft palate?
What environmental risk factors are linked to cleft palate?
Will my next child also have a cleft palate?
Questions to Ask Your Doctor
Curated prompts to bring to your next appointment.
- 1.Given my child's diagnosis, do you recommend we see a genetic counselor to determine if the cleft is syndromic or non-syndromic?
- 2.How will the type and width of my baby's cleft palate impact our immediate feeding plan?
- 3.Which specialists—such as a pediatric plastic surgeon, ENT, speech therapist, or feeding specialist—should be on our multidisciplinary cleft care team during the first year?
- 4.If we plan to have more children in the future, what are the chances that another child might have a cleft palate?
Questions For You
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References
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This page explains the potential causes of a cleft palate during pregnancy for educational purposes. It is not a substitute for professional medical advice, diagnosis, or genetic counseling.
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