You can’t eliminate the risk of cleft lip and palate entirely, but several evidence-based steps taken before and during early pregnancy can meaningfully lower it. The critical window is narrow: the lip forms between weeks 4 and 7 of pregnancy, and the palate forms between weeks 6 and 9. That means many of the most important protective actions need to happen before you even know you’re pregnant, which is why preconception planning matters so much.
Why the First Trimester Matters Most
A cleft forms when the tissues that make up the lip or the roof of the mouth don’t fully fuse together during early embryonic development. Because this fusion happens so early, between roughly weeks 4 and 9, any disruption during that window can have permanent effects. By the time most people confirm a pregnancy with a home test (around week 4 or 5), the lip is already forming. This timeline is the single most important thing to understand about prevention: the protective steps that matter most are the ones you take before conception or in the earliest days afterward.
Start Folic Acid Before Conception
Taking 400 micrograms of folic acid daily is the most well-supported nutritional step you can take. Current guidelines recommend starting this supplement at least four weeks before conception and continuing through the first 12 weeks of pregnancy. Folic acid supports the rapid cell division involved in forming facial structures and the neural tube. Because roughly half of pregnancies are unplanned, public health agencies recommend that all women of childbearing age take folic acid daily if there’s any possibility of becoming pregnant.
You can get folic acid through a standard prenatal vitamin or a standalone supplement. Fortified cereals and leafy greens contribute some folate through diet, but supplementation is the more reliable route for reaching the recommended dose consistently.
Avoid Smoking and Alcohol
Maternal smoking increases the risk of cleft lip and palate by 30% to 50%, according to the U.S. Surgeon General’s report. A large meta-analysis found that smokers had 42% higher odds of having a baby with a cleft compared to nonsmokers. Quitting before conception is ideal, but quitting at any point in early pregnancy still reduces exposure during the critical window.
Alcohol exposure during the first trimester can disrupt the cells that form the lip and palate by interfering with the gene activity that guides early facial development. Binge drinking in the first trimester has been specifically linked to increased cleft risk in large population studies. There is no established safe amount of alcohol during early pregnancy, and the safest approach is to stop drinking when you start trying to conceive.
Manage Fever Early and Aggressively
Running a fever from a cold or flu during the periconceptional period (the month before conception through the first two months after) is associated with a higher risk of cleft lip. In a large national study, fever-accompanied illness during this window raised cleft lip risk by about 23%. Notably, cold or flu without fever showed no increased risk, suggesting it’s the elevated body temperature itself, not the infection, that contributes to the problem.
If you develop a fever in early pregnancy, bringing your temperature down promptly matters. Talk to your healthcare provider about which fever-reducing options are appropriate for you during pregnancy.
Review Your Medications
Certain medications taken during the first trimester can increase cleft risk significantly. The most well-documented example is topiramate, an anticonvulsant used for epilepsy and sometimes prescribed for migraines. Data from a pregnancy registry found that infants exposed to topiramate alone in the first trimester had a 1.4% rate of oral clefts, compared to 0.07% among infants of mothers not taking antiepileptic drugs. That’s roughly a 20-fold increase.
Other medication classes that have been linked to cleft risk include certain acne treatments derived from vitamin A (retinoids), some corticosteroids, and other antiepileptic drugs, though at lower rates than topiramate. If you’re on any long-term medication and planning a pregnancy, a preconception medication review with your prescriber gives you time to switch to safer alternatives before the critical development window opens.
Control Blood Sugar if You Have Diabetes
Pre-existing diabetes (type 1 or type 2 diagnosed before pregnancy) roughly triples the risk of cleft lip and palate and nearly quadruples the risk of cleft palate alone, based on a study of over 650,000 births in New York. Gestational diabetes, the kind that develops during pregnancy, did not show the same association, likely because it typically appears after the palate has already formed.
The implication is clear: if you have diabetes and are planning a pregnancy, getting your blood sugar into a well-controlled range before conceiving is one of the most impactful things you can do. Elevated blood sugar during those first 9 weeks, when facial structures are forming, is the core risk. Women with pre-existing diabetes in this study also had higher average BMIs, and being overweight or obese before pregnancy is independently associated with certain birth defects, making weight management another relevant factor during preconception planning.
Reduce Exposure to Heavy Metals
A case-control study measuring heavy metal concentrations in umbilical cord tissue found striking increases in cleft risk associated with four metals: lead, arsenic, cadmium, and nickel. Lead exposure showed the strongest association, with a 15-fold increase in risk at higher concentrations. Arsenic, cadmium, and nickel showed 7- to 8-fold increases. The study also found a dose-response relationship, meaning higher concentrations corresponded to higher risk.
Practical steps to limit exposure include:
- Lead: Test old paint and household water if you live in a home built before 1978. Use a water filter certified for lead removal.
- Arsenic: If you rely on well water, get it tested. Some rice-based foods contain measurable arsenic levels.
- Cadmium: Found in cigarette smoke (another reason to quit), some fertilizers, and certain occupational settings.
- Nickel: Primarily an occupational exposure in metalworking and plating industries.
Understanding Genetic Risk
Cleft lip and palate is considered a multifactorial condition, meaning it results from a combination of genetic predisposition and environmental exposures. You can’t change the genetic component, but knowing your family history helps you understand your baseline risk and motivates more careful attention to the modifiable factors above.
A large Danish study of over 54,000 relatives of people born with clefts found that if one parent or sibling has a cleft lip with cleft palate, the risk for a subsequent child is about 4%. That’s significantly higher than the general population rate (roughly 0.1%), but it still means the odds are strongly in favor of an unaffected baby. For second-degree relatives like aunts, uncles, or grandparents, the risk drops to about 0.8%, and for third-degree relatives it’s around 0.6%.
If you or your partner have a family history of clefts, genetic counseling before pregnancy can help you understand your specific risk profile and create a plan that addresses both genetic and environmental factors.