Researchers in Ghana studied 103 children born with cleft lips or palates and compared them to children without these conditions. They wanted to understand if low folate (a B vitamin) in mothers’ blood caused these birth defects. While they found that mothers of affected children had lower folate levels, the story was more complicated than expected. When researchers looked at the whole picture of what mothers ate—including other B vitamins, iron, and zinc—they discovered that it’s not just about folate alone. A combination of good nutrition, especially B vitamins and iron, appeared to protect against these birth defects. This suggests doctors should think about mothers’ complete nutrition, not just one vitamin.

The Quick Take

  • What they studied: Does low folate (a B vitamin) in pregnant mothers’ blood increase the risk of babies being born with cleft lips or cleft palates, and do other nutrients play a role?
  • Who participated: The study included 103 children born with cleft lips or palates in Kumasi, Ghana, compared to a similar group of children born without these conditions. Researchers interviewed the mothers and measured their blood folate levels and diet.
  • Key finding: More than half of mothers whose babies had clefts had low folate levels (52.4%), compared to only 28.2% of mothers whose babies didn’t have clefts. However, when researchers looked at all the nutrients together, folate alone wasn’t the main predictor—other B vitamins, iron, and maternal age mattered too.
  • What it means for you: If you’re planning to get pregnant, focus on eating a balanced diet rich in B vitamins, iron, and other nutrients rather than worrying about just one vitamin. This research suggests that good overall nutrition is more protective than any single nutrient. Talk to your doctor about prenatal vitamins and nutrition planning.

The Research Details

This was a case-control study, which is like comparing two groups of people to find differences. Researchers identified children born with cleft lips or palates (the ‘case’ group) and matched them with children born without these conditions (the ‘control’ group). They then looked backward at the mothers’ nutrition during pregnancy.

The researchers collected information in two ways: they asked mothers detailed questions about what they ate over a 24-hour period, and they took blood samples to measure folate levels directly. They also measured mothers’ weight and body composition using a special device. This approach allowed them to see both what mothers reported eating and what their blood tests actually showed.

The study took place in Ghana from January to July 2024, which is important because nutrition patterns and food availability differ from developed countries. This helps us understand whether these findings apply to different populations around the world.

Case-control studies are useful for studying birth defects because they’re faster and less expensive than following pregnant women forward in time. By comparing mothers whose babies had clefts to those whose babies didn’t, researchers can identify nutritional patterns that might be protective or harmful. Measuring actual blood folate levels is more accurate than just asking what people ate, because it shows what the body actually absorbed.

Strengths: The study measured blood folate directly rather than relying only on memory of what was eaten. Researchers used standardized methods and collected detailed dietary information. The findings come from a real-world setting in a developing country, which adds valuable information. Limitations: The sample size was relatively small (103 cases), which means results might not apply to larger populations. The study was conducted in one city in Ghana, so results might differ in other regions. The study design looks backward, so it can show associations but not prove cause-and-effect. Some mothers might not accurately remember what they ate months earlier.

What the Results Show

The most striking finding was that mothers of children with cleft defects had significantly lower folate levels in their blood. Specifically, 52.4% of mothers in the cleft group had low folate compared to only 28.2% in the control group—a clear and statistically significant difference.

However, when researchers used statistical models to account for other factors, plasma folate alone stopped being a significant predictor. This was surprising and suggests that folate in the blood doesn’t tell the whole story. The real predictors turned out to be: how much dietary folate mothers consumed (from food), iron intake, vitamin B6 intake, vitamin B12 intake, and the mother’s age.

Vitamin B6 and B12 appeared especially protective—mothers with higher intakes of these vitamins had much lower odds of having babies with clefts. Iron also showed a protective effect. Interestingly, maternal age was a risk factor; older mothers had slightly higher odds of having babies with clefts.

This pattern suggests that the body’s ability to use and process folate depends on having adequate B6, B12, and iron. It’s like having all the right ingredients for a recipe rather than just one key ingredient.

The study revealed that dietary intake of folate (from food) was more predictive than blood folate levels alone. This suggests that what mothers actually eat matters more than a single blood test. Vitamin B6 showed the strongest protective effect among all nutrients studied. The combination of multiple B vitamins working together appeared important, suggesting these nutrients work as a team in the body. Maternal age emerged as an independent risk factor, which aligns with existing research showing that older maternal age increases risks for various birth defects.

Previous research has long emphasized folate’s importance for preventing cleft defects, and this study confirms that low folate is associated with increased risk. However, this research adds important nuance by showing that folate alone is insufficient. The finding that multiple B vitamins and iron work together aligns with modern understanding of nutrition science—that nutrients don’t work in isolation but as part of interconnected metabolic pathways. The study supports the growing recognition that ’nutrient interactions’ matter as much as individual nutrients.

The study was conducted in only one city in Ghana, so findings may not apply to other regions or countries with different food availability and dietary patterns. The sample size of 103 cases is relatively small, which limits statistical power and the ability to detect smaller effects. As a case-control study looking backward, it cannot prove that low nutrition caused the clefts—only that an association exists. Mothers may not accurately remember their diet from months earlier. The study didn’t account for genetic factors, which are known to influence cleft risk. Socioeconomic factors and access to healthcare weren’t fully explored.

The Bottom Line

Women planning pregnancy should aim for a balanced diet rich in B vitamins (especially B6 and B12), iron, and folate rather than focusing on any single nutrient. Taking a prenatal vitamin containing these nutrients is reasonable and supported by this research (moderate confidence). Eating a varied diet with leafy greens, whole grains, lean meats, and legumes naturally provides these nutrients. Consult with a healthcare provider about appropriate supplementation based on individual needs and local food availability.

Women planning to become pregnant should pay attention to these findings, especially those in developing countries where malnutrition is more common. Healthcare providers in resource-limited settings should consider comprehensive nutritional assessment rather than focusing on folate alone. This research is less immediately relevant to women already pregnant, though good nutrition remains important throughout pregnancy. Men don’t need to change behavior based on this research, as it focuses on maternal nutrition.

Nutritional status develops over months, so women should ideally improve their diet at least 2-3 months before trying to become pregnant. The critical period for cleft prevention is during the first trimester (first 3 months of pregnancy), so pre-pregnancy nutrition is particularly important. Benefits of improved nutrition would be seen in reduced cleft risk in future pregnancies, not in immediate personal health changes.

Want to Apply This Research?

  • Track daily intake of B vitamins (B6, B12, folate), iron, and zinc through food logging. Set targets: folate 400 mcg/day, B6 1.3 mg/day, B12 2.4 mcg/day, iron 18 mg/day (pre-pregnancy women). Monitor weekly averages rather than daily perfection.
  • Add one B-vitamin-rich food to each meal: leafy greens at lunch, eggs at breakfast, legumes at dinner. Use the app to identify which foods provide multiple protective nutrients simultaneously. Set reminders to take prenatal vitamins if recommended by your doctor.
  • Track nutritional intake for 4-week cycles, aiming for 80% compliance with nutrient targets. Use the app’s trending feature to see if intake improves over months. If planning pregnancy, maintain tracking for at least 3 months pre-conception. Share reports with healthcare provider during preconception counseling visits.

This research describes associations between maternal nutrition and cleft defects but does not prove that nutrition changes will prevent clefts, as genetic and other environmental factors also play important roles. Cleft lip and palate have multiple causes, and good nutrition is just one protective factor. This information is not a substitute for medical advice from your doctor or midwife. If you are planning pregnancy or are pregnant, consult with your healthcare provider about appropriate nutrition and supplementation for your individual situation. While this study was conducted in Ghana, results may not apply equally to all populations. Always discuss any dietary changes or supplements with your healthcare team before starting.