Trends in Cleft Palate Incidence in the Era of Prenatal Ultrasonography and Early Detection

ObjectiveTo evaluate whether temporal changes in prenatal detection and North Carolina abortion rates are associated with live-birth cleft palate (CP ± L) severity phenotypes.DesignRetrospective cohort study linking patient-level clinical data to annual state abortion rates. Analyses included Pearson correlation, multivariable logistic, and interrupted time-series modeling.SettingSingle-center craniofacial program, with linkage to annual statewide abortion rates as a population-level contextual variable.Patients, Participants554 patients undergoing primary palatoplasty (1999 to 2021).InterventionsNone.Main Outcome Measure(S)Primary outcomes: annual Veau classification distribution. Secondary outcomes: prenatal diagnosis rates and genetic syndrome or sequence rates.ResultsFrom 2004 to 2021, the proportion of Veau I cases increased from 18.2% to 25.0% (slope β= + 0.0074 proportion-units/year; P = .051), the proportion of Veau III cases declined significantly (slope β= -0.0085 proportion-units/year; P = .011), and the proportion of Veau IV cases trended downward non-significantly. Higher abortion rates correlated with greater Veau III proportions (r = 0.63, P = .005). Logistic regression demonstrated that each 1-SD increase in abortion rate raised severe-cleft odds by 26% (odds ratio (OR) 1.26; 95% CI 1.05-1.51; P = .014), prenatal diagnosis (OR 13.13; P < .001) and presence of genetic syndrome or sequence (OR 0.36; P < .001) were also significant. Cleft severity decreased prior to 2010 (β = -0.11 units/year; P = .036) and then plateaued. Prenatal diagnosis rates increased sevenfold during the study period.ConclusionsEnhanced prenatal detection and abortion rate shifts had minimal impact on live-birth CL/P trends. The paradoxical association between higher abortion rates and severe clefts suggests that reproductive decision-making is influenced by multifactorial factors beyond detection.