Birthweight in Infants with a Cleft Lip and/or Palate: A Systematic Review and Meta-Analysis.

Abstract

To understand the association between birthweight and orofacial cleft ("cleft"), considering key covariates. We conducted a systematic review and meta-analysis by searching 7 electronic databases for articles published before February 9, 2025. We used Rayyan systematic review software to screen 5,651 identified articles with birthweight estimates on infants with cleft. Two reviewers manually reviewed 296 articles for eligibility; a third reviewer resolved any discrepancies. We extracted data on birthweight (mean and low birthweight [<2500 grams]), cleft type (cleft lip, cleft palate, cleft lip and palate), comorbidity status (yes/no), and country income status (high vs low- or middle- income per World Bank). We used a multilevel mixed-effects model to estimate overall birthweight and birthweight stratified by cleft type, comorbidity status, and country income status. Sixty-three studies were included; 39 studies (66 effect sizes, n=25,991 infants) reported mean birthweight in infants with cleft. Unadjusted mean birthweight was 3143g (95% confidence interval [CI]: 3056, 3231). Mean birthweight was 3405g (95% CI: 3285, 3525) after adjusting for cleft type, comorbidity status and country income status. Lower birthweight estimates were observed among infants in low- or middle- income (vs high-income) country status and for infants with comorbidities (vs no comorbidities). Birthweight in infants with cleft is similar to global birthweight standards after accounting for country income status and comorbidity status and adjusted birthweight did not differ by cleft type. These findings emphasize the need for close attention to postnatal growth monitoring, feeding, and nutritional interventions among infants with cleft.