Babies and cleft lip or palette

[cjbenete]

Hi mommys or mommys to be,

This is my first pregnant and I am wrapping up week 6.  The hormones are the worst part right now.  I am worrying too much about everything.  Especially that I've been on a low therapeutic dose of klonopin for 4-5 years.  I began tapering one the test confirmed positive and I'm currently on .75 and moving to .50.  I'm having anxiety but I'd rather have a little anxiety that a baby born with malformations.  I will never forgive myself.  Right now, I guess the babies lips are forming and at 10 weeks the palette will.  I'm afraid, although the risks are low, that I could cause problems for my baby.  I can't cold turkey the drug because of the extreme danger and risk of seizure.   Does anyone have information on the prevalance of cleft lips with mother who had been on klonopin or the first trimester?  I am scheduled to be off completely at 9 weeks.  I hope that's not too late!  

[HopieN]

I have been on Xanax since I was thirteen and i am 28 now, so I was taking a considerable dose. I am currently 21 weeks pregnant and although I had stopped taking all my meds at least six months ago (well before I became pregnant) I have had three previous pregnancies where I was order by my doctor and prenatal specialist to continue taking my meds for the entire pregnancy. All three of my boys are perfectly normal and had no kind of deformities, emotional, or mental problems what-so-ever. Hope this helps to put your mind at ease because I know how hard it is not to worry about these types of things.

[cjbenete]

Thank you so much. It helps to know the risk is low.  I just read the risk is .07% higher in women with exposure.  I know it's not the end of the world.  The guilt is eating away at me that I didn't discontinue my meds before I was pregnant.  

[AHP84]

Cleft lip and palate is most often a congenital defect (meaning hereditary) only. It can be caused by environmental toxins as well, but I think that risk is, in general, much lower. I'd suggest talking with your doctor about your concerns.
Here's an exerpt from Wiki that I found that might ease your mind a little until you can discuss this further with your doctor.

Cause

The development of the face is coordinated by complex morphogenetic events and rapid proliferative expansion, and is thus highly susceptible to environmental and genetic factors, rationalising the high incidence of facial malformations. During the first six to eight weeks of pregnancy, the shape of the embryo's head is formed. Five primitive tissue lobes grow:
a) one from the top of the head down towards the future upper lip; (Frontonasal Prominence) b-c) two from the cheeks, which meet the first lobe to form the upper lip; (Maxillar Prominence) d-e) and just below, two additional lobes grow from each side, which form the chin and lower lip; (Mandibular Prominence)
If these tissues fail to meet, a gap appears where the tissues should have joined (fused). This may happen in any single joining site, or simultaneously in several or all of them. The resulting birth defect reflects the locations and severity of individual fusion failures (e.g., from a small lip or palate fissure up to a completely malformed face).

The upper lip is formed earlier than the palate, from the first three lobes named a to c above. Formation of the palate is the last step in joining the five embryonic facial lobes, and involves the back portions of the lobes b and c. These back portions are called palatal shelves, which grow towards each other until they fuse in the middle.[19] This process is very vulnerable to multiple toxic substances, environmental pollutants, and nutritional imbalance. The biologic mechanisms of mutual recognition of the two cabinets, and the way they are glued together, are quite complex and obscure despite intensive scientific research.[20]

Genetics

Genetic factors contributing to cleft lip and cleft palate formation have been identified for some syndromic cases, but knowledge about genetic factors that contribute to the more common isolated cases of cleft lip/palate is still patchy.

Many clefts run in families, even though in some cases there does not seem to be an identifiable syndrome present,[21] possibly because of the current incomplete genetic understanding of midfacial development.

A number of genes are involved including cleft lip and palate transmembrane protein 1 and GAD1,[22] one of the glutamate decarboxylases. Many genes are known to play a role in craniofacial development and are being studied through the FaceBase initiative for their part in clefting. These genes are AXIN2, BMP4, FGFR1, FGFR2, FOXE1, IRF6, MAFB (gene), MMP3, MSX1, MSX2 (Msh homeobox 2), MSX3, PAX7, PDGFC, PTCH1, SATB2, SOX9, SUMO1 (Small ubiquitin-related modifier 1), TBX22, TCOF (Treacle protein), TFAP2A, VAX1, TP63, ARHGAP29, NOG, NTN1, WNT genes, and locus 8q24. (http://en.wikipedia.org/wiki/Cleft_lip_and_palate)

I have a maternal aunt who was born with a cleft lip and palate and she has led a fulfilling and healthy life--she is 57 or 58 years old.