Orofacial clefts, including cleft lip and/or palate, are common congenital anomalies that pose significant feeding, speech, dental, hearing, and psychosocial challenges. Folic acid supplementation before and during early pregnancy is increasingly recognized as a preventive measure for these defects. This case series study investigates the association between the absence of maternal folic acid supplementation and orofacial clefts in nine infants at Guardian Hospital, Meru, Kenya, from April 13–16, 2025.

Eight mothers were interviewed, with only three reporting folic acid use, and none taking it during the critical peri-conceptional period when craniofacial structures form. Infants of mothers who did not take folic acid or started supplementation late were more likely to present with clefts. Barriers to supplementation included delayed antenatal care, lack of awareness, intolerance to supplement taste, and vomiting.

The clinical presentations included unilateral and bilateral clefts, cleft palate, and clefts with fistulas across both male and female infants, with six out of nine being male. The finding align with global evidence indicating that folic acid supplementation reduces the risk of cleft lip and palate.

This study highlights the urgent need for strengthened public health education, improved ANC attendance, formulations that minimize side effects, and consideration of folic acid fortification initiatives. These measures may significantly lower the burden of cleft anomalies in Kenya.

The results emphasize that folic acid intake must begin before conception and continue through early pregnancy to maximize its impact on craniofacial development. The study further underscores the importance of addressing cultural, systemic, and individual barriers to supplementation.