ORIGINAL ARTICLE Professional opinion on oral cleft during pregnancy: a comparison between Israel and the Netherlands Wies Maarse 1 *, Chantal W. B. Boonacker 2 , Oren Lapid 3 , Henriette F. N. Swanenburg De Veye 4 , Zeev Weiner 5 , Moshe Kon 1 , Johannes J. M. van Delden 2 and Aebele B. Mink van der Molen 1 1 Department of Plastic and Reconstructive Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands 3 Department of Plastic and Reconstructive Surgery, Academic Medical Center, Amsterdam, The Netherlands 4 Department of Pediatric Psychology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands 5 Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel *Correspondence to: Wies Maarse. E-mail: w.i.maarse@gmail.com ABSTRACT Objective The aim of this study was to assess the opinion of obstetric care providers who perform prenatal ultrasounds to screen for anomalies and who advise women about their options, including termination of pregnancy, when an oral cleft is detected. We compared providers’ opinions about pregnancy termination for isolated oral cleft in the Netherlands, where the number of terminations is low, and in Israel, where the number is high. Methods Online questionnaires were used. The questions assessed the providers’ views regarding the estimated burden of treatment, the functioning ability, and the level of happiness of children with an oral cleft and their parents. Additionally, we assessed providers’ opinions on pregnancy termination for isolated oral cleft. Results In the Netherlands, more professionals considered oral cleft a disability (rate differences 17.8%, 95% confidence interval: 0.5–33.1%) than in Israel. In the Netherlands, 10.6% of respondents (compared with 11.1% in Israel) thought that an isolated cleft was a reason for terminations of pregnancy (TOP) (rate differences 0.6%, 95% confidence interval: À12% to 10.9%). Conclusions Prenatal care providers in the Netherlands and Israel do not differ in their opinions about the severity of oral cleft and the acceptability of TOP for an isolated oral cleft. This study shows that prenatal care providers’ attitudes do therefore not explain the dramatic difference between these countries in the number of TOP for isolated oral cleft. © 2015 John Wiley & Sons, Ltd. Funding sources: None Conflicts of interest: None declared INTRODUCTION Oral clefts are among the most common congenital malfor- mations; they occur in approximately one out of 700 live births. 1 Because the use of ultrasound screening during pregnancy has become the standard of care, the prenatal diagnosis of oral clefts is common and has a detection rate of 88%. 2 There is some controversy about the parental, social, and ethical consequences of prenatal detection of oral clefts. 3 The prenatal detection of an oral cleft has numerous advantages. Not only are the parents better prepared psychologically for the anomaly, but awareness of the diagnosis provides an opportunity to educate about both the treatment of oral clefts and the management of possible feeding problems. The prenatal diagnosis of an oral cleft also provides an opportunity to offer additional genetic testing to screen for possible associated anomalies and chromosomal defects. 4,5 The disadvantages of the prenatal diagnosis of oral cleft are the possibility of a false positive diagnosis and the resulting emotional stress on the pregnancy. 6,7 The fact that at present time prenatal surgery may not be an option or may carry very high risks is another disadvantage. 8 Additionally, there are concerns about the possible increasing number of terminations of pregnancy (TOP) of fetuses with an isolated oral cleft. 9 Because most nonsyndromic oral clefts are nonlethal birth defects that have an excellent functional and esthetic prognosis with proper treatment, the use of prenatal diagnosis raises important ethical issues, especially in terms of TOP. 10,11 High numbers of TOPs for prenatally diagnosed isolated oral clefts have been reported in Israel (93.4%). 9 In the Netherlands, the number of parents who choose TOP when an oral cleft is detected is low (6.7%). 12 The reasons for these differences are unknown. In addition to cultural and religious influences, the Prenatal Diagnosis 2015, 35,1–5 © 2015 John Wiley & Sons, Ltd. DOI: 10.1002/pd.4570