Reproductive Patterns Among Danish Women With Oral Clefts Janne Elin Yttri, M.D., Kaare Christensen, M.D., D.M.Sc., Lisbeth B. Knudsen, Mag. Scient. Soc., Camilla Bille, M.D., Ph.D. Objective: The aim of this study was to compare reproduction patterns among Danish women born with isolated oral clefts versus the Danish background population. Design and Setting: A nationwide population-based historic cohort study based on three registers: The Danish Facial Cleft Register, The Danish Civil Registration System, and the Fertility of Women and Couples Dataset. Participants: Through linkages of the registers, the number of children and the exact age at childbirth of all Danish women born with an oral cleft from 1950 through 1988 (N = 1931) were obtained. These data were compared with similar data for the entire Danish female background population (N = 1,184,390). Results and Conclusions: This study suggests that childlessness is higher among women born with an oral cleft (55%) than among women in the Danish background population (44%). Excluding women without children, women born with oral cleft had an average of 1.98 children per woman. This did not differ significantly from the background population (2.02 children/woman). Further- more, the present study found that Danish women born with oral clefts on average were older (27.3 years of age) than the background population (24.7 years of age) when they had their first child (difference = 2.6 years, confidence interval = 2.41 to 2.80). Conclusion: Danish women born with an oral cleft more often are childless or have their first child later, but if they have children, they tend to have as many children as other Danish women. Social, psychological, and biological reasons might be responsible for the reduced fertility. KEY WORDS: birth defects, oral clefts Oral clefts (OCs) are among the more common congenital malformations, with a birth prevalence of 1.4 per 1000 live births (Bille et al., 2005). Treatment of an OC is often complex and long term, starting in infancy and ending in young adulthood. Even though OC is often considered to be a repairable malformation, it might have severe consequences in childhood, through adolescence, and into adulthood. Focus on the psychological functioning of children and adolescents with OC has increased (Edwards et al., 2005). Several studies suggest that children and adolescents have unfavorable psychosocial experiences because of their facial appearance (Hunt et al., 2006; Hunt et al., 2007; Brand et al., 2009), but a recent systematic review was not able to conclude whether being born with an OC is associated with severe psychosocial difficulties (Hunt et al., 2005). One aspect of studying psychosocial well-being is to compare whether OC individuals act as individuals without OC regarding different long-term outcomes, e.g., mating/ mate selection, and reproduction. However, few studies have been done on this subject. A study of 233 adults 20 to 35 years of age with repaired OC indicated that fewer with OC marry, and when they marry, they do so later in life. This trend was particularly strong if the OC was bilateral (Ramstad et al., 1995). Also, fewer children were born to persons with OC, although this was not significant. Other Norwegian studies of females and males with registered birth defects, born in Norway from 1967 through 1982, found that females and males with different kinds of birth defects, here among OC, were one third less likely to have given birth to a child than those with no birth defects (Skjaerven et al., 1999; Lie et al., 2001). However, these studies followed individuals only until the age of 30 years. The studies discussed previously indicate that being born with an OC is associated with some kind of restraint in relation to establishing a family. However, these studies are based on relatively few OC cases. Furthermore, changes over time are possible. Great surgical improvement regarding cosmetic and functional results has occurred (Cohen et al., 2009); on the other hand, an increased focus Dr. Yttri is medical intern, Dr. Christensen is Professor, and Dr. Bille is senior fellow, Institute of Public Health, University of Southern Denmark, Odense, Denmark. Dr. Knudsen is Professor, Department of Sociology, Social Work, and Organization, Aalborg University, Aalborg, Denmark. Submitted November 2009; Accepted August 2010. Address correspondence to: Dr. Janne Elin Yttri, Vallmova ¨gen 58, 218 73 Tygelsjo ¨ , 004526363798, Sweden. E-mail jyttri@gmail.com. DOI: 10.1597/09-245 601