The relationship between alkaline earth elements in utero exposure and the risk of
cleft lip with or without
cleft palate (CL ± P) remains unclear. We aimed to investigate the associations between the concentration of alkaline earth elements in umbilical cord and risk for CL ± P. A case-control study was carried out in this study, including 78 cases and 142 controls. Association between each metals and the risk of CL ± P were evaluated with conventional logistic regression, bayesian kernel machine regression and weighted quantile sum regression models. Logistic regression model indicated that in utero exposure to higher levels of
Barium was associated with increasing risk for CL ± P (odds ratio = 2.79, 95% confidence interval, 1.22-6.38) and for
cleft lip with
cleft palate (odds ratio = 3.94, 95% confidence interval, 1.45-10.72). Bayesian kernel machine regression model showed the statistical association between the metals mixture and risk difference of CL ± P, and
barium was associated with CL ± P risk when all other metals were held fixed at the 25th percentiles (risk difference = 1.07, 95% confidence interval, 1.01-1.14). In weighted quantile sum model,
barium accounted for most of the weight index in the combined effect of the metals mixture. The weighted quantile sum index showed that a quartile increase in the index resulted in an increase odds of 1.69 (95% confidence interval, 1.16-2.46) for CL ± P and of 2.11 (95% confidence interval, 1.34-3.35) for CLP. No associations were found in the three statistical models between
Calcium,
Magnesium and
Strontium and the risks of CL ± P. In conclusion, in utero exposure to mixtures of alkaline earth elements was associated with an increased risk for CL ± P, of which
barium was likely to be important factors in the development.