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In 2022, the European Food Safety Authority (EFSA) conducted a dietary cumulative risk assessment for active substances of plant protection products on two types of craniofacial alterations: 1) craniofacial alterations due to abnormal skeletal development and 2) head soft tissue alterations and brain neural tube defects. These effects were selected based on developmental biology knowledge and a hypothetical teratogenic process. Cumulative risk assessment was conducted for 14 European populations of women in childbearing age. The dietary cumulative exposure was determined using individual consumption data collected under national food consumption surveys, and the calculations were based on occurrence data collected by Member States under their official monitoring programmes. A rigorous uncertainty analysis was performed using expert knowledge elicitation. Considering all sources of uncertainty, their dependencies, and differences between populations, it was concluded that the total margin of exposure (MOET) resulting from cumulative exposure to residues of pesticides is above 100 for both types of craniofacial alterations and therefore the threshold for regulatory consideration is not exceeded. For the head soft tissue alterations and brain neural tube defects the MOET was even above 500 while for the alterations due to abnormal skeletal development, it was found about as likely as not that the MOET is above 500 in most populations. These results need to be interpreted in the light of the conservatism of the hazard assessment methodology. This review is a summary of the EFSA report on a retrospective cumulative dietary risk assessment of craniofacial alterations by residues of pesticides published in 2022., Competing Interests: Declaration of Competing Interest Authors do not have any interest to declare, (Copyright © 2024 Elsevier Inc. All rights reserved.)