The simultaneous occurrence of 3 facial features (small palpebral fissures, a smooth philtrum, and a thin upper lip), assessed clinically, is currently required to diagnose fetal alcohol syndrome (FAS); the simultaneous occurrence of 2 of the 3 features is required to diagnose partial FAS. Recent research, using objective 3-dimensional facial imaging, has found differences between the facial shape of individuals with FAS and the facial shape of individuals without FAS or with partial FAS, as well as those with heavy prenatal alcohol exposure (PAE) but without a diagnosis of FAS or partial FAS.1 The study by Muggli and colleagues2 in this issue of JAMA Pediatrics extends this work by investigating the effects of lower levels of PAE using a regression-based approach to craniofacial shape. Their study has strengths in the measurement of both the exposure and the outcome.
Bower C, Baynam G. New Opportunities for Evidence in Fetal Alcohol Spectrum Disorder. JAMA Pediatr. 2017;171(8):731–732. doi:10.1001/jamapediatrics.2017.1342