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Original Investigation
August 2017

Association Between Prenatal Alcohol Exposure and Craniofacial Shape of Children at 12 Months of Age

Author Affiliations
  • 1Public Health Genetics, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  • 2Department of Paediatrics, University of Melbourne, Victoria, Australia
  • 3Plastic and Maxillofacial Surgery, Royal Children’s Hospital, Melbourne, Victoria, Australia
  • 4Plastic Surgery, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  • 5Department of Electrical Engineering, Processing Speech and Images, Katholieke Universiteit Leuven, Leuven, Belgium
  • 6Medical Imaging Research Center, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
  • 7Telethon Kids Institute, Perth, Western Australia, Australia
  • 8Judith Lumley Centre, School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
  • 9Midwifery and Maternity Services Research Unit, The Royal Women’s Hospital, Parkville, Victoria, Australia
  • 10Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  • 11Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
  • 12Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  • 13Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia
  • 14Women’s and Children’s Division, Western Health, St Albans, Victoria, Australia
  • 15Environmental and Genetic Epidemiology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  • 16Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  • 17Paediatrics and Child Health, Children’s Hospital Westmead, University of Sydney, Sydney, New South Wales, Australia
JAMA Pediatr. 2017;171(8):771-780. doi:10.1001/jamapediatrics.2017.0778
Key Points

Question  Is there an association between different levels of prenatal alcohol exposure and child craniofacial shape at 12 months?

Findings  This cohort study conducted an objective and sensitive craniofacial phenotype analysis of 415 children, which showed an association between prenatal alcohol exposure and craniofacial shape at almost every level of exposure examined. Differences in the midface and nose resemble midface anomalies associated with fetal alcohol spectrum disorder.

Meaning  Any alcohol consumption has consequences on craniofacial development, supporting advice that complete abstinence from alcohol while pregnant is the safest option; it remains unclear whether the facial differences are associated neurocognitive outcomes of prenatal alcohol exposure.

Abstract

Importance  Children who receive a diagnosis of fetal alcohol spectrum disorder may have a characteristic facial appearance in addition to neurodevelopmental impairment. It is not well understood whether there is a gradient of facial characteristics of children who did not receive a diagnosis of fetal alcohol spectrum disorder but who were exposed to a range of common drinking patterns during pregnancy.

Objective  To examine the association between dose, frequency, and timing of prenatal alcohol exposure and craniofacial phenotype in 12-month-old children.

Design, Setting, and Participants  A prospective cohort study was performed from January 1, 2011, to December 30, 2014, among mothers recruited in the first trimester of pregnancy from low-risk, public maternity clinics in metropolitan Melbourne, Australia. A total of 415 white children were included in this analysis of 3-dimensional craniofacial images taken at 12 months of age. Analysis was performed with objective, holistic craniofacial phenotyping using dense surface models of the face and head. Partial least square regression models included covariates known to affect craniofacial shape.

Exposures  Low, moderate to high, or binge-level alcohol exposure in the first trimester or throughout pregnancy.

Main Outcomes and Measures  Anatomical differences in global and regional craniofacial shape between children of women who abstained from alcohol during pregnancy and children with varying levels of prenatal alcohol exposure.

Results  Of the 415 children in the study (195 girls and 220 boys; mean [SD] age, 363.0 [8.3] days), a consistent association between craniofacial shape and prenatal alcohol exposure was observed at almost any level regardless of whether exposure occurred only in the first trimester or throughout pregnancy. Regions of difference were concentrated around the midface, nose, lips, and eyes. Directional visualization showed that these differences corresponded to general recession of the midface and superior displacement of the nose, especially the tip of the nose, indicating shortening of the nose and upturning of the nose tip. Differences were most pronounced between groups with no exposure and groups with low exposure in the first trimester (forehead), moderate to high exposure in the first trimester (eyes, midface, chin, and parietal region), and binge-level exposure in the first trimester (chin).

Conclusions and Relevance  Prenatal alcohol exposure, even at low levels, can influence craniofacial development. Although the clinical significance of these findings is yet to be determined, they support the conclusion that for women who are or may become pregnant, avoiding alcohol is the safest option.

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