Even Low Levels of Alcohol Exposure Can Change Shape of Babies' Faces

Even at very low levels, prenatal alcohol exposure can still affect the way a baby’s face develops, including the shape of their eyes, nose and lips, according to a prospective cohort study in JAMA pediatrics.

Researchers led by Evelyne Muggli, MPH, of the Murdoch Children’s Research Institute in Victoria, Australia, found a consistent association between craniofacial development and prenatal alcohol exposure at almost any level, regardless of whether the exposure occurred only in the first trimester or throughout all three trimesters of the pregnancy.

“We observed aspects of craniofacial phenotype with almost any level of [prenatal alcohol exposure], something previously only documented following a high level of long-term alcohol exposure,” researchers wrote.

The prospective cohort study was conducted over a nearly 4-year period from January 2011 to December 2014, and monitored mothers recruited during the first-trimester of pregnancy from maternity clinics in Melbourne, Australia. 415 Caucasian children were included in the analysis.

Researchers measured for anatomical differences in the global and regional craniofacial shape between children of women who did not drink alcohol during pregnancy and children who experienced varying levels of prenatal alcohol exposure. Analysis in previous studies was typically performed using subjective clinical examinations or facial measurements, which, according to the researchers, captured limited information and were prone to measurement error.

To measure results in this study, researchers used objective, holistic craniofacial phenotyping using dense, 3-dimensional photographs and surface models of the face and head, which allowed them to control for covariates and compare average faces statistically.

“Regions of difference were concentrated around the midface, nose, lips, and eyes,” researchers wrote. “Directional visualization showed that these differences correspond 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 tips.”

According to the researchers, the location of craniofacial dysmorphologies corresponded with the amount and duration of prenatal alcohol exposure.

“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),” they wrote.

While it was shown that craniofacial development could be affected even at very low levels of exposure, comparisons of the physical characteristics of children with fetal alcohol spectrum disorder (FASD) and children without the condition have shown that higher levels of drinking predict higher dysmorphology.

Prior to these observations, it was not well understood whether there was a gradient of distinct facial characteristics in children who did not receive a diagnosis of (FASD), but who were exposed to a range of common drinking patterns in utero.

“Although the clinical significance of our findings is yet to be determined, these findings support the conclusion that, for women who are, or may become pregnant, avoiding alcohol is the safest option,” researchers wrote.