Relation Over Time Between Facial Measurements and Cognitive Outcomes in Fetal Alcohol-Exposed Children

Authors

  • Tatiana Foroud,

    Corresponding author
    • Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana
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  • Leah Wetherill,

    1. Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana
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  • Sophia Vinci-Booher,

    1. Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana
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  • Elizabeth S. Moore,

    1. Department of Anthropology, School of Liberal Arts, Indiana University, Indianapolis, Indiana
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  • Richard E. Ward,

    1. Department of Anthropology, School of Liberal Arts, Indiana University, Indianapolis, Indiana
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  • H. Eugene Hoyme,

    1. Department of Pediatrics, Sanford Children's Hospital, Sanford School of Medicine of the University of South Dakota, Sioux Falls, South Dakota
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  • Luther K. Robinson,

    1. Department of Pediatrics, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, New York
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  • Jeffrey Rogers,

    1. Office of the Vice President for Information Technology, Indiana University School of Medicine, Indianapolis, Indiana
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  • Ernesta M. Meintjes,

    1. Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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  • Christopher D. Molteno,

    1. Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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  • Joseph L. Jacobson,

    1. Department of Psychiatry and Behavioral Neurosciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
    2. Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
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  • Sandra W. Jacobson

    1. Department of Psychiatry and Behavioral Neurosciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
    2. Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
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Reprint requests: Tatiana Foroud, PhD, Indiana University School of Medicine, 410 W 10th St (HS4021), Indianapolis, IN 46202; Tel.: 317-278-1291; Fax: 317-278-1100; E-mail: tforoud@iupui.edu

Abstract

Background

The identification of individuals exposed prenatally to alcohol can be challenging, with only those having the characteristic pattern of facial features, central nervous system abnormality, and growth retardation receiving a clinical diagnosis of fetal alcohol syndrome (FAS).

Methods

Seventeen anthropometric measurements were obtained at 5 and 9 years from 125 Cape Town, South African children, studied since birth. The children were divided into 3 groups: FAS or partial FAS (PFAS), heavily exposed nonsyndromal (HE), and non-alcohol-exposed controls (C). Anthropometric measurements were evaluated for mean group differences. Logistic regression models were used to identify the subset of anthropometric measures that best predicted group membership. Anthropometric measurements were examined at the 2 ages in relation to prenatal alcohol exposure obtained prospectively from the mothers during pregnancy. Correlation of these facial measurements with key neurobehavioral outcomes including Wechsler Intelligence Scales for Children-IV IQ and eyeblink conditioning was used to assess their utility as indicators of alcohol-related central nervous system impairment.

Results

Significant group differences were found for the majority of the anthropometric measures, with means of these measures smaller in the FAS/PFAS compared with HE or C. Upper facial widths, ear length, lower facial depth, and eye widths were consistent predictors distinguishing those exposed to alcohol from those who were not. Using longitudinal data, unique measures were identified that predicted facial anomalies at one age but not the other, suggesting the face changes as the individual matures. And 41% of the FAS/PFAS group met criteria for microtia at both ages. Three of the predictive anthropometric measures were negatively related to measures of prenatal alcohol consumption, and all were positively related to at least 1 neurobehavioral outcome.

Conclusions

The analysis of longitudinal data identified a common set of predictors, as well as some that are unique at each age. Prenatal alcohol exposure appears to have its primary effect on brain growth, reflected by smaller forehead widths, and may suppress neural crest migration to the branchial arches, reflected by deficits in ear length and mandibular dimensions. These results may improve diagnostic resolution and enhance our understanding of the relation between the face and the neuropsychological deficits that occur.

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