The realtionship between common patterns of prenatal alcohol exposure and the neurodevelopment of two-year old children

Background: Around 60% of women drink some alcohol while pregnant. There is conflicting evidence on the effect on the fetus of common patterns of prenatal alcohol exposure (PAE) e.g. low level or sporadic drinking. Guidelines recommend abstinence as the safest option, creating problems for those advising women who drink at these levels before pregnancy recognition or beyond. The Asking QUestions about Alcohol (AQUA) study aimed to accurately measure PAE and account for important cofactors, to reduce uncertainty about child outcomes. Method: Detailed data on PAE were prospectively collected in a pre-birth cohort of over 1500 mother/child dyads. There was also extensive data collection of predictors of child development at one and two-year's post-partum. A sub-group of children was followed up at two years of age with a neurodevelopmental assessment (Bayley III). Two-step multivariable regression analyses of an effect of PAE accounted for independent risk factors that related to 1) pregnancy, including sociodemographic, psychologic and lifestyle variables such as diet and supplement use, and 2) the postnatal care-giving environment, including breastfeeding and maternal psychological wellbeing. Results: Adjustment for independent risk factors ameliorated any putative associations between PAE and cognitive, language and motor development in 554 two year-old children spread evenly across six PAE groups. Conclusions: Assessing neurodevelopmental outcomes associated with PAE is strongly influenced by other modifiable and non-modifiable risk factors. Although we found no adverse neurodevelopmental outcomes at two years of age, follow-up will be necessary in these children when complex higher-level cognitive, language and motor skills are required

Prenatal alcohol exposure and facial shape of one-year old children: no amount of alcohol is without consequence

Background: Children with Fetal Alcohol Spectrum Disorder (FASD) can have a characteristic facial appearance in addition to neurodevelopmental impairment. We do not know if there is a gradient of effects on the face of children with prenatal alcohol exposure (PAE). Method: This is an analysis of 3D craniofacial images of 415 one year-old Caucasian children with detailed, prospectively collected PAE data. Analysis involved objective, holistic craniofacial phenotyping applying partial least-square regression to dense-surface models of the facial images. Results: We saw a significant association between craniofacial shape and PAE, whether exposure occurred only in trimester one, or throughout pregnancy. Regions of difference (p < 0.05) were concentrated around the mid-face, nose, lips and eyes. Directional visualisation showed these 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. Significant differences existed between groups with no exposure and groups with low exposure in trimester one (forehead), moderate/high exposure in trimester one (eyes, midface, chin, parietal region) and binge level exposure in trimester one (chin). Conclusion: PAE, even at low levels, can influence craniofacial development. The observed differences were subtle, but are typical of dysmorphic features often seen in children with FASD. Although facial development is complex and each person's face is unique, it is sensitive to some influences at critical stages of development. Our study shows that alcohol contributes to how the face is formed in the womb