Even low levels of prenatal alcohol exposure will be reflected on the baby’s face

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A small amount of drinking by an expectant mother will show itself by changes in child's craniofacial shape at 12 months reports a study published online in JAMA.

Guidelines from physicians and experts around the world advise against drinking in pregnancy.

The ACOG writes that “there is no safe level of alcohol use during pregnancy,” as also UK’s Department of health which previously advised pregnant women to limit themselves to 1 to 2units once or twice per week. Now the updated guidelines in January 2016, advises even against a small amount of drinking.

The concurrent occurrence of 3 classic facial features( small palpebral fissure, a smooth philtrum, and a thin upper lip is hallmark of fetal alcohol syndrome (FAS). If only 2 features are concurrently present, the condition is labelled as partial FAS.

Some fetuses also present with heavy prenatal alcohol exposure (PAE), but no evidence of FAS or partial FAS.

The study by Evelyne Muggli and her colleagues, shed some light on relationship between low alcohol exposure and changes in child craniofacial shape.

The facial measurements were performed at 12 months of age with the help of 3-D images.

A total of 415 white children were included in the study over a period of 3 years. The mothers were recruited early in first trimester and the amount of alcohol consumed was well documented throughout the pregnancy, including records of drinking even before the pregnancy was documented.

Other confounders which can affect the development of face were taken into consideration.

The authors found consistent association between craniofacial shape and PAE, regardless of whether the exposure occurred early in pregnancy or throughout the pregnancy.  

The faces of affected children had difference in midface, nose, lips, and eyes regions. They also had mid-facial hypoplasia, with shorter and upturned nose. Further analysis showed that different regions of face were affected according to level of drinking in first trimester: in low exposure (forehead), moderate to high exposure (eyes, midface, chin, and parietal region), and binge-level exposure (chin) were affected.

According to a survey, 40% of OB-GYN advice the patients that some amount of alcohol in pregnancy is fine. According to CDC’s Morbidity and Mortality Weekly Report (MMWR), One in 10 pregnant women in the United States reports drinking alcohol and 3.1 percent of pregnant women report binge drinking – defined as 4 or more alcoholic beverages on one occasion.

https://www.mofas.org/drinking-pregnancy/trying-to-get-pregnant/what-women-need-to-know/

The study strength’s lies in well documentation of exposure and outcome. The clinical implications of changes in craniofacial features is not yet known but, the study provides evidence in favor of total abstinence of alcohol during pregnancy.