Unique facial features distinguish fetal alcohol syndrome patients and controls in diverse ethnic populations.
BACKGROUND
Effective management of fetal alcohol spectrum disorders (FASD) is dependent on the timely and reliable diagnosis of affected individuals. There are significant diagnostic difficulties because of the reduced prominence of facial features as children age to adulthood as well as potential population or ethnic differences in the most characteristic alcohol-related facial features.


METHODS
A total of 276 subjects were recruited from 4 sites (Cape Town, South Africa; Helsinki, Finland; Buffalo, New York; and San Diego, California) and completed a detailed dysmorphology evaluation to classify subjects as either fetal alcohol syndrome (FAS; 43%) or control (57%). Computerized anthropometry was employed to identify facial features that could distinguish FAS patients from controls across a wide age range and across ethnically disparate study populations.


RESULTS
Subjects were placed into 1 of 4 populations based on their ancestry (Cape Coloured, Finnish Caucasian, African American, or North American Caucasian). Analyses performed in each of the 4 study populations were able to identify a unique set of variables which provided excellent discrimination between the 2 groups (FAS, control). In each study group, at least one ocular-related measurement, shortened palpebral fissure, reduced outer canthal width, or reduced inner canthal width, was included in the final classification model.


CONCLUSIONS
We found measurements that reflected reduced size of the eye orbit to be a consistent feature discriminating FAS and controls across each study population. However, each population had a unique, though often overlapping, set of variables which discriminated the 2 groups, suggesting important ethnic differences in the presentation of FAS. It is possible that these differences were accentuated by the wide age distribution of the study subjects.
Moore
Elizabeth S
ES
St. Vincent Hospital, Indianapolis, Indiana, USA. esmoore@stvincent.org
Ward
Richard E
RE
Wetherill
Leah Flury
LF
Rogers
Jeffrey L
JL
Autti-Rämö
Ilona
I
Fagerlund
Ase
A
Jacobson
Sandra W
SW
Robinson
Luther K
LK
Hoyme
H Eugene
HE
Mattson
Sarah N
SN
Foroud
Tatiana
T
D000293:Adolescent; D001741:Black or African American; D000886:Anthropometry / Q000379:methods; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005123:Eye / Q000473:pathology*; D019066:Facies; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis* / Q000208:ethnology* / Q000473:pathology; D005387:Finland; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D011247:Pregnancy; D013019:South Africa; D014481:United States; D044465:White People