Population differences in dysmorphic features among children with fetal alcohol spectrum disorders.
OBJECTIVE
To examine the variation in significant dysmorphic features in children from 3 different populations with the most dysmorphic forms of fetal alcohol spectrum disorders, fetal alcohol syndrome (FAS), and partial fetal alcohol syndrome (PFAS).


METHODS
Advanced multiple regression techniques are used to determine the discriminating physical features in the diagnosis of FAS and PFAS among children from Northern Plains Indian communities, South Africa, and Italy.


RESULTS
Within the range of physical features used to identify children with fetal alcohol spectrum disorders, specifically FAS and PFAS, there is some significant variation in salient diagnostic features from one population to the next. Intraclass correlations in diagnostic features between these 3 populations is 0.20, indicating that about 20% of the variability in dysmorphology core features is associated with location and, therefore, specific racial/ethnic population. The highly significant diagnostic indicators present in each population are identified for the full samples of FAS, PFAS, and normals and also among children with FAS only. A multilevel model for these populations combined indicates that these variables predict dysmorphology unambiguously: small palpebral fissures, narrow vermillion, smooth philtrum, flat nasal bridge, and fifth finger clinodactyly. Long philtrum varies substantially as a predictor in the 3 populations. Predictors not significantly related to fetal alcohol spectrum disorders dysmorphology across the 3 populations are centile of height (except in Italy) strabismus, interpupilary distance, intercanthal distance, and heart murmurs.


CONCLUSIONS
The dysmorphology associated with FAS and PFAS vary across populations, yet a particular array of common features occurs in each population, which permits a consistent diagnosis across populations.
May
Philip A
PA
Center on Alcoholism, Substance Abuse, and Addictions (CASAA), The University of New Mexico, Albuquerque, NM 87106, USA. pmay@unm.edu;phyl@unm.edu
Gossage
J Phillip
JP
Smith
Matthew
M
Tabachnick
Barbara G
BG
Robinson
Luther K
LK
Manning
Melanie
M
Cecanti
Mauro
M
Jones
Kenneth Lyons
KL
Khaole
Nathaniel
N
Buckley
David
D
Kalberg
Wendy O
WO
Trujillo
Phyllis M
PM
Hoyme
H Eugene
HE
D020751:Alcohol-Induced Disorders / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis* / Q000473:pathology*; D005315:Fetal Diseases / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D007198:Indians, North American; D007558:Italy; D008297:Male; D011247:Pregnancy; D044469:Racial Groups; D012044:Regression Analysis; D013019:South Africa; D014481:United States