title: Facial dysmorphism across the fetal alcohol spectrum.
abstract: OBJECTIVE
  Classic facial characteristics of fetal alcohol syndrome (FAS) are shortened palpebral fissures, smooth philtrum, and thin upper vermillion. We aim to help pediatricians detect facial dysmorphism across the fetal alcohol spectrum, especially among nonsyndromal heavily exposed (HE) individuals without classic facial characteristics.
  
  
  METHODS
  Of 192 Cape Coloured children recruited, 69 were born to women who reported abstaining from alcohol during pregnancy. According to multifaceted criteria, the remainder were allocated clinically to the FAS (n = 22), partial FAS (n = 26) or nonsyndromal HE (n = 75) categories. We used dense surface modeling and signature analyses of 3-dimensional facial photographs to determine agreement between clinical categorization and classifications induced from face shape alone, to visualize facial differences, and to consider predictive links between face shape and neurobehavior.
  
  
  RESULTS
  Face classification achieved significant agreement with clinical categories for discrimination of nonexposed from FAS alone (face: 0.97-1.00; profile: 0.92) or with the addition of partial FAS (face: 0.90; profile: 0.92). Visualizations of face signatures delineated dysmorphism across the fetal alcohol spectrum and in half of the nonsyndromal HE category face signature graphs detected facial characteristics consistent with prenatal alcohol exposure. This subgroup performed less well on IQ and learning tests than did nonsyndromal subjects without classic facial characteristics.
  
  
  CONCLUSIONS
  Heat maps and morphing visualizations of face signatures may help clinicians detect facial dysmorphism across the fetal alcohol spectrum. Face signature graphs show potential for identifying nonsyndromal heavily exposed children who lack the classic facial phenotype but have cognitive impairment.
authors: Molecular Medicine Unit, UCL Institute of Child Health, 30 Guilford St, London WC1N 1EH, UK.
authors: Michael
authors: M
authors: Suttie
authors: Tatiana
authors: T
authors: Foroud
authors: Leah
authors: L
authors: Wetherill
authors: Joseph L
authors: JL
authors: Jacobson
authors: Christopher D
authors: CD
authors: Molteno
authors: Ernesta M
authors: EM
authors: Meintjes
authors: H Eugene
authors: HE
authors: Hoyme
authors: Nathaniel
authors: N
authors: Khaole
authors: Luther K
authors: LK
authors: Robinson
authors: Edward P
authors: EP
authors: Riley
authors: Sandra W
authors: SW
authors: Jacobson
authors: Peter
authors: P
authors: Hammond
mesh_terms: D000886:Anthropometry / Q000379:methods; D002648:Child; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005145:Face / Q000002:abnormalities*; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D007361:Intelligence Tests; D008137:Longitudinal Studies; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology