Second-Trimester Ultrasound as a Tool for Early Detection of Fetal Alcohol Spectrum Disorders.
Early detection of fetal alcohol spectrum disorders (FASDs) is desirable to allow earlier and more comprehensive interventions to be initiated for the mother and infant. We examined prenatal ultrasound as an early method of detecting markers of the physical features and neurobehavioral deficits characteristic of FASD.



A longitudinal cohort of pregnant women in Ukraine was recruited as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders. Women were enrolled into a moderately to heavy-alcohol-exposed group or a low- or no-alcohol exposure group and were followed to pregnancy outcome. In the second trimester, a fetal ultrasound was performed to measure transverse cerebellar diameter, occipital frontal diameter (OFD), caval-calvarial distance, frontothalamic distance (FTD), interorbital distance (IOD), outer orbital diameter, and orbital diameter (OD). Live born infants received a dysmorphological examination and a neurobehavioral evaluation using the Bayley Scales of Infant Development. These data were used to classify infants with respect to FASD. Comparisons were made on the ultrasound measures between those with and without features of FASD, adjusting for gestational age at ultrasound and maternal smoking.



A total of 233 mother/child dyads were included. Children classified as FASD had significantly longer IOD and lower FTD/IOD, OFD/IOD, and FTD/OD ratios (p < 0.05). Children with a Bayley score <85 had significantly shorter FTD, longer IOD, lower OFD/IOD, and FTD/IOD ratios (p < 0.05). In general, mean differences were small. Ultrasound variables alone predicted <10% of the variance in the FASD outcome.



Some ultrasound measurements were associated with FASD, selected facial features of the disorder, and lower neurobehavioral scores. However, mean differences were relatively small, making it difficult to predict affected children based solely on these measures. It may be advantageous to combine these easily obtained ultrasound measures with other data to aid in identifying high risk for an FASD outcome.
Department of Pediatrics, University of California San Diego, La Jolla, California. amontag@ucsd.edu.
Annika C
AC
Montag
Department of Reproductive Medicine, University of California San Diego, La Jolla, California.
Andrew D
AD
Hull
Rivne Provincial Medical Diagnostic Center and OMNI-Net Center, Rivne, Ukraine.
Lyubov
L
Yevtushok
Khmelnytsky City Perinatal Center and OMNI-Net Center, Khmelnytsky, Ukraine.
Natalya
N
Zymak-Zakutnya
Rivne Provincial Medical Diagnostic Center and OMNI-Net Center, Rivne, Ukraine.
Zoryana
Z
Sosyniuk
Khmelnytsky City Perinatal Center and OMNI-Net Center, Khmelnytsky, Ukraine.
Viktor
V
Dolhov
Department of Pediatrics, University of California San Diego, La Jolla, California.|Rady Children's Hospital, San Diego, California.
Kenneth Lyons
KL
Jones
Department of Pediatrics, University of California San Diego, La Jolla, California.|Department of Medical Genetics, University of South Alabama, Mobile, Alabama.
Wladimir
W
Wertelecki
Department of Pediatrics, University of California San Diego, La Jolla, California.|Rady Children's Hospital, San Diego, California.|Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California.
Christina D
CD
Chambers
D000328:Adult; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D008297:Male; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D016216:Ultrasonography, Prenatal; D055815:Young Adult
Alcohol; Brain Measurement; Fetal Alcohol Spectrum Disorders; Prenatal; Ultrasound
Pediatrics. 2015 Feb;135(2):264-70
25583914
Br J Ophthalmol. 1996 Oct;80(10 ):918-21
8976706
Alcohol Clin Exp Res. 2006 May;30(5):892-8
16634859
J Pediatr. 1996 Jul;129(1):33-41
8757560
Arch Intern Med. 1998 Sep 14;158(16):1789-95
9738608
Alcohol Res Health. 2001;25(3):204-9
11810959
Invest Ophthalmol Vis Sci. 1998 Nov;39(12):2232-8
9804130
Birth Defects Res C Embryo Today. 2011 Mar;93(1):3-11
21425437
Alcohol Clin Exp Res. 2016 Jan;40(1):18-32
26727519
Pediatrics. 2005 Jan;115(1):39-47
15629980
Teratology. 1997 Nov;56(5):317-26
9451756
Adv Data. 2000 Jun 8;(314):1-27
11183293
Matern Child Health J. 2008 May;12(3):332-41
17680215
Dev Disabil Res Rev. 2009;15(3):176-92
19731384
Lancet. 1973 Nov 3;302(7836):999-1001
4127281
MMWR Morb Mortal Wkly Rep. 2015 Sep 25;64(37):1042-6
26401713
Subst Use Misuse. 2001 Feb;36(3):313-31
11325169
Alcohol Clin Exp Res. 2014 Apr;38(4):1078-85
24511895
Alcohol Clin Exp Res. 1994 Oct;18(5):1156-61
7847599
J Dev Behav Pediatr. 2004 Aug;25(4):228-38
15308923
Ultrasound Obstet Gynecol. 2009 Jun;33(6):683-9
19444822
Alcohol Clin Exp Res. 2014 Apr;38(4):1012-9
24834525
Contraception. 2011 Nov;84(5):478-85
22018121
Dev Med Child Neurol. 2000 Jan;42(1):25-31
10665972
BMC Pregnancy Childbirth. 2014 Apr 03;14:127
24708684
Prenat Diagn. 2014 Sep;34(9):831-8
24691675
Am J Obstet Gynecol. 2001 Sep;185(3):737-42
11568807
J Pediatr. 1987 Aug;111(2):267-8
3612403
Alcohol Alcohol. 2000 Jul-Aug;35(4):400-10
10906009
Eur J Orthod. 2006 Jun;28(3):254-61
16648213