Prenatal Alcohol Exposure and Dysmorphic Features in Adults at Midlife

Dysmorphology examinations have established that fetal alcohol spectrum disorders (FASD) are associated with characteristic physical features from infancy through adolescence. As individuals mature into young adulthood and beyond, the aging process may attenuate characteristic features over time. The purpose of this study was to evaluate FASD-related dysmorphology at midlife.

Subjects (N = 192) were recruited from two longitudinal cohorts and from the general community (M_age = 39.5 years, SD_age = 8.1 years). A majority (n = 132, 68.8%) had an FASD or well-documented prenatal alcohol exposure (PAE). Standard dysmorphology examinations of 23 physical features were conducted, blind to FASD/PAE status. Participants were stratified into experimental groups according to actual or inferred degree of dysmorphology at the time of their initial examination in childhood or adolescence: high dysmorphology or low dysmorphology. Age-matched controls with no diagnosed or suspected FASD formed the third experimental group. Hierarchical multiple and logistic regression analyses were conducted, regressing the 23 physical characteristics on age, race/ethnicity, and sex (Block 1), experimental group (Block 2), and the two-way interactions between experimental group and the demographic variables (Block 3).

Numerous main effects were found for the demographic variables. Controlling for these, main effects for experimental group were found for orbitofrontal circumference, palpebral fissure lengths, philtrum score, vermilion border score, hypoplastic midface, and camptodactyly. Demographics moderated effects of experimental group for philtrum length, philtrum score, and vermilion border score, cardinal features of FASD.

Findings indicate that PAE-related dysmorphological features persist into adulthood and further into midlife and may remain useful in diagnosis of FASD beyond young adulthood. However, as demographic factors appear to impact some of the cardinal features of FASD, age-, gender-, and race-related norms and reference image sets for the sentinel features of FASD in adults of different ages may be helpful in diagnosing individuals in adulthood and beyond.