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Effect of in utero exposure to anticonvulsants on craniofacial development and growth
Insights
Children exposed to anticonvulsants during pregnancy may exhibit subtle craniofacial changes. Cephalometric analysis revealed reduced bony interorbital distance and smaller cranial base and maxilla dimensions in exposed children.
Area of Science:
- Craniofacial development
- Teratology
- Pediatric medicine
Background:
- Prenatal exposure to anticonvulsants is linked to craniofacial anomalies in some children.
- Observed anomalies include broad nasal bridge, upturned nose, wide mouth, low-set ears, epicanthal folds, and ocular hypertelorism.
- However, some exposed children show no apparent craniofacial abnormalities.
Purpose of the Study:
- To precisely define craniofacial features in children exposed to anticonvulsants in utero.
- Utilize anthropometric measurements and cephalometric radiography for detailed analysis.
- Investigate subtle craniofacial architectural changes not evident through external examination.
Main Methods:
- Prospective identification of nine infants exposed to anticonvulsants at birth.
- Longitudinal assessment from birth to 4-10 years of age.
- Detailed anthropometric measurements and frontal/lateral cephalometric radiographic analyses.
Main Results:
- No major malformations, growth, or mental deficiencies were observed in the children studied.
- External craniofacial measurements were within normal ranges.
- Cephalometric analysis revealed reduced bony interorbital distance, maxillary size, mandibular length, cranial base, skull size, and nose dimensions compared to normal populations.
Conclusions:
- External measurements are insufficient for detecting subtle craniofacial architectural alterations.
- Prenatal anticonvulsant exposure is associated with a pattern of reduced bony interorbital distance, cranial base, and maxillary size.
- Concomitant decreases in nose and mandibular dimensions are observed in exposed children, indicating a subtle craniofacial developmental impact.
Abstract:
It has been widely reported that some children exposed to anticonvulsants in utero have a characteristic pattern of craniofacial anomalies including a broad, low nasal bridge with a short upturned nose, wide mouth, low set ears, epicanthal folds, and ocular hypertelorism, while others show no evidence of craniofacial abnormalities. The purpose of this paper is to define the craniofacial features in nine exposed children using anthropometric measurements and frontal and lateral cephalometric radiographs. These children were identified at birth as part of a prospective study of infants exposed to anticonvulsants at the Boston Hospital for Women (now part of the Brigham and Women's Hospital). At birth, none of these infants had any major malformations; at 4 to 10 years of age, none demonstrated any growth deficiency or mental deficiency, and all external craniofacial measurements were within the normal range. However, cephalometric analyses demonstrated a pattern of reduced bony interorbital distance, maxillary size, mandibular length, cranial base and skull size, and a reduction in nose dimensions when compared to data of normal populations. This study demonstrates the inadequacy of external measurements in determining the details of underlying craniofacial architecture. The data also suggest that a subtle craniofacial change occurs in exposed children which is characterized by a decrease in bony interorbital distance and the size of the cranial base and maxilla with concomitant decreases in nose and mandibular dimensions.