Facial Curvature Detects and Explicates Ethnic Differences in Effects of Prenatal Alcohol Exposure

Michael Suttie, Leah Wetherill, Sandra W. Jacobson, Joseph L. Jacobson, H. Eugene Hoyme, Elizabeth R. Sowell, Claire Coles, Jeffrey R. Wozniak, Edward P. Riley, Kenneth L. Jones, Tatiana Foroud, Peter Hammond, the CIFASD

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Our objective is to help clinicians detect the facial effects of prenatal alcohol exposure by developing computer-based tools for screening facial form. Methods: All 415 individuals considered were evaluated by expert dysmorphologists and categorized as (i) healthy control (HC), (ii) fetal alcohol syndrome (FAS), or (iii) heavily prenatally alcohol exposed (HE) but not clinically diagnosable as FAS; 3D facial photographs were used to build models of facial form to support discrimination studies. Surface curvature-based delineations of facial form were introduced. Results: (i) Facial growth in FAS, HE, and control subgroups is similar in both cohorts. (ii) Cohort consistency of agreement between clinical diagnosis and HC-FAS facial form classification is lower for midline facial regions and higher for nonmidline regions. (iii) Specific HC-FAS differences within and between the cohorts include: for HC, a smoother philtrum in Cape Coloured individuals; for FAS, a smoother philtrum in Caucasians; for control-FAS philtrum difference, greater homogeneity in Caucasians; for control-FAS face difference, greater homogeneity in Cape Coloured individuals. (iv) Curvature changes in facial profile induced by prenatal alcohol exposure are more homogeneous and greater in Cape Coloureds than in Caucasians. (v) The Caucasian HE subset divides into clusters with control-like and FAS-like facial dysmorphism. The Cape Coloured HE subset is similarly divided for nonmidline facial regions but not clearly for midline structures. (vi) The Cape Coloured HE subset with control-like facial dysmorphism shows orbital hypertelorism. Conclusions: Facial curvature assists the recognition of the effects of prenatal alcohol exposure and helps explain why different facial regions result in inconsistent control-FAS discrimination rates in disparate ethnic groups. Heavy prenatal alcohol exposure can give rise to orbital hypertelorism, supporting a long-standing suggestion that prenatal alcohol exposure at a particular time causes increased separation of the brain hemispheres with a concomitant increase in orbital separation.

Original languageEnglish (US)
Pages (from-to)1471-1483
Number of pages13
JournalAlcoholism: Clinical and Experimental Research
Issue number8
StatePublished - Aug 2017

Bibliographical note

Funding Information:
This international collaborative study was completed in conjunction with the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD) and is funded by NIH/National Institute on Alcohol Abuse and Alcoholism: U01AA014809 (TF and PH); U24AA014815 (KLJ); U01AA017122 (ERS); U24AA014811 (EJR); the Cape Town Longitudinal Cohort Study, by RO1AA09524, U01AA014790, R01AA016781 (SWJ). Additional information about CIFASD can be found at www.cifasd.org.

Publisher Copyright:
Copyright © 2017 by the Research Society on Alcoholism


  • 3D Face Analysis
  • Facial Curvature
  • Facial Dysmorphism
  • Fetal Alcohol Spectrum Disorders

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