Ocular measurements in fetal alcohol spectrum disorders

Abstract

Fetal alcohol spectrum disorders (FASD) describe a range of physical, behavioral, and neurologic deficits in individuals exposed to alcohol prenatally. Reduced palpebral fissure length is one of the cardinal facial features of FASD. However, other ocular measurements have not been studied extensively in FASD. Using the Fetal Alcohol Syndrome Epidemiologic Research (FASER) database, we investigated how inner canthal distance (ICD), interpupillary distance (IPD), and outer canthal distance (OCD) centiles differed between FASD and non‐FASD individuals. We compared ocular measurement centiles in children with FASD to non‐FASD individuals and observed reductions in all three centiles for ICD, IPD, and OCD. However, when our non‐FASD children who had various forms of growth deficiency (microcephaly, short‐stature, or underweight) were compared to controls, we did not observe a similar reduction in ocular measurements. This suggests that reductions in ocular measurements are a direct effect of alcohol on ocular development independent of its effect on growth parameters, which is consistent with animal models showing a negative effect of alcohol on developing neural crest cells. Interpupillary distance centile appeared to be the most significantly reduced ocular measure we evaluated, suggesting it may be a useful measure to be considered in the diagnosis of FASD.

The prevalence of fetal alcohol spectrum disorders in rural communities in South Africa: A third regional sample of child characteristics and maternal risk factors

“…The physical traits of FASD are mostly indicators of stunted growth and midface hypoplasia indicative of poor brain development. Other minor anomalies provide additional clues of poor brain growth and midface development (e.g., PFL, ICD, IPD, OCD, and maxillary and mandibular arcs), and stunted development (Abell et al, 2016; Gomez et al, 2020; Valentine et al, 2017). As illustrated well in this study, physical traits aid in the diagnosis of multiple categories of FASD (see also Carter et al, 2013; Jacobson et al, 2021), even when differentiating children with ARND from controls who may have been borderline in their neurobehavioral functioning in their younger years (Carter et al, 2016).…”

Multifaceted case management during pregnancy is associated with better child outcomes and less fetal alcohol syndrome

“…Therefore, a significant reduction in antenatal drinking and often during the first year of life via breastmilk when brain growth was vulnerable [ 86 ], is likely associated with the major differences in group means, and in the lower odds ratios for adverse outcomes (small head circumference, midface hypoplasia, and a diagnosis of FAS in the MCM offspring). The diagnosis of FAS is, by definition, characterized by the most depressed physical growth and development, more dysmorphology—especially in the brain and midface [ 66 , 87 , 88 ]. Children with FAS are generally exposed to the most alcohol over the duration of the pregnancy, and OFC and brain development can be affected by alcohol in all trimesters.…”

“…In-person examinations and assessments of physical growth and dysmorphology of the children born to the participating women were undertaken at six weeks and 9, 18, 42, and 60 to 72 months by research staff. Final examinations were administered by pediatric dysmorphologists and consisted of measuring height, weight, occipitofrontal (head) circumference (OFC), facial anthropometry, and the assessment of 30 minor anomalies of the face, heart, and hands [ 66 , 67 ].…”

Gestational age and birth growth parameters as early predictors of fetal alcohol spectrum disorders

“…Less frequent and slightly lower binge drinking in the second and third trimesters in these South African populations also provides a partial explanation for the somewhat better growth measures for children with PFAS than the others with another FASD diagnosis. But the fact remains that two of the most predictable teratogenic effects of heavy maternal prenatal alcohol use, especially in first and second trimesters, are dysmorphology and growth suppression through interruption of, or interference with, developmental processes through downregulation of neural crest development, interference with gastrulation, abnormal cell migration, and apoptosis (del Campo & Jones, 2017; Gomez et al, 2020; Hoyme et al, 2005, 2016; Wozniak et al, 2020).…”