The mother’s alcohol consumption is reflected in the child’s face

The mother’s alcohol consumption is reflected in the child’s face

Concavity (red) and convexity (blue) of the child’s face with maternal alcohol consumption before pregnancy (Tier 1), in the first trimester (2a), or continuously (2b). © Human Reproduction journal

Alcohol during pregnancy has a serious impact on the health of the child. A new study now shows that changes in the child's face shape can still be detected at the age of nine if the mother drank alcohol during or shortly before pregnancy. The higher the consumption, the more serious the abnormalities were. But even with small amounts of alcohol, such as just a small glass of wine per week, a suitably trained artificial intelligence could identify changes in the child's face.

When children are exposed to alcohol in the womb, it can have a serious impact on their development. For example, children of women who regularly drank large amounts of alcohol during pregnancy often suffer from what is known as fetal alcohol syndrome. This is associated with growth disorders, neurological and cognitive impairments and behavioral disorders. Another noticeable feature is a recognizable abnormal facial development. While the effects of heavy alcohol consumption on children's facial development are well established, little was known about the impact of small amounts of alcohol.

Face as a mirror of health

A team led by Xianjing Liu from the University of Rotterdam has now dealt with this. To do this, the researchers trained artificial intelligence to recognize subtle changes in the shape of children's faces. "I would call the face a 'health mirror' because it reflects a child's overall health," says Liu's colleague Gennady Roshchupkin. "It is already known that fetal alcohol syndrome shows up on the child's face."

For their study, Liu and his team used data from the Generation R study, a large cohort study that accompanies children of different ethnic groups from urban areas in the Netherlands from before birth to adolescence, recording their state of health and possible influencing factors. Among other things, the mothers were asked during the pregnancy to fill in questionnaires about their alcohol consumption before and during the pregnancy.

Analysis with artificial intelligence

To uncover possible links to the children's face shapes, the research team took three-dimensional images of the faces of 3,149 children aged nine and 2,477 children aged 13, all of whom had been part of the cohort since before birth. “The face is a complex entity and analyzing it is a challenging task. 3D imaging is very helpful in this, but requires more advanced algorithms,” Roshchupkin said. "For this task, we developed an AI-based algorithm that takes high-resolution 3D images of the face and generates 200 unique measurements or 'features'. We analyzed these to look for associations with prenatal alcohol exposure.”

The result: "We found a statistically significant association between prenatal alcohol exposure and face shape in the nine-year-old children," reports Liu. “The more alcohol the mothers drank, the more statistically significant changes there were. The most common features were an upturned tip of the nose, a shortened nose, an outwardly curved chin, and an incurved lower eyelid.”

Effects even with low alcohol consumption

In children born to women who reported drinking alcohol at least occasionally throughout their pregnancy, the changes were detectable even when the mothers' reported alcohol consumption was very low, below 12 grams per week. That's about the equivalent of a small glass of wine or a can of beer. "This is the first time that a link has been demonstrated with such low alcohol consumption," says Liu. However, the authors point out that the information on alcohol consumption is based on the mothers' own statements. It is therefore possible that women who drank more alcohol during pregnancy also indicated a lower amount for reasons of social desirability.

Similar results were seen in children whose mothers had only consumed alcohol during the first trimester of pregnancy. Even children whose mothers had not drunk alcohol since conception but had consumed alcohol in the three months before pregnancy showed changes compared to children whose mothers had not drunk before or during pregnancy. "Our study suggests that women who are pregnant or about to become pregnant should completely stop drinking alcohol several months before conception and during pregnancy to avoid adverse health consequences for the offspring," Liu and his colleagues conclude.

Fewer abnormalities in older children

In children aged 13, the researchers no longer found any significant correlations between maternal alcohol consumption and the shape of the child's face. "It's possible that these changes diminish with age and other environmental influences, or are obscured by normal growth patterns," explains Roshchupkin. "However, that doesn't mean that alcohol's health effects will go away as well."

The mechanisms of action behind the observed associations have not yet been fully elucidated. Previous studies have already provided evidence that alcohol could lead to metabolic disorders in mothers, for example in relation to the regulation of blood sugar, which could have a negative impact on the development of the unborn child. "Further investigations into the mechanism of the association are needed to fully understand how the association develops and then weakens with age," says Roshchupkin.

Source: Xianjing Liu (Erasmus MC University Medical Center Rotterdam) et al., Human Reproduction, doi: 10.1093/humrep/dead006

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