{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T09:35:13Z","timestamp":1789724113557,"version":"4.0.1"},"reference-count":36,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,5,24]],"date-time":"2019-05-24T00:00:00Z","timestamp":1558656000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alcoholism Clin &amp;amp; Exp Res"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Fetal alcohol syndrome (FAS) typically is observed among individuals with high prenatal alcohol exposures (PAE), but exposure histories obtained in clinical diagnostic settings are often inaccurate. The present analysis used the Lifestyle During Pregnancy Study (<jats:styled-content style=\"fixed-case\">LDPS<\/jats:styled-content>) to assess the potential effects of low\u2010to\u2010moderate average weekly alcohol consumption and binge drinking in early pregnancy on facial features associated with <jats:styled-content style=\"fixed-case\">FAS<\/jats:styled-content> among children 5\u00a0years of age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The analysis is a prospective follow\u2010up study of 670 women and their children sampled from the <jats:styled-content style=\"fixed-case\">LDPS<\/jats:styled-content> cohort based on maternal alcohol consumption during pregnancy. The 4\u2010Digit Code <jats:styled-content style=\"fixed-case\">FAS<\/jats:styled-content> Facial Photographic Analysis Software was used to measure the magnitude of expression of the 3 diagnostic facial features of <jats:styled-content style=\"fixed-case\">FAS<\/jats:styled-content> from standardized digital photographs. Logistic regression was used to estimate the odds of presenting with the <jats:styled-content style=\"fixed-case\">FAS<\/jats:styled-content>\/partial fetal alcohol syndrome (<jats:styled-content style=\"fixed-case\">PFAS<\/jats:styled-content>) facial phenotypes relative to different patterns of prenatal alcohol exposure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ten children presented with the <jats:styled-content style=\"fixed-case\">FAS<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">PFAS<\/jats:styled-content> facial phenotypes. None of the children sampled met the central nervous system (<jats:styled-content style=\"fixed-case\">CNS<\/jats:styled-content>) criteria for <jats:styled-content style=\"fixed-case\">FAS<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">PFAS<\/jats:styled-content> at age 5\u00a0years. All remained at risk for <jats:styled-content style=\"fixed-case\">PFAS<\/jats:styled-content> since some types of <jats:styled-content style=\"fixed-case\">CNS<\/jats:styled-content> dysfunction associated with this diagnosis may only be assessed at older ages. The <jats:styled-content style=\"fixed-case\">FAS<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">PFAS<\/jats:styled-content> facial phenotypes were 8.5\u2010fold more likely among children exposed to an average of 1 to 4 drinks\/wk and 2.5\u2010fold more likely among children with a single binge exposure in gestational weeks 3 to 4 compared to children with no such exposures. The magnitude of expression of the <jats:styled-content style=\"fixed-case\">FAS<\/jats:styled-content> facial phenotype was significantly correlated with all other diagnostic features of <jats:styled-content style=\"fixed-case\">FAS<\/jats:styled-content>: growth deficiency, microcephaly, and measures of <jats:styled-content style=\"fixed-case\">CNS<\/jats:styled-content> dysfunction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These findings suggest that low\u2010to\u2010moderate levels of <jats:styled-content style=\"fixed-case\">PAE<\/jats:styled-content> or isolated binge exposures may place some fetuses at risk for <jats:styled-content style=\"fixed-case\">FAS<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">PFAS<\/jats:styled-content>. Thus, conservative advice is still for women to abstain from alcohol consumption during pregnancy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.14047","type":"journal-article","created":{"date-parts":[[2019,4,12]],"date-time":"2019-04-12T14:48:48Z","timestamp":1555080528000},"page":"1199-1212","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Are Low\u2010to\u2010Moderate Average Alcohol Consumption and Isolated Episodes of Binge Drinking in Early Pregnancy Associated with Facial Features Related to Fetal Alcohol Syndrome in 5\u2010Year\u2010Old Children?"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3868-106X","authenticated-orcid":false,"given":"Ulrik Schi\u00f8ler","family":"Kesmodel","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology (USK, SSN) Herlev University Hospital Herlev Denmark"},{"name":"Department of Clinical Medicine (USK) University of Copenhagen Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siv Steffen","family":"Nygaard","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology (USK, SSN) Herlev University Hospital Herlev Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik Lykke","family":"Mortensen","sequence":"additional","affiliation":[{"name":"Center for Healthy Aging (ELM) Institute of Public Health University of Copenhagen Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacquelyn","family":"Bertrand","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention (CDC) (JB, CHD) Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clark H.","family":"Denny","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention (CDC) (JB, CHD) Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Glidewell","sequence":"additional","affiliation":[{"name":"University of Washington (AG) Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Astley Hemingway","sequence":"additional","affiliation":[{"name":"Departments of Epidemiology and Pediatrics (SAH) University of Washington Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,5,24]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_9_3_1","unstructured":"2004 University of Washington Publication Services Seattle WA SJ Astley Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4\u2010Digit Diagnostic Code"},{"key":"e_1_2_9_4_1","first-page":"e132","article-title":"Profile of the first 1,400 patients receiving diagnostic evaluations for fetal alcohol spectrum disorder at the Washington State Fetal Alcohol Syndrome Diagnostic & Prevention Network","volume":"17","author":"Astley S","year":"2010","journal-title":"Can J Clin Pharmacol"},{"key":"e_1_2_9_5_1","first-page":"3","volume-title":"Diagnosis, Assessment and New Directions in Research and Multimodal Treatment","author":"Astley S","year":"2011"},{"key":"e_1_2_9_6_1","first-page":"e416","article-title":"Validation of the fetal alcohol spectrum disorder (FASD) 4\u2010Digit Diagnostic Code","volume":"20","author":"Astley SJ","year":"2013","journal-title":"J Popul Ther Clin Pharmacol"},{"key":"e_1_2_9_7_1","unstructured":"2016 University of Washington SJ Astley FAS Facial Photographic Analysis Software Instruction Manual. Version 2.1"},{"issue":"3","key":"e_1_2_9_8_1","first-page":"1","article-title":"The essential role of growth deficiency in the diagnosis of fetal alcohol spectrum disorder","volume":"3","author":"Astley SJ","year":"2016","journal-title":"Adv Pediatr Res"},{"issue":"3","key":"e_1_2_9_9_1","first-page":"1","article-title":"Comparison of the FASD 4\u2010digit code and Hoyme et al. 2016 FASD diagnostic guidelines","volume":"4","author":"Astley SJ","year":"2017","journal-title":"Adv Pediatric Res"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(96)70187-7"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/35.4.400"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/36.2.147"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9926(199903)59:3<163::AID-TERA8>3.0.CO;2-8"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1530-0277.2011.01657.x"},{"key":"e_1_2_9_15_1","unstructured":"2004 Centers for Disease Control and Prevention Atlanta GA J Bertrand RL Floyd MK Weber M O'Connor EP Riley KA Johnson DE Cohen National Task Force on FAS\/FAE Fetal Alcohol Syndrome: Guideline for Referral and Diagnosis"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-018-0356-1"},{"key":"e_1_2_9_17_1","unstructured":"BowerC ElliottEJ On Behalf of the Steering Group(2016)Report to the Australian Government Department of Health: \u201cAustralian Guide to the diagnosis of Fetal Alcohol Spectrum Disorder (FASD)\u201d."},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.13032"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.141593"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1076\/chin.6.3.235.3152"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13295"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-4256"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/154.8.777"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13330"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.12072"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2012.03393.x"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech.55.10.738"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/1403494809357093"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13319"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1465-3362.2011.00331.x"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/14034948010290040201"},{"key":"e_1_2_9_32_1","unstructured":"1996 Institute of Medicine National Academy Press Washington DC K Stratton C Howe F Battaglia Fetal Alcohol Syndrome: Diagnosis Epidemiology Prevention and Treatment"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1080\/02844319950159631"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/9780470720868.ch8"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0082843"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2012.03396.x"},{"key":"e_1_2_9_37_1","unstructured":"1990 The Psychological Corporation Sidcup Kent D Wechsler Manual for the Wechsler Preschool and Primary Scale of Intelligence\u2014Revised"}],"container-title":["Alcoholism: Clinical and Experimental Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acer.14047","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/acer.14047","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acer.14047","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,10]],"date-time":"2023-09-10T17:22:51Z","timestamp":1694366571000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acer.14047"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,24]]},"references-count":36,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2019,6]]}},"alternative-id":["10.1111\/acer.14047"],"URL":"https:\/\/doi.org\/10.1111\/acer.14047","archive":["Portico"],"relation":{},"ISSN":["0145-6008","1530-0277"],"issn-type":[{"value":"0145-6008","type":"print"},{"value":"1530-0277","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5,24]]},"assertion":[{"value":"2018-10-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-05-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}