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To elucidate the etiology of FASD, we established a prenatally recruited prospective birth cohort collecting biological samples at birth and longitudinal data from alcohol\u2010exposed and unexposed control children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Dysmorphological, neuropediatric, and neuropsychological assessments were performed at 6\u2009years of age in 28 children with substantial PAE and 52 control children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the PAE group, 76% (19\/25) of the children who completed the full evaluation met the diagnostic criteria for FASD, including five with fetal alcohol syndrome (FAS), six with partial FAS, seven with alcohol\u2010related neurodevelopmental disorder, and one with alcohol\u2010related birth defect. None of the tested children had a prior FASD diagnosis. In addition to the characteristic features of FAS, including short palpebral fissures, smooth philtrum, and thin vermilion border, several additional anomalies, such as mild midface hypoplasia, were significantly associated with PAE (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Also, PAE was associated with both underweight and overweight at 6\u2009years of age, particularly among boys. Neurocognitive assessments revealed lower performance scores and a high prevalence of ADHD symptoms in PAE children compared with controls. Furthermore, PAE children exhibited additional phenotypic features not captured by the diagnostic FASD criteria, including impairments in adaptive and social functioning, somatic health problems, and reduced postural stability. Moreover, 11 children with early\u2010only PAE limited to the first seven gestational weeks showed dysmorphic features and cognitive outcomes comparable to those of children with longer exposure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The high proportion of affected children demonstrates the need for systematic follow\u2010up of those with PAE and comprehensive phenotypic characterization to improve FASD identification. Importantly, these findings indicate that substantial PAE limited to very early pregnancy is sufficient to result in FASD with clinically significant neurocognitive impairment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acer.70320","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T10:26:44Z","timestamp":1778668004000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Dysmorphological and Neuropsychological Phenotypes of Prenatally Alcohol\u2010Exposed 6\u2010Year\u2010Old Children: A Prospective Longitudinal Birth Cohort Study"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6760-0495","authenticated-orcid":false,"given":"M.","family":"Jolma","sequence":"first","affiliation":[{"name":"Division of Child Neurology P\u00e4ij\u00e4t\u2010H\u00e4me Central Hospital  Lahti Finland"},{"name":"Faculty of Medicine University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9926-0106","authenticated-orcid":false,"given":"E.","family":"Wall\u00e9n","sequence":"additional","affiliation":[{"name":"Environmental Epigenetics Laboratory, Department of Medical and Clinical Genetics, Medicum, Faculty of Medicine University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4061-554X","authenticated-orcid":false,"given":"E.","family":"Saure","sequence":"additional","affiliation":[{"name":"BABA Center, Pediatric Research Center Helsinki University Hospital and University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8070-4785","authenticated-orcid":false,"given":"K.","family":"R\u00e4m\u00f6","sequence":"additional","affiliation":[{"name":"Environmental Epigenetics Laboratory, Department of Medical and Clinical Genetics, Medicum, Faculty of Medicine University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9658-1193","authenticated-orcid":false,"given":"H.","family":"Kahila","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Helsinki University Hospital and University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1255-4716","authenticated-orcid":false,"given":"N.","family":"Kaminen\u2010Ahola","sequence":"additional","affiliation":[{"name":"Environmental Epigenetics Laboratory, Department of Medical and Clinical Genetics, Medicum, Faculty of Medicine University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"ADHD: Current Care Guidelines.2025.\u201cWorking Group Set Up by the Finnish Medical Society Duodecim Finnish Pediatric Neurology Association Finnish Childrens Psychiatry Association Finnish Adolescent Psychiatry Association.\u201dHelsinki: Finnish Medical Society Duodecim.https:\/\/www.kaypahoito.fi."},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2015.10.049"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjophth-2021-000852"},{"issue":"3","key":"e_1_2_10_5_1","article-title":"Comparison of the FASD 4\u2010Digit Code and Hoyme Et\u00a0al. 2016 FASD Diagnostic Guidelines","volume":"4","author":"Astley S. 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