Low to Moderate Prenatal Alcohol Exposure and Facial Shape of Children at Age 6 to 8 Years.JAMA pediatrics • February 10, 2025
Evelyne Muggli, Harold Matthews, Michael Suttie, Jane Halliday, Anthony Penington, Elizabeth Elliott, Deanne Thompson, Alicia Spittle, Stephen Hearps, Peter Anderson, Peter Claes
In addition to confirmed prenatal alcohol exposure and severe neurodevelopmental deficits, three cardinal facial features are included in the diagnostic criteria for fetal alcohol spectrum disorder. It is not understood whether subtle facial characteristics occur in children without a diagnosis but who were exposed to a range of common pregnancy drinking patterns and, if so, whether these persist throughout childhood. To determine whether subtle changes in facial shape with prenatal alcohol exposure found in 12-month-old children were evident at age 6 to 8 years using extended phenotyping methods and, if so, whether facial characteristics were similar to those seen in fetal alcohol spectrum disorder. In a prospective cohort study in Melbourne, Victoria, Australia, commencing in July 2011 with follow-up through April 2021, pregnant women were recruited in the first trimester from low-risk, metropolitan, public maternity clinics over a period of 12 months. Three-dimensional craniofacial images from 549 children of European descent taken at age 12 months (n = 421 images) and 6 to 8 years (n = 363) were included. Data analysis was performed from May 2021 to October 2024. Predominantly low to moderate prenatal alcohol exposure in the first trimester or throughout pregnancy compared with controls without prenatal alcohol exposure. Following hierarchical facial segmentation, phenotype descriptors were computed. Hypothesis testing was performed for 63 facial modules to analyze different facial parts independently using principal component analysis and response-based imputed predictor (RIP) scores. Comparison was made with a clinical discovery sample of facial images of children with a confirmed diagnosis of partial or full fetal alcohol syndrome. A total of 549 children took part in the 3-dimensional craniofacial image analysis, of whom 235 (42.8%) contributed an image at both time points. Time 1 included 421 children, comprising 336 children (159 [47.3%] female) with any prenatal alcohol exposure and 85 control children (45 [52.9%] female); time 2 included 363 children, comprising 260 children with any prenatal alcohol exposure (125 [48.1%] female; mean [SD] age, 6.9 [0.7] years) and 103 control children (53 [51.5%] female; mean [SD] age, 6.8 [0.7] years). At both time points, there was consistent evidence for an association between prenatal alcohol exposure and the shape of the eyes (eg, module 15: RIP partial Spearman ρ, 0.19 [95% CI, 0.10-0.29; P < .001] at 6-8 years) and nose (eg, module 5: RIP partial Spearman ρ, 0.19 [95% CI, 0.09-0.27; P < .001] at 6-8 years), whether exposure occurred only in trimester 1 or throughout pregnancy. Facial variations observed differed from those in the clinical discovery sample. Low to moderate prenatal alcohol exposure was associated with characteristic changes in the face, which persisted until at least 6 to 8 years of age. A linear association between alcohol exposure levels and facial shape was not supported.
Elevated scaled scores when using the digital version of the WISC-V coding subtest.Child Neuropsychology : A Journal On Normal And Abnormal Development In Childhood And Adolescence • February 03, 2025
Stephanie Malarbi, Rachel Ellis, Elisha Josev, Kristina Haebich, Thi-nhu-ngoc Nguyen, Kristal Lau, Alice Burnett, Natalie Pride, Jonathan Payne, Peter Anderson
This study investigated the digital version of the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) Coding subtest in a large Australian clinical and non-clinical sample of 6-11 year old children (N = 794). Data was retrospectively pooled from several studies. Results showed the digital Coding scaled score was significantly elevated compared with all other subtests (M difference = 2.01, 95% CI. 1.74-2.27). Overall FSIQ was higher when calculated using Coding compared with Symbol Search (M difference = 2.067, 95% CI. 1.79-2.34). The Coding and Symbol Search discrepancy in digital administration did not vary according to age and was unrelated to general intelligence. Girls scored higher on average than boys on the digital Coding subtest, but there was no sex effect for the digital Symbol Search subtest (girls: M = 10.76, 95% CI 10.41-11.12; boys: M = 10.27, 95% CI 9.92-10.63). Inflated digital Coding scaled scores were observed across our subsamples of clinical and non-clinical cases, without any significant group differences. Overall, our findings support the notion that the digital WISC-V Coding subtest is inflated, particularly for girls, supporting cessation in the digital administration of this subtest.
Descriptive epidemiology of orofacial clefts in South Australia.Journal Of Cranio-Maxillo-Facial Surgery • January 22, 2025
Objective: There is wide variability in the prevalence of orofacial clefts at birth across geographic locations. The study aimed to quantify the prevalence of orofacial clefts and provide demographic details of the individuals identified with an orofacial cleft in South Australia.
Methods: The South Australian Birth Defects Register (SABDR) data was used to identify individuals born in South Australia with any orofacial cleft including cleft lip (CL), cleft lip and palate (CL + P), cleft palate (CP), cleft uvula (CU) and facial clefts (FC) between 1986 and 2019. The proportion of orofacial clefts for livebirths was calculated by sex, Indigenous status, geographic location, socioeconomic status, maternal age, plurality, gestation, birthweight and family history of orofacial clefts.
Results: A total of 1127 individuals were identified as having an orofacial cleft and livebirth: with a combined prevalence of 17.1 in 10,000 or 1 in 580 livebirths for all orofacial clefts. The prevalence for CL was 3.3 per 10,000, CL + P was 5.4 per 10,000, CP was 8.1 per 10,000, CU was 0.2 per 10,000 and FC was 0.1 in 10,000. A greater proportion of orofacial cleft diagnoses were male, born in major cities, non-Indigenous, higher SES, lower maternal age, normal gestational age and birthweight, non-syndromic diagnoses, with no family history of orofacial clefts.
Conclusions: Prevalence data provides an understanding of individuals born with orofacial clefts in South Australia since 1986 which are comparative to national and international birth registries. The quality of the SABDR is high and provides a reference for comparison to published prevalence reports.
The association between gestation at birth and maternal sensitivity: An individual participant data (IPD) meta-analysis.Early Human Development • February 05, 2025
Julia Jaekel, Peter Anderson, Dieter Wolke, Günter Esser, Gorm Greisen, Alicia Spittle, Jeanie Cheong, Anneloes Van Baar, Marjolein Verhoeven, Noa Gueron Sela, Naama Atzaba Poria, Lianne Woodward, Erica Neri, Francesca Agostini, Ayten Bilgin, Riikka Korja, Elizabeth Loi, Karli Treyvaud
Objective: Studies have documented differences in dyadic sensitivity between mothers of preterm (<37 weeks' gestation) and term born children, but findings are inconsistent and studies often include small and heterogeneous samples. It is not known to what extent variations in maternal sensitivity are associated with preterm birth across the full spectrum of gestational age. Objective: To perform a systematic review and individual participant data (IPD) meta-analysis assessing variations in observed dyadic maternal sensitivity according to child gestational age at birth, while adjusting for known confounders correlated with maternal sensitivity.
Methods: We harmonised data from 12 birth cohorts from ten countries and carried out one-stage IPD meta-analyses (N = 3951) using mixed effects linear regression. Maternal sensitivity was z-standardised according to the scores of contemporary term-born controls within each respective cohort. All models were adjusted for child sex, age at assessment, neurodevelopmental impairment, small for gestational age birth, and maternal education.
Results: The fixed linear effect of the association between gestation at birth and maternal sensitivity across all 12 cohorts was small but stable (0.02 per week [95 % CI = 0.01, 0.02], p < .001). The binary effects of maternal education (0.32 [0.24, 0.40], p < .001) and child neurodevelopmental impairment (-0.33 [-0.50, -0.17], p < .001) were associated with maternal sensitivity.
Conclusions: Gestational age at birth is positively associated with dyadic maternal sensitivity, however, the size of the effect is small. Over and above gestation, maternal education and child neurodevelopmental impairment appear to affect sensitivity, highlighting the importance of considering these factors in future research and intervention designs.
Socioeconomic outcomes in very preterm/very low birth weight adults: individual participant data meta-analysis.Pediatric Research • December 21, 2024
Yanlin Zhou, Marina Mendonça, Nicole Tsalacopoulos, Peter Bartmann, Brian Darlow, Sarah Harris, John Horwood, Lianne Woodward, Peter Anderson, Lex Doyle, Jeanie L Cheong, Eero Kajantie, Marjaana Tikanmäki, Samantha Johnson, Neil Marlow, Chiara Nosarti, Marit Indredavik, Kari Anne Evensen, Katri Räikkönen, Kati Heinonen, Sylvia Van Der Pal, Dieter Wolke
Background: Very preterm (VPT; <32 weeks) or very low birth weight (VLBW; <1500 g) birth is associated with socioeconomic disadvantages in adulthood; however, the predictors of these outcomes remain underexplored. This study examined socioeconomic disparities and identified neonatal and sociodemographic risk factors among VPT/VLBW individuals.
Methods: A one-stage individual participant data meta-analysis was conducted using 11 birth cohorts from eight countries, comprising 1695 VPT/VLBW and 1620 term-born adults aged 18-30 years.
Results: VPT/VLBW adults had lower odds of higher educational attainment (0.40[0.26-0.59]), remaining in education (0.63[0.47-0.84]) or paid work (0.76[0.59-0.97]), and higher odds of receiving social benefits (3.93[2.63-5.68]) than term-borns. Disparities in education and social benefits persisted after adjusting for age, sex, and maternal education, even among those without neurosensory impairments (NSI). Among VPT/VLBW adults, NSI significantly impacted all socioeconomic outcomes, increasing the odds of receiving social benefits 6.7-fold. Additional risk factors included medical complications, lower gestational age and birth weight, lower maternal education, younger maternal age, and non-white ethnicity.
Conclusions: NSI is the strongest risk factor for adulthood socioeconomic challenges in the VPT/VLBW population. Mitigating these disparities may require improved neonatal care to reduce NSI prevalence and targeted social and educational support for VPT/VLBW individuals. Conclusions: Very preterm or very low birth weight (VPT/VLBW) birth is associated with socioeconomic disadvantages in adulthood, including lower educational attainment, lower employment rates, and a higher need for social benefits compared with individuals born at term. Neurosensory impairments are strongly associated with adverse socioeconomic outcomes among VPT/VLBW adults, while lower gestational age, lower birth weight, and sociodemographic disadvantages serve as additional risk factors. Early interventions in the NICU that reduce medical complications, along with enhanced educational support throughout childhood, may help mitigate long-term socioeconomic disparities for individuals born VPT/VLBW.
