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Effects of intrauterine alcohol exposure on fetal facial development
Thesis (PhD)--Stellenbosch University, 2021.
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| Language: | English |
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Stellenbosch : Stellenbosch University
2021
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| _version_ | 1867614117628477440 |
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| access_status_str | Open Access |
| author | Geerts, Lutgart Therese Gaston Maria |
| author2 | Odendaal, H. J. |
| author_browse | Geerts, Lutgart Therese Gaston Maria Odendaal, H. J. |
| author_facet | Odendaal, H. J. Geerts, Lutgart Therese Gaston Maria |
| author_sort | Geerts, Lutgart Therese Gaston Maria |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (PhD)--Stellenbosch University, 2021. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/110851 |
| institution | Stellenbosch University (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:46:56.603Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2021 |
| publishDateRange | 2021 |
| publishDateSort | 2021 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/110851 Effects of intrauterine alcohol exposure on fetal facial development Geerts, Lutgart Therese Gaston Maria Odendaal, H. J. Urban, M. F. Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology. Fetal alcohol spectrum disorders Alcoholism in pregnancy Fetus -- Abnormalities UCTD Thesis (PhD)--Stellenbosch University, 2021. ENGLISH ABSTRACT: Background: Prenatal identification of fetuses harmed by prenatal alcohol exposure (PAE) can potentially lead to earlier interventions and improved outcomes. Aim: To identify facial characteristics at 28-31 weeks gestation for fetuses who have PAE or who display features of (partial) Fetal Alcohol Syndrome ((P)FAS) at one year of age. Study population: A subset of pregnant women of two urban townships of Cape Town, South Africa, randomly selected from the geographically representative cohort participating in the Safe Passage Study (SPS). Methods: SPS was a prospective cohort study with meticulous data collection (with a modified timeline follow-back method) on PAE across gestation, maternal, newborn and infant characteristics. (P)FAS case definitions were only based on infant biometry, a short palpebral fissure length (PFL) and abnormal lip-and philtrum scores on photographic or live assessments. In several cohort studies (N between 164 and 308), facial measurements (on multiplanar images) and lip-and philtrum scores (on surface rendered images) were obtained by observers blinded to clinical data, on 3D-ultrasound volumes collected at 28-31 weeks. After the reference standard for the local population was established on 97 non-exposed fetuses, all facial measurements were transformed into z-scores, to correct for the exact gestational age for comparisons according to several alcohol exposure metrics and infant phenotypic features. Analyses were corrected for maternal and newborn confounders. Results: PAE in the study groups was common but low or modest for most, resulting in a limited number of cases with heavy early exposure or (P)FAS. Significant potential confounders were identified, especially maternal smoking, infant sex and birth weight z-score. Several facial measurements showed significant changes with increasing PAE according to various exposure metrics. Strongest results for exposure during pregnancy were seen for the nose-philtrum angle (NPA), nose protrusion (NP), philtrum length (PL), upper vermillion thickness (UVT), subnasal-mouth distance (SM) and face protrusion (FP) (effect sizes > 0.55 SD, except SM). Some measurements were only related to preconception exposure metrics (pronasal-subnasal distance (PS), nose length (NL), maxillary (MA) and frontomaxillary facial angle (FMF) (effect sizes < 0.55 SD). Strongest associations with the postnatal (P)FAS case definitions (and some individual diagnostic features) were seen for the nasal bone length (NBL), NL, SM, NPA, MA and the prenatal lip-and philtrum scores. While all prenatal ocular measurements were strongly associated with a short PFL, both correlated weakly and inconsistently with PAE metrics and not with (P)FAS case definitions or other FAS features. Conclusion: Compared to controls, several facial measurements representing cardinal (smooth philtrum, thin vermillion) and non-cardinal FAS features (a short, upturned nose, a long philtrum and midface hypoplasia) were affected by increasing PAE or the presence of (P)FAS features at one year of age. The overlap between the variables associated with PAE or with (P)FAS features was incomplete, perhaps related to classification criteria for (P)FAS being suboptimal for this population. No facial features can be proposed as stand-alone biomarkers, but combinations of measurements or sores could be useful for PAE or (P)FAS identification before birth and should be explored further. AFRIKAANSE OPSOMMING: Agtergrond Om, reeds tydens swangerskap, fetusse te identifiseer wat benadeel is deur voorgeboortelike blootstelling aan alkohol (VBA), mag lei tot vervroegde ingrepe met verbeterde uitkomste. Doelwit Identifisering van gesigskenmerke tussen 28 en 31 weke swangerskapsduurte vir fetusse wat VBA het of kenmerke van (gedeeltelike) Fetale Alkohol Sindroom ((G)FAS) vertoon op eenjarige ouderdom. Studiebevolking Swanger vrouens van twee stedelike woongebiede in Kaapstad, Suid Afrika, ewekansig gekies uit deelnemers van die Veilige Geboorte Studie (VGS), wat verteenwoordigend was van die geografiese area. Metodes Die VGS was ‘n voornemende kohortstudie met baie noukeurige inligting oor VBA regdeur swangerskap (met ‘n aangepaste tydlyn-terugvolg metode), asook eienskappe van moeder, pasgebore baba en eenjarige kind. (G)FAS definisies is baseer op kinderbiometrie, ‘n kort oogspleet en abnormale tellings vir filtrum en bolipkenmerke, baseer op ‘n fisiese ondersoek of op digitale fotos. Beoordelaars wat blind was vir kliniese inligting, het in verskeie studiegroepe (tussen 164 en 308 pasiënte) gesigmates geneem (op veelvlakbeelde) en lip- en filtrumtellings toegeken (op oppervlak-verbeelde fotos) op drie-dimensionele ultraklank volumes, wat tussen 28 en 31 weke swangerskapsduurte versamel is. Nadat verwysingswaardes uitgewerk is op 97 nie-blootgestelde fetusse, is alle metings omgeskakel na z-tellings, om te korrigeer vir swangerskapsduurte in vergelykings volgens verskeie grade van alkoholblootstelling en fenotipiese kenmerke van die kind. Ontledings is korrigeer vir moederlike en pasgeborene strengelingsveranderlikes. Resultate VBA in die studie groepe was algemeen, maar meestal laag of matig, wat getalle met ernstige VBA en (G)FAS beperk het. Betekenisvolle strengelingsveranderlikes is gevind, veral rook, geboortemassa-z-telling en fetale geslag. Verskeie gesigmates het betekenisvol verskil met toenemende VBA volgens ‘n verskeidenheid van blootstellingsmates. Die sterkste effekte vir blootstelling tydens swangerskap is gevind op die neusfiltrumhoek (NFH), die neusprojeksie (NP), die bolip dikte (BLD), die afstand tussen die sub-nasale landmerk en die mondspleet (SM) en die gesigprojeksie (GP) (effek groottes was > 0.55 standaardafwyking, behalwe vir die SM). Sommige metings het verskil met blootstellingsmates in die 4 weke voor bevrugting (die afstand tussen die pro-nasale en sub-nasale landmerk (PS), die neus lengte (NL), die maksillêre hoek (MH) en die frontomaksillêre gesigshoek (FMF) (met effekgroottes < 0.55 standaardafwyking). Die sterkste verband met nageboortelike (G)FAS definisies en diagnostiese FAS-kenmerke is gevind vir die fetale neusbeenlengte (NBL), NL, SM, NFH, MH asook die voorgeboortelike lip- en filtrumtellings. Voorgeboortelike oogmates het sterk korreleer met ‘n kort oogspleet in die kind, maar beide het swak korreleer met blootstellingmates en geen verband met (G)FAS definisies of ander FAS kenmerke getoon nie. Gevolgtrekking Verskeie gesigsmates wat hoofkenmerke (sagte filtrum en dun bo-lip) asook sekondêre FAS kenmerke verteenwoordig (‘n kort wipneusie, ‘n lang filtrum en ‘n onderontwikkelde mid-gesig) word beinvloed deur toenemende VBA en die teenwoordigheid van (G)FAS kenmerke op eenjarige ouderdom. Die oorvleueling tussen die kenmerke wat beinvloed was deur met VBA of (G)FAS was onvolledig, moontlik as gevolg van tekortkomings in die definisies vir (G)FAS kenmerke. Geen fetale gesigskenmerk kan aanbeveel word as ‘n alleenstaande biomerker nie, maar kombinasies van metings of tellings mag bruikbaar wees vir die voorgeboortelike identifisering van VBA of (G)FAS en behoort verder ondersoek te word. Doctoral 2021-08-16T08:18:59Z 2021-08-16T08:18:59Z 2021-12 Thesis http://hdl.handle.net/10019.1/110851 en Stellenbosch University xxx, 436 pages : illustrations application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Fetal alcohol spectrum disorders Alcoholism in pregnancy Fetus -- Abnormalities UCTD Geerts, Lutgart Therese Gaston Maria Effects of intrauterine alcohol exposure on fetal facial development |
| title | Effects of intrauterine alcohol exposure on fetal facial development |
| title_full | Effects of intrauterine alcohol exposure on fetal facial development |
| title_fullStr | Effects of intrauterine alcohol exposure on fetal facial development |
| title_full_unstemmed | Effects of intrauterine alcohol exposure on fetal facial development |
| title_short | Effects of intrauterine alcohol exposure on fetal facial development |
| title_sort | effects of intrauterine alcohol exposure on fetal facial development |
| topic | Fetal alcohol spectrum disorders Alcoholism in pregnancy Fetus -- Abnormalities UCTD |
| url | http://hdl.handle.net/10019.1/110851 |
| work_keys_str_mv | AT geertslutgarttheresegastonmaria effectsofintrauterinealcoholexposureonfetalfacialdevelopment |