Combined Prenatal Alcohol and Tobacco Exposure Linked to Greater Fetal Facial Developmental Changes: Study
UK: A longitudinal study from South Africa using 3D facial scans has found that prenatal exposure to both alcohol and tobacco smoke was associated with greater craniofacial developmental differences in infants than exposure to either substance alone. The findings highlight the importance of integrated alcohol and smoking cessation interventions during pregnancy to protect fetal development and reduce the risk of craniofacial abnormalities.
The study was published in the journal Pediatrics by Leah Wetherill of the Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, and colleagues.
Alcohol consumption and tobacco use during pregnancy are independently recognised as risk factors for adverse fetal development. However, since these substances are frequently used together, their combined influence on embryonic development remains an important area of investigation. Facial dysmorphism, which refers to differences in facial structure and appearance, can serve as an indicator of disturbances during early embryonic development.
To investigate whether simultaneous exposure to alcohol and tobacco produces greater developmental changes than exposure to either substance individually, researchers conducted a longitudinal study involving 634 infants from a high-risk population in South Africa.
Maternal alcohol consumption and smoking patterns were documented through modified timeline follow-back interviews conducted at different study visits. Researchers recorded the frequency and quantity of substance use during pregnancy.
Three-dimensional facial images were collected when the infants were one month and one year old. Participants were classified into five groups based on prenatal exposure: unexposed controls, continuous alcohol exposure alone, continuous smoking alone, continuous exposure to both substances, and continuous smoking accompanied by any alcohol exposure.
The researchers used facial anthropometric measurements and advanced surface-modelling techniques to examine differences in facial structure, dimensions and developmental patterns.
The analysis revealed the following findings:
- Infants exposed continuously to both alcohol and tobacco during pregnancy exhibited the greatest degree of facial dysmorphism compared with unexposed infants and those exposed to either substance individually.
- Combined exposure was also associated with smaller facial dimensions, suggesting greater alterations in craniofacial development.
- The observed effects differed by sex, with girls demonstrating more pronounced facial changes than boys.
- Ocular abnormalities were particularly evident, including shorter palpebral fissures (the horizontal openings between the eyelids) and an increased canthal index, reflecting changes in the relative positioning of the inner and outer eye corners.
- Exposure to alcohol or tobacco individually was associated with fewer facial alterations than simultaneous exposure to both substances.
- Despite the differences in facial structure and size, prenatal exposure did not significantly influence facial growth trajectories during the study period.
The researchers concluded that simultaneous prenatal exposure to alcohol and tobacco was associated with more pronounced facial developmental differences than exposure to either substance alone.
Overall, the findings emphasise the importance of addressing both alcohol consumption and tobacco use during pregnancy. Integrated cessation programmes and early prenatal counselling may help reduce combined teratogenic exposures and support healthier fetal development.
Reference:
Leah Wetherill, Hanie Moghaddasi, Scott E. Parnell, Hein Odendaal, Lut Geerts, Rosemary Meyer, Heidi Nolan, Lucy Brink, Michael Suttie; Facial Dysmorphism in Infants Following Combined Prenatal Exposure to Alcohol and Tobacco. Pediatrics 2026; e2025074567. 10.1542/peds.2025-074567
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