TL;DR
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A longitudinal South African study linked continuous prenatal exposure to both alcohol and tobacco smoke with greater differences in infants’ facial size, shape and growth than exposure to either substance alone. Differences were largest at one month and remained detectable at one year; the study shows an association, not proof that co-exposure caused the changes.
A South African longitudinal study found that infants exposed to alcohol and tobacco smoke throughout pregnancy had greater differences in facial size, shape and growth than infants exposed to either substance alone or neither. The findings, published in Pediatrics, were based on 3D facial scans at one month and one year of age and indicate an association, not proof that the exposures caused the differences.
Michael Suttie, PhD, of the University of Oxford, and colleagues analyzed a subset of the Safe Passage Study, a prospective cohort involving more than 7,000 pregnancies in low-income communities in Cape Town, South Africa. Their analysis included 634 infants with prenatal exposure information and facial imaging at both ages. Researchers assessed alcohol and smoking through interviews during prenatal visits, recording frequency and quantity.
The analysis divided infants into five groups: no exposure (152), continuous alcohol exposure alone (48), continuous smoking alone (149), continuous co-exposure (150), and continuous smoking with any alcohol use (135). Continuous exposure meant exposure in the first trimester and at least one later trimester. The researchers reported that continuous co-exposure was associated with smaller facial size than no exposure or either single-exposure group, with the size finding driven by girls. The single-exposure groups did not differ from controls on that measure.
Overall facial dysmorphism, or differences in facial features, was also greater in the continuously co-exposed group. The largest difference was observed at one month; a smaller difference remained statistically significant at one year. The researchers reported midline displacement at both time points and outward movement of the inner corners of the eyes. Patterns differed by sex: among girls, the combination was associated with reduced facial growth and measurements around the eyes; among boys, it was associated with reduced nasal growth and smaller noses at one year.
How Combined Exposure May Affect Facial Growth
The findings add evidence that combined prenatal exposures may be associated with different outcomes from alcohol or smoking alone. That matters for prenatal care because people may encounter both exposures, and the study’s results suggest that considering each substance separately could miss a potential association between them. The researchers said the findings support interventions addressing both alcohol use and smoking during pregnancy.
The study does not establish that either exposure, or their combination, caused the observed facial differences. It also does not determine whether those differences lead to health or developmental problems later in childhood. Its findings are specific to the infants studied and should be understood alongside the study’s limitations, rather than treated as a prediction for any individual pregnancy.
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Inside the Safe Passage Analysis
The Safe Passage Study followed more than 7,000 pregnancies in Cape Town communities described in the report as having low socioeconomic status. The analysis focused on infants for whom both 3D facial scans and antenatal substance-use data were available. Mothers were interviewed at prenatal visits about alcohol and tobacco use. The analysis excluded pregnancies involving reported illicit drug use, including marijuana, and infants with genetic diagnoses.
The researchers noted that alcohol and tobacco are both teratogens—exposures that can affect development before birth. They proposed that both may affect neural crest cells involved in forming facial structures, while nicotine may also affect oxygen and nutrient delivery. Those explanations provide biological context, but the analysis did not directly test these mechanisms.
The report also cited estimates that 5.4% of women in the United States smoke during pregnancy and 9.8% of pregnant women globally consume alcohol. These figures come from the source report and describe different populations; they are not estimates from the South African study.
“Findings highlight tobacco’s potentiating effect on alcohol-related craniofacial harm.”
— Michael Suttie, PhD, and colleagues
Limits on Interpreting the Findings
The observational analysis cannot establish that alcohol and tobacco exposure caused the facial differences, or separate the effects of exposure from other factors that may affect growth. The researchers noted that maternal nutritional deficiencies could have modified results. They also said the infants had to be scanned while asleep, a constraint that may affect imaging, and that the findings may not generalize to populations with different genetic profiles.
The analysis included only 634 infants from a much larger pregnancy cohort, because participants needed both imaging at two ages and exposure data. The report does not establish whether the observed differences persist beyond age one, affect function, or have longer-term developmental consequences. It also does not provide evidence that any particular intervention changes the facial outcomes measured.
Further Follow-Up and Prenatal Support
The report does not identify a planned follow-up study or a next publication date. Longer-term assessment would be needed to determine whether facial differences continue as children grow and whether they are linked to later health or developmental outcomes. Research in other populations could also test how well these findings apply beyond the Cape Town cohort.
For now, the authors urged clinicians and health authorities to emphasize the potential risks associated with concurrent smoking and alcohol use during pregnancy. The study supports attention to both exposures, but it does not replace individualized care or establish the effect of a specific cessation program.
Key Questions
What did the study find?
Infants with continuous prenatal exposure to both alcohol and tobacco smoke had greater facial differences than those with no exposure or either exposure alone. The largest overall difference was seen at one month, with a smaller difference still detected at one year.
Does the study prove the exposures caused the differences?
No. It was an observational analysis and found an association. It cannot establish that alcohol, tobacco, or their combination caused the measured facial differences.
Were the findings the same for boys and girls?
No. The study reported reduced facial growth and measurements around the eyes among girls with co-exposure, while among boys it reported reduced nasal growth and smaller noses at one year. The facial-size finding overall was driven by differences among girls.
What are the study’s main limitations?
The analysis covered 634 infants from a larger cohort and may not generalize to populations with different genetic profiles. The researchers also noted possible effects from maternal nutrition and practical limits on scanning infants while asleep.
What happens next?
The report does not specify a next study or publication. Longer-term research is needed to track the findings beyond age one; the authors called for attention to both smoking and alcohol use during pregnancy.
Source: medpagetoday.com
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