An alarming study suggests prenatal alcohol exposure changes the shape of your baby's face

In 2016, the Centers for Disease Control and Prevention (CDC) was criticized for making a strong recommendation about alcohol and the possibility of pregnancy: women who were not on birth control should abstain from alcohol to avoid the risk of giving birth to babies with fetal alcohol spectrum disorders, the agency said. The agency was lambasted for asking for a self-imposed constraint on such a large demographic: the number of American women not on birth control is enormous, and asking all of them to become teetotalers is a huge and invasive ask. 

The recommendation came after a report estimated that 3.3 million women were at risk for an "alcohol-exposed pregnancy." The Washington Post called the guidance "incredibly condescending." "Forget that the real problem is abortion access and the fact that birth control occasionally fails," Jezebel opined.

Still, the CDC currently warns that there is "no known safe amount of alcohol use during pregnancy or while trying to get pregnant."

Now, a new study published in the journal Human Reproduction is resurfacing nuanced discussions around this topic. The reason? The study concluded there could be an association between drinking three months before and during pregnancy, and potential adverse health and developmental problems in a newborn child.

The study in question was published by researchers in the Netherlands, who used artificial intelligence (AI) to find an association between alterations in the shape of children's faces and the amount of alcohol their mothers drank before and during pregnancy.

"I would call the face a 'health mirror' as it reflects the overall health of a child," Gennady Roshchupkin, an assistant professor at Erasmus Medical Centre and lead author of the study, said in a statement.

To land on their conclusion, researchers used AI and deep learning technology to analyze three-dimensional images of children taken at ages 9 and 13 born between April 2009 and January 2006. These images were part of a study called Generation R in The Netherlands, which is an ongoing population study of pregnant women and their children.

Researchers looked at maternal alcohol consumption in early, mid and late pregnancy, which was reported by the pregnant women themselves. The researchers divided the treatment groups into three tiers. The first were those who drank three months before pregnancy and stopped after; the next were mothers who drank before pregnancy and during the first trimester; the final one being those who drank before pregnancy and throughout the pregnancy.

"We found a statistically significant association between prenatal alcohol exposure and face shape in the nine-year-old children," said Xianjing Liu, first author of the study and a PhD student in Prof. Roshchupkin's group, who developed the AI algorithm, in a statement. "The more alcohol the mothers drank, the more statistically significant changes there were."

Liu noted: "The most common traits were turned-up nose tip, shortened nose, turned-out chin and turned-in lower eyelid."

The researchers also found an association with altered face shape in mothers who drank less than 12 grams of alcohol a week throughout pregnancy, which is the equivalent of a small glass or wine or beer. Notably, the association between face shape and a mother's alcohol consumption decreased among the older group of children.

The researchers noted that the study included children from multiple ethnic backgrounds. Notably, the conclusion did rely on participants self-reporting their drinking habits, which may leave room for error. As a separate study suggested, self-reported maternal drinking habits are likely underreported. However the researchers concluded with a strict recommendation: "Our study suggests that women who are pregnant or want to become pregnant soon should quit alcohol consumption several months before conception and completely during pregnancy to avoid adverse health outcomes in the offspring."

When studies like these come out with suggestions to completely abstain from something, it can be difficult to truly understand the causation. Dr. Vanessa Parisi, a Fetal Alcohol Spectrum Disorder (FASD) Champion of the American College of Obstetricians & Gynecologists (ACOG) who was not part of the study, told Salon this study adds to the literature that suggests there is no safe amount of alcohol to consume while pregnant. She notes that the safety guidelines on drinking during or before pregnancy touch on the fact that many do not actually know they are pregnant initially. As an OBGYN, Parisi said she does ask her patients to stop drinking when they're actively trying to conceive.

"Many people do not know that they are pregnant until after organogenesis (organ formation) has occurred, weeks 3 to 8," Parisi said. "This is a key time where structural deficits can occur; the study indicated that even some women who stopped after the first trimester when they found out they were pregnant, had children with these specific facial changes."

Want more health and science stories in your inbox? Subscribe to Salon's weekly newsletter The Vulgar Scientist.

When it comes to drinking during pregnancy, there is a lot of misinformation out there.  

"Sometimes things are not always what they appear, someone may feel, 'Well my cousin had one glass of red wine a day or week with her pregnancy and her child is fine," Parisi said, adding that studies have shown there is no way to predict which fetuses can be affected and unaffected by alcohol in pregnancy. "We've seen this in twin studies where one child (with the same prenatal exposure) expresses a more severe fetal alcohol spectrum disorder (FASD) versus another."

However, Parisi added that the shape of a child's face or facial characteristic is not always an indication of a health and developmental problem.

"Diagnosing an Fetal Alcohol Spectrum Disorder is a multidisciplinary approach," Parisi said. "There are structural and/or neurocognitive deficits with FASDs, and the more subtle ones may be misdiagnosed or not diagnosed at all; the consequence of not diagnosing can be detrimental and very costly."

As a whole, Parisi said that this study cannot "conclude that having a drink in the 3 months leading up to pregnancy can cause a change in your child's face shape or an FASD," adding more research is needed.