Prenatal Coexposure to Smoking, Alcohol Linked to Facial Dysmorphism

THURSDAY, Nov. 12, 2026 (HealthDay News) — Prenatal coexposure to alcohol and smoking is associated with greater facial dysmorphism and reduced facial size in offspring compared with single exposure, according to a study published online Nov. 6 in Pediatrics.

Leah Wetherill, Ph.D., from the Indiana University School of Medicine in Indianapolis, and colleagues conducted a longitudinal study involving 634 infants from a high-risk population in South Africa to examine whether concomitant prenatal exposure to alcohol and tobacco exerts synergistic effects on infant facial dysmorphism, facial size, and growth trajectories. A modified timeline follow-back interview was used to assess prenatal alcohol and smoking behaviors. At one month and one year postnatally, three-dimensional facial images were obtained.

The researchers found that compared with controls and single-exposure groups, continuous prenatal coexposure to smoking and alcohol was associated with the greatest facial dysmorphism and reduced facial size in offspring. The effects were mainly sex-specific, with stronger alterations seen in girls. There was an association observed for coexposure with ocular changes, including reduced palpebral fissure length and increased canthal index. More limited effects were seen with single exposures; exposure did not significantly influence facial growth trajectories.

“Our results contribute to a growing body of evidence on the harms of coexposures, and we encourage clinicians and health care authorities to emphasize the potential harm of concurrent smoking and alcohol use during pregnancy,” the authors write.

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