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Using facial morphology traits related to attention problems in children to identify prenatal exposure history

Published online by Cambridge University Press:  16 January 2026

Anna Shchetinina Open the ORCID record for Anna Shchetinina [Opens in a new window] ,
Xianjing Liu ,
Natalie Slopen ,
Christina Chambers ,
Eppo Wolvius ,
Manfred Kayser ,
Gennady Roshchupkin  and
Henning Tiemeier
Anna Shchetinina*
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Xianjing Liu
Affiliation:
Department of Oral and Maxillofacial Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
Natalie Slopen
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Christina Chambers
Affiliation:
Department of Pediatrics and Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
Eppo Wolvius
Affiliation:
Department of Oral and Maxillofacial Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
Manfred Kayser
Affiliation:
Department of Pathology and Clinical Bioinformatics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
Gennady Roshchupkin
Affiliation:
Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
Henning Tiemeier
Affiliation:
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
*
Corresponding author: Anna Shchetinina; Email: ashchetinina@g.harvard.edu
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Abstract

Brain development and face morphology are related through underlying biological mechanisms, namely embryonic neuroectodermal processes. This study examined whether the facial parameters identified in children can help understand the neurodevelopmental impact of prenatal exposures on child behavior. We studied 9- to 10-year-old children of European descent from Generation R Study (N = 2,779) with three-dimensional face photographs. With an AI model of a 3D graph autoencoder, each facial shape was compressed into 200 traits representing facial morphology. We examined associations of traits with internalizing and externalizing behaviors and attention problems. Next, select prenatal substance and micronutrient exposures were related to facial traits using adjusted linear regression analyses. We identified a robust association between one specific facial trait and attention problem scores (β = −1.47, p = 0.038). This trait features chin retrusion, mild nasal contour variation, nose tip protrusion, and overall facial asymmetry. Higher prenatal vitamin D and folic acid concentrations were associated with more facial curvature (β = 0.0001, 95%CI: 0.00001 to 0.0002, p = 0.002; and β = 0.0003, 95%CI: 0.00002 to 0.0005, p = 0.03 accordingly), while prenatal tobacco smoking showed a negative association both until the mother became aware of pregnancy (β = −0.008, 95%CI: −0.0135 to −0.0014, p = 0.02) and throughout pregnancy (β = −0.006, 95%CI: −0.0113 to −0.0005, p = 0.03). Findings suggest that facial morphology may serve as a marker of impaired neuroectodermal development. Leveraging its association with attention problems enabled a robust examination of prenatal exposures’ impact. The associations of maternal smoking, vitamin D, and folic acid concentrations with facial morphology provide insights into the origins of neurodevelopment.

Keywords

Facial morphologyprenatal exposureschildren’s attention problemsprenatal tobaccoprenatal vitamin Dprenatal folic acid

Information

Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 17 , 2026 , e6
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Copyright
© The Author(s), 2026. Published by Cambridge University Press in association with The International Society for Developmental Origins of Health and Disease (DOHaD)

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Footnotes

Article updated 20 January 2026

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