Hill S Y, Lowers L, Locke-Wellman J, Shen S A
Department of Psychiatry, University of Pittsburgh School of Mediicne, Pennsylvania 15213, USA.
J Stud Alcohol. 2000 Sep;61(5):661-8. doi: 10.15288/jsa.2000.61.661.
To examine the relative importance of prenatal exposure to cigarettes and alcohol and familial/genetic susceptibility for alcohol dependence in the etiology of childhood psychopathology.
A longitudinal prospective study of 150 children/adolescents (51.3% male), who were at either high or low risk for developing alcohol dependence because of their familial loading for alcoholism, provided multiple diagnostic assessments (N = 318) of these subjects. High-risk families were identified through the presence of two adult alcoholic sisters; low-risk control families were selected from the community. Annual assessments of offspring from these families included an in-depth psychiatric interview of each child and his/her parent to determine the presence or absence of childhood disorders. Mothers were interviewed concerning their prenatal use of substances, and information was gathered concerning their personal and familial loading for psychiatric disorders.
Using conventional logistic regression analyses, internalizing and externalizing disorders were found to be associated with familial loading for alcoholism and prenatal exposure to cigarettes and alcohol. In addition, a specialized statistical analysis, a multivariate confounder score approach, was conducted using familial risk status and the child's exposure to maternal prenatal use of alcohol and cigarettes. This analysis demonstrated that only one relationship between a single variable and a childhood disorder was significant while controlling for the other two variables: Oppositional disorder remained significant in association with familial risk status. Three additional analyses were performed to evaluate the effects of familial risk status, prenatal alcohol exposure and prenatal cigarette exposure on childhood psychopathology while controlling for two known risk factors (SES and parental ASPD) for externalizing disorders. Results of these analyses revealed that the only childhood disorder that was elevated was ADHD, and that this was the result of the familial risk variable only.
Familial loading for alcohol dependence is an important risk factor for the development of childhood psychopathology and may account for the previously reported associations between prenatal exposure to nicotine and alcohol. Studies of substance abuse/dependence etiology and childhood psychopathology need to include consideration of both prenatal exposures and familial loading for alcohol dependence and other psychiatric disorders.
探讨产前接触香烟和酒精以及家族/遗传易感性在儿童精神病理学病因中对酒精依赖的相对重要性。
对150名儿童/青少年（51.3%为男性）进行纵向前瞻性研究，这些儿童/青少年因家族酗酒史而有高或低的酒精依赖发病风险，对这些受试者进行了多次诊断评估（N = 318）。通过有两名成年酗酒姐妹来确定高风险家庭；低风险对照家庭从社区中选取。对这些家庭的后代进行年度评估，包括对每个孩子及其父母进行深入的精神病学访谈，以确定是否存在儿童期疾病。就母亲孕期物质使用情况进行访谈，并收集有关她们个人和家族精神疾病负担的信息。
使用传统逻辑回归分析，发现内化和外化障碍与家族酗酒史以及产前接触香烟和酒精有关。此外，采用家族风险状况以及儿童接触母亲孕期酒精和香烟使用情况进行了一项专门的统计分析，即多变量混杂因素评分法。该分析表明，在控制其他两个变量时，单个变量与儿童期疾病之间只有一种关系显著：对立违抗障碍与家族风险状况相关仍显著。进行了另外三项分析，以评估家族风险状况、产前酒精暴露和产前香烟暴露对儿童精神病理学的影响，同时控制外化障碍的两个已知风险因素（社会经济地位和父母反社会人格障碍）。这些分析结果显示，唯一升高的儿童期疾病是注意力缺陷多动障碍（ADHD），且这仅是家族风险变量导致的结果。
酒精依赖的家族负担是儿童精神病理学发展的一个重要风险因素，可能解释了先前报道的产前接触尼古丁和酒精之间的关联。药物滥用/依赖病因学和儿童精神病理学研究需要同时考虑产前暴露以及酒精依赖和其他精神疾病的家族负担。
