Chiodo Lisa M, Janisse James, Delaney-Black Virginia, Sokol Robert J, Hannigan John H
Carman and Ann Adams Department of Pediatrics, School of Medicine, Wayne State University, Detroit, Michigan 48201, USA.
Alcohol Clin Exp Res. 2009 Apr;33(4):634-44. doi: 10.1111/j.1530-0277.2008.00878.x. Epub 2009 Jan 12.
Fetal Alcohol Spectrum Disorders (FASDs), including Fetal Alcohol Syndrome, continue to be high-incidence developmental disorders. Detection of patterns of maternal drinking that place fetuses at risk for these disorders is critical to diagnosis, treatment, and prevention, but is challenging and often insufficient during pregnancy. Various screens and measures have been used to identify maternal risk drinking but their ability to predict child outcome has been inconsistent. This study hypothesized that a metric of fetal "at-risk" alcohol exposure (ARAE) derived from several indicators of maternal self-reported drinking would predict alcohol-related neurobehavioral dysfunctions in children better than individual measures of maternal alcohol consumption alone.
Self-reported peri-conceptional and repeated maternal drinking during pregnancy were assessed with semi-structured interviews and standard screens, i.e., the CAGE, T-ACE, and MAST, in a prospective sample of 75 African-American mothers. Drinking volumes per beverage type were converted to standard quantity and frequency measures. From these individual measures and screening instruments, a simple dichotomous index of prenatal ARAE was defined and used to predict neurobehavioral outcomes in the 4- to 5-year-old offspring of these women. Study outcomes included IQ, attention, memory, visual-motor integration, fine motor skill, and behavior. Statistical analyses controlled for demographic and other potential confounders.
The current "at-risk" drinking metric identified over 62% of the mothers as drinking at risk levels--23% more than the selection criterion identified--and outperformed all individual quantity and frequency consumption measures, including averages of weekly alcohol use and "binge" alcohol exposures (assessed as intake per drinking occasion), as well as an estimate of the Maternal Substance Abuse Checklist (Coles et al., 2000), in predicting prenatal alcohol-related cognitive and behavioral dysfunction in 4- to 5-year-old children.
A metric reflecting multiple indices of "at-risk" maternal alcohol drinking in pregnancy had greater utility in predicting various prenatal alcohol-related neurobehavioral dysfunction and deficits in children compared to individual measures of maternal self-reported alcohol consumption or a previous maternal substance abuse index. Assessing fetal risk drinking in pregnant women was improved by including multiple indicators of both alcohol consumption and alcohol-related consequences and, if appropriate practical applications are devised, may facilitate intervention by health care workers during pregnancy and potentially reduce the incidence or severity of FASDs.
胎儿酒精谱系障碍（FASDs），包括胎儿酒精综合征，仍然是高发性发育障碍。识别使胎儿面临这些障碍风险的母亲饮酒模式对于诊断、治疗和预防至关重要，但在孕期具有挑战性且往往不充分。已经使用了各种筛查和措施来识别母亲的风险饮酒行为，但其预测儿童结局的能力并不一致。本研究假设，从母亲自我报告饮酒的几个指标得出的胎儿“风险”酒精暴露（ARAE）指标，比单独的母亲饮酒量个体测量方法能更好地预测儿童与酒精相关的神经行为功能障碍。
通过半结构化访谈和标准筛查工具，即CAGE、T - ACE和MAST，对75名非裔美国母亲的前瞻性样本进行自我报告的受孕前后及孕期重复饮酒情况评估。将每种饮料类型的饮酒量转换为标准量和频率测量。从这些个体测量和筛查工具中，定义了一个简单的二分类产前ARAE指数，并用于预测这些女性4至5岁后代的神经行为结局。研究结局包括智商、注意力、记忆力、视觉 - 运动整合能力、精细运动技能和行为。统计分析对人口统计学和其他潜在混杂因素进行了控制。
当前的“风险”饮酒指标识别出超过62%的母亲处于风险饮酒水平——比选择标准识别出的多23%——并且在预测4至5岁儿童产前与酒精相关的认知和行为功能障碍方面，优于所有个体饮酒量和频率测量方法，包括每周平均饮酒量和“暴饮”酒精暴露（按每次饮酒场合的摄入量评估），以及母亲药物滥用清单（科尔斯等人，2000年）的估计值。
与母亲自我报告饮酒量的个体测量方法或先前的母亲药物滥用指数相比，反映孕期母亲“风险”饮酒多个指标的指标在预测儿童各种产前与酒精相关的神经行为功能障碍和缺陷方面具有更大的效用。通过纳入饮酒量和与酒精相关后果的多个指标来评估孕妇的胎儿风险饮酒情况得到了改善，如果设计出合适的实际应用方法，可能会促进医护人员在孕期进行干预，并有可能降低胎儿酒精谱系障碍的发生率或严重程度。
