Makelarski Jennifer A, Romitti Paul A, Sun Lixian, Burns Trudy L, Druschel Charlotte M, Suarez Lucina, Olshan Andrew F, Siega-Riz Anna Maria, Olney Richard S
Department of Epidemiology, The University of Iowa, Iowa City, Iowa 52242, USA.
Birth Defects Res A Clin Mol Teratol. 2013 Mar;97(3):152-60. doi: 10.1002/bdra.23122. Epub 2013 Mar 4.
Neural tube defects (NTD)s, which occur when the neural tube fails to close during early gestation, are some of the most common birth defects worldwide. Alcohol is a known teratogen and has been shown to induce NTDs in animal studies, although most human studies have failed to corroborate these results. Using data from the National Birth Defects Prevention Study, associations between maternal reports of periconceptional (1 month prior through 2 months postconception) alcohol consumption and NTDs were examined.
NTD cases and unaffected live born control infants, delivered from 1997 through 2005, were included. Interview reports of alcohol consumption (quantity, frequency, variability, and type) were obtained from 1223 case mothers and 6807 control mothers. Adjusted odds ratios (aOR)s and 95% confidence intervals were estimated using multivariable logistic regression analysis.
For all NTDs combined, most aORs for any alcohol consumption, one or more binge episodes, and different type(s) of alcohol consumed were near unity or modestly reduced (≥ 0.7 < aOR ≤ 1.1) and were not statistically significant. Findings were similar for individual NTD subtypes.
These findings suggest no elevated association between maternal periconceptional alcohol consumption and NTDs. Underreporting of alcohol consumption, due to negative social stigma associated with alcohol consumption during pregnancy, and limited reports for mothers with early pregnancy loss of a fetus with an NTD may have affected the estimated odds ratios. Future studies should aim to increase sample sizes for less prevalent subtypes, reduce exposure misclassification, and improve ascertainment of fetal deaths and elective terminations.
神经管缺陷（NTD）是指在妊娠早期神经管未能闭合时发生的情况，是全球最常见的出生缺陷之一。酒精是一种已知的致畸剂，在动物研究中已显示可诱发神经管缺陷，尽管大多数人类研究未能证实这些结果。利用国家出生缺陷预防研究的数据，研究了孕期（受孕前1个月至受孕后2个月）酒精摄入的母亲报告与神经管缺陷之间的关联。
纳入1997年至2005年分娩的神经管缺陷病例和未受影响的活产对照婴儿。从1223名病例母亲和6807名对照母亲那里获得了酒精摄入（数量、频率、变异性和类型）的访谈报告。使用多变量logistic回归分析估计调整后的比值比（aOR）和95%置信区间。
对于所有合并的神经管缺陷，任何酒精摄入、一次或多次暴饮发作以及不同类型酒精摄入的大多数aOR接近1或略有降低（≥0.7＜aOR≤1.1），且无统计学意义。单个神经管缺陷亚型的结果相似。
这些发现表明，母亲孕期酒精摄入与神经管缺陷之间没有升高的关联。由于与孕期饮酒相关的负面社会耻辱感，酒精摄入报告不足，以及对于早期妊娠丢失患有神经管缺陷胎儿的母亲报告有限，可能影响了估计的比值比。未来的研究应旨在增加较少见亚型的样本量，减少暴露错误分类，并改善死胎和选择性终止妊娠的确定。
