Discipline of Paediatrics and Child Health, The University of Sydney, The Children's Hospital at Westmead, Westmead, Australia;The George Institute for Global Health, Sydney Medical School, andPoche Centre for Indigenous Health, Sydney Medical School, The University of Sydney, Sydney, Australia;Physiotherapy Department, and
The George Institute for Global Health, Sydney Medical School, and.
Pediatrics. 2014 Jul;134(1):e192-209. doi: 10.1542/peds.2013-3733. Epub 2014 Jun 9.
Gross motor (GM) deficits are often reported in children with prenatal alcohol exposure (PAE), but their prevalence and the domains affected are not clear. The objective of this review was to characterize GM impairment in children with a diagnosis of fetal alcohol spectrum disorder (FASD) or "moderate" to "heavy" maternal alcohol intake.
A systematic review with meta-analysis was conducted. Medline, Embase, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PEDro, and Google Scholar databases were searched. Published observational studies including children aged 0 to ≤18 years with (1) an FASD diagnosis or moderate to heavy PAE, or a mother with confirmed alcohol dependency or binge drinking during pregnancy, and (2) GM outcomes obtained by using a standardized assessment tool. Data were extracted regarding participants, exposure, diagnosis, and outcomes by using a standardized protocol. Methodological quality was evaluated by using Strengthening the Reporting of Observational Studies in Epidemiology guidelines.
The search recovered 2881 articles of which 14 met the systematic review inclusion criteria. The subjects' mean age ranged from 3 days to 13 years. Study limitations included failure to report cutoffs for impairment, nonstandardized reporting of PAE, and small sample sizes. The meta-analysis pooled results (n = 10) revealed a significant association between a diagnosis of FASD or moderate to heavy PAE and GM impairment (odds ratio: 2.9; 95% confidence interval: 2.1-4.0). GM deficits were found in balance, coordination, and ball skills. There was insufficient data to determine prevalence.
The significant results suggest evaluation of GM proficiency should be a standard component of multidisciplinary FASD diagnostic services.
产前酒精暴露（PAE）的儿童常出现粗大运动（GM）缺陷，但这些缺陷的普遍性及其受影响的领域尚不清楚。本研究的目的是描述具有胎儿酒精谱系障碍（FASD）诊断或“中度”至“重度”母体酒精摄入的儿童的 GM 损伤。
进行了系统评价和荟萃分析。检索了 Medline、Embase、综合与补充医学数据库、护理学及相关健康文献累积索引、心理学信息数据库、物理治疗电子数据库和 Google Scholar 数据库。纳入了年龄在 0 至≤18 岁的儿童，这些儿童具有（1）FASD 诊断或中重度 PAE，或母亲在怀孕期间确诊酒精依赖或 binge drinking，（2）使用标准化评估工具获得 GM 结果的观察性研究。使用标准化方案提取关于参与者、暴露、诊断和结局的数据。使用 Strengthening the Reporting of Observational Studies in Epidemiology 指南评估方法学质量。
搜索共获得 2881 篇文章，其中 14 篇符合系统评价纳入标准。研究对象的平均年龄从 3 天到 13 岁不等。研究局限性包括未能报告损伤的截止值、PAE 的非标准化报告以及样本量小。荟萃分析合并了 10 项研究的结果，发现 FASD 或中重度 PAE 诊断与 GM 损伤之间存在显著关联（比值比：2.9；95%置信区间：2.1-4.0）。GM 缺陷出现在平衡、协调和球技方面。没有足够的数据来确定患病率。
这些显著的结果表明，GM 熟练程度的评估应该成为多学科 FASD 诊断服务的标准组成部分。
