Knudsen Ann Kristin, Ystrom Eivind, Skogen Jens Christoffer, Torgersen Leila
Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway.
Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway.
Eur Child Adolesc Psychiatry. 2015 Oct;24(10):1269-77. doi: 10.1007/s00787-015-0677-5. Epub 2015 Jan 14.
Using data from the longitudinal Norwegian Mother and Child Cohort Study, the aims of the current study were to examine associations between postnatal maternal heavy alcohol use and toddler behavior problems, taking both observed and unobserved confounding factors into account by employing fixed effects regression models. Postnatal maternal heavy alcohol use (defined as drinking alcohol 4 or more times a week, or drinking 7 units or more per alcohol use episode) and toddler internalizing and externalizing behavior problems were assessed when the toddlers were aged 18 and 36 months. Maternal psychopathology, civil status and negative life events last year were included as time-variant covariates. Maternal heavy alcohol use was associated with toddler internalizing and externalizing behavior problems (p < 0.001) in the population when examined with generalized estimating equation models. The associations disappeared when observed and unobserved sources of confounding were taken into account in the fixed effects models [(p = 0.909 for externalizing behaviors (b = 0.002, SE = 0.021), p = 0.928 for internalizing behaviors (b = 0.002, SE = 0.023)], with an even further reduction of the estimates with the inclusion of time-variant confounders. No causal effect was found between postnatal maternal heavy alcohol use and toddler behavior problems. Increased levels of behavior problems among toddlers of heavy drinking mothers should therefore be attributed to other adverse characteristics associated with these mothers, toddlers and families. This should be taken into account when interventions aimed at at-risk families identified by maternal heavy alcohol use are planned and conducted.
利用挪威母婴队列纵向研究的数据，本研究的目的是通过采用固定效应回归模型，考察产后母亲大量饮酒与幼儿行为问题之间的关联，同时考虑观察到的和未观察到的混杂因素。当幼儿18个月和36个月大时，评估产后母亲大量饮酒（定义为每周饮酒4次或更多，或每次饮酒7单位或更多）以及幼儿内化和外化行为问题。将母亲精神病理学、婚姻状况和去年的负面生活事件作为随时间变化的协变量纳入。在使用广义估计方程模型进行检验时，母亲大量饮酒与总体中幼儿内化和外化行为问题相关（p<0.001）。当在固定效应模型中考虑观察到的和未观察到的混杂因素时，这种关联消失了[外化行为（p=0.909，b=−0.002，SE=0.021），内化行为（p=0.928，b=−0.002，SE=0.023）]，随着纳入随时间变化的混杂因素，估计值进一步降低。未发现产后母亲大量饮酒与幼儿行为问题之间存在因果效应。因此，大量饮酒母亲的幼儿中行为问题水平升高应归因于与这些母亲、幼儿和家庭相关的其他不良特征。在规划和实施针对因母亲大量饮酒而确定的高危家庭的干预措施时，应考虑到这一点。
