Warren Kenneth R
National Institute on Alcohol Abuse and Alcoholism , National Institutes of Health, Bethesda, Maryland.
Alcohol Clin Exp Res. 2015 Jul;39(7):1110-7. doi: 10.1111/acer.12757.
It is now well accepted in pediatrics and obstetrics that prenatal alcohol is a teratogenic agent and the primary causative factor underlying fetal alcohol spectrum disorders (FASDs), although for the majority of the 20th century that knowledge was either unknown or ignored. At least 2 factors contributed to the delay in recognizing alcohol's role in teratogenicity: the rejection of earlier evidence pertaining to alcohol and pregnancy following the repeal of Prohibition in the United States, Canada, and several European countries; and misinterpretation of earlier research findings in a eugenic rather than toxicological context. The pervasive belief held well into the 1970s that there was no risk to either mother or fetus from prenatal alcohol posed a major challenge to changing physician and public attitudes on alcohol and pregnancy. This review provides insight on key events that occurred in changing physician and public understanding of the risks posed by prenatal alcohol use in pregnancy.
Historical review of events primarily in the U.S. federal government, found in referenced documents.
The transition in physician and public understanding of the risks posed by prenatal alcohol use was aided by the existence of National Institute on Alcohol Abuse and Alcoholism (NIAAA) which was created in 1971. This government agency was able to support research on alcohol and pregnancy immediately following the 1973 published clinical reports calling attention to a proposed fetal alcohol syndrome (FAS). These early research studies provided the foundation for the first government health advisory on alcohol and pregnancy, issued by NIAAA in 1977. Subsequently, the U.S. Food and Drug Administration (FDA) used this new knowledge on FAS in their effort to add alcoholic beverages to the range of products with ingredient and consumer information labeling. The ensuing hearings and actions resulted in a new health advisory under the auspices of the Surgeon General, encouraging avoidance of alcohol consumption in pregnancy. In subsequent years, Congressional attention to the FAS issue resulted in the Alcoholic Beverage Labeling Law.
The pace at which understanding of the risks of prenatal alcohol moved forward from a total misunderstanding to acceptance was aided by both the efforts of the NIAAA in its support of research, and the FDA in its efforts to improve consumer information. Today, many women in the United States as well as other countries continue to ignore advisories on avoiding alcohol consumption in pregnancy, emphasizing the need for persistence in education on these health risks.
在儿科学和产科学领域，产前饮酒是一种致畸剂以及胎儿酒精谱系障碍（FASDs）的主要致病因素，这一观点如今已被广泛接受，尽管在20世纪的大部分时间里，这一认知要么不为人知，要么被忽视。至少有两个因素导致了对酒精致畸作用的认知延迟：在美国、加拿大和一些欧洲国家禁酒令废除后，早期有关酒精与妊娠的证据遭到摒弃；以及在优生学而非毒理学背景下对早期研究结果的错误解读。直到20世纪70年代，人们普遍认为产前饮酒对母亲和胎儿都没有风险，这给改变医生和公众对酒精与妊娠的态度带来了重大挑战。本综述深入探讨了在改变医生和公众对孕期产前饮酒风险的理解过程中发生的关键事件。
主要通过参考文件对美国联邦政府发生的事件进行历史回顾。
1971年成立的美国国立酒精滥用与酒精中毒研究所（NIAAA）推动了医生和公众对产前饮酒风险理解的转变。1973年发布的临床报告呼吁关注拟议中的胎儿酒精综合征（FAS）后，该政府机构能够立即支持有关酒精与妊娠的研究。这些早期研究为NIAAA于1977年发布的首份关于酒精与妊娠的政府健康咨询报告奠定了基础。随后，美国食品药品监督管理局（FDA）利用这一关于FAS的新知识，努力在含成分和消费者信息标签的产品范围内增加酒精饮料。随后的听证会和行动促成了在卫生局局长主持下发布的一份新的健康咨询报告，鼓励孕妇避免饮酒。在随后的几年里，国会对FAS问题的关注促成了《酒精饮料标签法》。
NIAAA支持研究的努力以及FDA改善消费者信息的努力，加快了从完全误解到接受产前饮酒风险这一认知转变的步伐。如今，美国以及其他国家的许多女性仍然无视孕期避免饮酒的建议，这凸显了持续开展这些健康风险教育的必要性。
