Little R E, Anderson K W, Ervin C H, Worthington-Roberts B, Clarren S K
Department of Epidemiology, University of Michigan, Ann Arbor 48109.
N Engl J Med. 1989 Aug 17;321(7):425-30. doi: 10.1056/NEJM198908173210703.
The detrimental effects of maternal drinking during pregnancy on fetal health have been documented. The consequences for infants of maternal drinking during breast-feeding are unknown, but research in animals suggests that the infant could be affected by exposure to alcohol through the mother's milk. In a study of 400 infants born to members of a health maintenance organization, we investigated the relation of the mother's use of alcohol during breast-feeding to the infant's development at one year of age. Mental development, as measured by the Bayley Mental Development Index (MDI), was unrelated to maternal drinking during breast-feeding. However, motor development, as measured by the Psychomotor Development Index (PDI), was significantly lower in infants exposed regularly to alcohol in breast milk (after alcohol exposure during gestation was controlled for), with a dose-response relation (P for linear trend, 0.006). The infants of breast-feeding mothers who had at least one drink daily had a mean PDI score of 98, whereas the infants exposed to less alcohol in breast milk had a mean PDI score of 103 (95 percent confidence interval for the difference of the two means, 1.2 to 9.8). The effect was more pronounced when mothers who supplemented breast-feeding with formula were excluded from the analysis. The association persisted even after we controlled for more than 100 potentially confounding variables, including smoking and other drug use during pregnancy and in the postpartum period. We conclude that ethanol ingested through breast milk has a slight but significant detrimental effect on motor development, but not mental development, in breast-fed infants.
孕期母亲饮酒对胎儿健康的有害影响已有文献记载。母乳喂养期间母亲饮酒对婴儿的影响尚不清楚，但动物研究表明，婴儿可能会通过母乳接触酒精而受到影响。在一项针对健康维护组织成员所生的400名婴儿的研究中，我们调查了母乳喂养期间母亲饮酒与婴儿一岁时发育之间的关系。通过贝利心理发展指数（MDI）衡量的心理发展与母乳喂养期间母亲饮酒无关。然而，通过心理运动发展指数（PDI）衡量的运动发展在母乳中经常接触酒精的婴儿中显著较低（在控制了孕期酒精暴露后），存在剂量反应关系（线性趋势P值为0.006）。母乳喂养的母亲中每天至少喝一杯酒的婴儿的平均PDI评分为98，而母乳中接触酒精较少的婴儿的平均PDI评分为103（两种平均值差异的95%置信区间为1.2至9.8）。当将用配方奶补充母乳喂养的母亲排除在分析之外时，这种影响更为明显。即使在我们控制了100多个潜在的混杂变量后，这种关联仍然存在，这些变量包括孕期和产后的吸烟及其他药物使用情况。我们得出结论，母乳中摄入的乙醇对母乳喂养婴儿的运动发展有轻微但显著的有害影响，但对心理发展没有影响。
