Crépin G, Dehaene P, Samaille C
Bull Acad Natl Med. 1989 May;173(5):575-82; discussion 582-5.
Foetal and neonatal consequences of exogenous intoxications are nowadays better apprehended especially regarding alcohol. Alcoholism during pregnancy is the cause of the syndrome of foetal alcoholism described in France by Lemoine in 1968 and then by Jones and Smith in 1973. The prevalence of the table is 1 out of 700 to 800 deliveries for the severe forms and concerns especially by not exclusively the most underprivileged sections of the population and shows in: -- a very specific dysmorphy of skull and face and other abnormalities which give to the face a singular and persistent aspect; -- various and frequent malformative abnormalities with a pronounced tendency for cardiopathy. Most of them are latent or of late discovery; -- a constant growth lateness which is also part of the table as well as prematurity and spontaneous abortion. Hypotrophy is moderate, total, and cerebral; -- effects on central nervous system: it is the third overall cause of mental lateness after trisomy and deficiency of neural canal. Other causes and themselves to alcohol to produce these effects that show themselves on badly affected children or dead in utero because of macroscopic and microscopic alterations of numerous cerebral structures. From a clinical view point, they show themselves by abnormalities of the neural canal, a decreasing of the crane perimeter, neonatal neurologic troubles due to deficiency in the first hours of life, followed during the second and third day by a table evoking a weaning syndrome. The evolution on a medium term is characterized by the persistence of the crane and skull dysmorphy modified by parents phenotype, a persistence of the growth lateness leading to dwarfism in the severe forms. In the moderate and medium form thinness and paleness are spectacular and malformations exist in 2/3 of the cases. The neurologic and behaving evolution is documented by some prospective studies. They tend to indicate the persistence for the severe forms of troubles concerning hyperactivity, lack of attention and decreasing of the crane perimeter as well as a main mental lateness in half of the cases. The study made in Roubaix shows that behaving and intellectual troubles are more pronounced when the dysmorphy is marked. The effects of alcohol lead to a syndrome of foetal alcoholism when the level of alcoholization is high which correspond to K. Sulik's experimental data in 1982. On the other hand, a relation dose-effect has not been yet demonstrated except for hypotrophy. This is the same for threshold-dose. There is no residual effects confirming that alcoholism and its intensity during pregnancy have a direct effect upon descendants. As a matter of fact after weaning and recovery children are again normal and normotroph. Pregnancy and especially delivery are privileged period for detection of maternal alcoholism and beginning of a prevention in a view to avoid. These effects during a later pregnancy.(ABSTRACT TRUNCATED AT 400 WORDS)
如今，人们对外源性中毒对胎儿和新生儿的影响有了更好的认识，尤其是关于酒精方面。孕期酗酒是胎儿酒精综合征的病因，1968年由法国的勒莫瓦纳首次描述，1973年琼斯和史密斯也进行了相关描述。严重形式的发病率为每700至800例分娩中有1例，尤其影响但并非仅局限于最贫困的人群，表现为：——头骨和面部非常特殊的畸形以及其他异常，使面部呈现出独特且持久的样貌；——各种常见的畸形异常，有明显的心脏病发病倾向。其中大多数是潜在的或发现较晚；——持续的生长迟缓，这也是该综合征的一部分，还有早产和自然流产。发育迟缓有中度、完全性和脑部的；——对中枢神经系统的影响：它是智力发育迟缓的第三大总体原因，仅次于三体综合征和神经管缺陷。还有其他因素与酒精共同导致这些影响，在受严重影响的儿童或子宫内死亡的胎儿身上表现出来，因为众多脑结构存在宏观和微观改变。从临床角度看，表现为神经管异常、头围减小、出生后最初几小时因缺乏营养导致的新生儿神经问题，在第二天和第三天则表现出类似断奶综合征的症状。中期的发展特点是头和颅骨畸形持续存在，并受父母表型影响而改变，生长迟缓持续存在，严重形式会导致侏儒症。中度和中等形式中，消瘦和面色苍白很明显，三分之二的病例存在畸形。一些前瞻性研究记录了神经和行为方面的发展。这些研究倾向于表明，严重形式中多动、注意力不集中和头围减小等问题持续存在，半数病例存在主要的智力发育迟缓。鲁贝的研究表明，畸形明显时，行为和智力问题更突出。当酒精摄入量高时，酒精的影响会导致胎儿酒精综合征，这与1982年K. 苏利克的实验数据相符。另一方面，除了发育迟缓外，尚未证明存在剂量效应关系。阈值剂量也是如此。没有残留影响证实孕期酗酒及其强度对后代有直接影响。事实上，断奶和恢复后，儿童再次恢复正常且营养正常。怀孕尤其是分娩是检测孕妇酗酒并开始预防以避免这些影响的有利时期。这些影响发生在怀孕后期。（摘要截取自400字）
