Halliday Jane L, Muggli Evelyne, Lewis Sharon, Elliott Elizabeth J, Amor David J, O'Leary Colleen, Donath Susan, Forster Della, Nagle Cate, Craig Jeffrey M, Anderson Peter J
Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
J Epidemiol Community Health. 2017 Oct;71(10):990-998. doi: 10.1136/jech-2017-209165. Epub 2017 Aug 24.
Prenatal alcohol exposure (PAE) is a community health problem with up to 50% of pregnant women drinking alcohol. The relationship between low or sporadic binge PAE and adverse child outcomes is not clear. This study examines the association between PAE in the general antenatal population and child neurodevelopment at 2 years, accounting for relevant contributing factors.
This prospective population-based cohort recruited 1570 pregnant women, providing sociodemographic, psychological and lifestyle information and alcohol use for five time periods. PAE categories were 'low', 'moderate/high', 'binge', in trimester 1 or throughout pregnancy. Measures of cognitive, language and motor development (Bayley Scales of Infant and Toddler Development) were available for 554 children, while measures of sensory processing (Infant/Toddler Sensory Profile) and social-emotional development (Brief Infant Toddler Social Emotional Assessment) were available for 948.
A positive association in univariate analysis with low-level PAE throughout pregnancy and cognition (β=4.1, 95% CI -0.02 to 8.22, p=0.05) was attenuated by adjusting for environmental/social deprivation risk factors (β=3.06 (-1.19 to 7.30), p=0.16). Early binge drinking, plus continued PAE at lower levels, was associated with the child being more likely to score low in sensation avoidance (adjusted OR 1.88 (1.03 to 3.41), p=0.04).
Early binge exposure, followed by lower-level PAE, demonstrated an increase in sensation-avoiding behaviour. There were, however, no significant associations between PAE and neurodevelopment following adjustment for important confounders and modifiers. Follow-up is paramount to investigate subtle or later onset problems.
产前酒精暴露（PAE）是一个社区健康问题，多达50%的孕妇饮酒。低度或偶尔暴饮的PAE与儿童不良结局之间的关系尚不清楚。本研究探讨了一般产前人群中的PAE与儿童2岁时神经发育之间的关联，并考虑了相关影响因素。
这项基于人群的前瞻性队列研究招募了1570名孕妇，收集了社会人口学、心理和生活方式信息以及五个时间段的饮酒情况。PAE类别分为妊娠早期或整个孕期的“低度”、“中度/高度”、“暴饮”。554名儿童可获得认知、语言和运动发育指标（贝利婴幼儿发展量表），948名儿童可获得感觉加工指标（婴幼儿感觉概况）和社会情感发育指标（婴幼儿社会情感简短评估）。
在单变量分析中，整个孕期低度PAE与认知呈正相关（β=4.1，95%CI -0.02至8.22，p=0.05），但在调整环境/社会剥夺风险因素后这种相关性减弱（β=3.06（-1.19至7.30），p=0.16）。早期暴饮，加上较低水平的持续PAE，与儿童在感觉回避方面得分较低的可能性增加有关（调整后的OR为1.88（1.03至3.41），p=0.04）。
早期暴饮暴露，随后是较低水平的PAE，表现为感觉回避行为增加。然而，在调整重要的混杂因素和修饰因素后，PAE与神经发育之间没有显著关联。随访对于调查细微或后期出现的问题至关重要。
