妊娠期和社会经济地位作为产前酒精暴露对 6 个月发育影响的中介因素。
Gestational age and socioeconomic status as mediators for the impact of prenatal alcohol exposure on development at 6 months.
机构信息
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
出版信息
Birth Defects Res. 2019 Jul 15;111(12):789-796. doi: 10.1002/bdr2.1408. Epub 2018 Oct 31.
BACKGROUND
Of the many negative outcomes associated with gestational alcohol use, one that has received relatively little attention is preterm birth and its possible contribution to effects of prenatal alcohol exposure (PAE) on development. To examine the increased risk for premature delivery associated with PAE and the joint influence of preterm birth and alcohol on child outcomes, analysis was carried out in a longitudinal cohort recruited in Western Ukraine.
METHODS
Alcohol-using women and low or nondrinking controls were identified prenatally for a clinical trial of multivitamins and minerals (MVM) in ameliorating effects of PAE. Women were interviewed to provide information about medical and social status and other drug use. At delivery, information was collected about infant (N = 686) status including gestational age (GA) in weeks. Finally, 441 infants were followed to 6 months of age and cognitive (Mental Developmental Index [MDI]) and motor development (Psychomotor Developmental Index [PDI]) (measured using the Bayley Scales of Infant Development, second Ed (BSID-II).
RESULTS
Seven percent infants were born at <37 weeks GA. The odds ratio for preterm delivery for Alcohol Exposed versus Low/No Alcohol was 2.6 (95% Confidence Interval 1.37, 4.94) (p < .003); MVM supplements were associated with a lower rate of preterm delivery overall, but the relative proportion of preterm births did not vary by MVM supplement status between alcohol exposure groups. In mediation models of 6 month cognitive and motor development with reference to Barron and Kenney in 1986, GA significantly mediated alcohol effects (MDI: Z = -2.64, p < .008; PDI: Z = -2.35, p < .02) although PAE independently affected both outcomes (MDI: t = -5.6, p < .000; PDI: t = -3.19, p < .002).
CONCLUSION
Results suggest that PAE is associated with higher rates of preterm birth and that alcohol's effect on development in infancy may be both direct and mediated by shortened length of gestation.
背景
在与妊娠期间饮酒相关的诸多不良后果中，早产及其对产前酒精暴露（PAE）对发育影响的可能贡献，是一个受到关注较少的问题。为了研究与 PAE 相关的早产风险增加以及早产和酒精对儿童结局的共同影响，对在乌克兰西部招募的一个纵向队列进行了分析。
方法
在一项关于多种维生素和矿物质（MVM）改善 PAE 影响的临床试验中，在产前确定了饮酒女性和低饮酒或不饮酒的对照组。对女性进行访谈以获取有关医疗和社会状况以及其他药物使用的信息。在分娩时，收集了包括婴儿（N=686）胎龄（GA）在内的婴儿情况信息。最后，对 441 名婴儿进行了 6 个月的随访，以评估认知（精神发育指数[MDI]）和运动发育（心理运动发育指数[PDI]）（使用贝利婴幼儿发展量表第二版[BSID-II]进行测量）。
结果
7%的婴儿在<37 周 GA 时出生。与低/无酒精相比，酒精暴露组早产的比值比为 2.6（95%置信区间 1.37，4.94）（p<.003）；MVM 补充剂总体上与早产率较低相关，但在酒精暴露组之间，MVM 补充剂状态与早产率的差异并不显著。在 1986 年 Barron 和 Kenney 的中介模型中，GA 对 6 个月认知和运动发育的中介作用显著（MDI：Z=-2.64，p<.008；PDI：Z=-2.35，p<.02），尽管 PAE 独立影响这两个结果（MDI：t=-5.6，p<.000；PDI：t=-3.19，p<.002）。
结论
结果表明，PAE 与较高的早产率相关，并且酒精对婴儿期发育的影响可能是直接的，也可能是通过缩短妊娠期来介导的。
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