Department of Obstetrics and Gynecology, (USK, SSN), Herlev University Hospital, Herlev, Denmark.
Department of Clinical Medicine, (USK), University of Copenhagen, Copenhagen, Denmark.
Alcohol Clin Exp Res. 2019 Jun;43(6):1199-1212. doi: 10.1111/acer.14047. Epub 2019 May 24.
Fetal alcohol syndrome (FAS) typically is observed among individuals with high prenatal alcohol exposures (PAE), but exposure histories obtained in clinical diagnostic settings are often inaccurate. The present analysis used the Lifestyle During Pregnancy Study (LDPS) to assess the potential effects of low-to-moderate average weekly alcohol consumption and binge drinking in early pregnancy on facial features associated with FAS among children 5 years of age.
The analysis is a prospective follow-up study of 670 women and their children sampled from the LDPS cohort based on maternal alcohol consumption during pregnancy. The 4-Digit Code FAS Facial Photographic Analysis Software was used to measure the magnitude of expression of the 3 diagnostic facial features of FAS from standardized digital photographs. Logistic regression was used to estimate the odds of presenting with the FAS/partial fetal alcohol syndrome (PFAS) facial phenotypes relative to different patterns of prenatal alcohol exposure.
Ten children presented with the FAS/PFAS facial phenotypes. None of the children sampled met the central nervous system (CNS) criteria for FAS or PFAS at age 5 years. All remained at risk for PFAS since some types of CNS dysfunction associated with this diagnosis may only be assessed at older ages. The FAS/PFAS facial phenotypes were 8.5-fold more likely among children exposed to an average of 1 to 4 drinks/wk and 2.5-fold more likely among children with a single binge exposure in gestational weeks 3 to 4 compared to children with no such exposures. The magnitude of expression of the FAS facial phenotype was significantly correlated with all other diagnostic features of FAS: growth deficiency, microcephaly, and measures of CNS dysfunction.
These findings suggest that low-to-moderate levels of PAE or isolated binge exposures may place some fetuses at risk for FAS/PFAS. Thus, conservative advice is still for women to abstain from alcohol consumption during pregnancy.
胎儿酒精谱系障碍（FAS）通常发生在具有高产前酒精暴露（PAE）的个体中，但在临床诊断环境中获得的暴露史往往不准确。本分析使用孕期生活方式研究（LDPS）评估低至中度平均每周饮酒量和孕早期 binge 饮酒对 5 岁儿童与 FAS 相关的面部特征的潜在影响。
该分析是对来自 LDPS 队列的 670 名女性及其儿童进行的前瞻性随访研究，其依据是母亲在怀孕期间的饮酒量。使用 4 位数字 FAS 面部摄影分析软件测量来自标准化数字照片的 3 个诊断性 FAS 面部特征的表达程度。使用逻辑回归来估计相对于不同的产前酒精暴露模式，表现出 FAS/部分胎儿酒精谱系障碍（PFAS）面部表型的可能性。
有 10 名儿童表现出 FAS/PFAS 面部表型。在 5 岁时，没有一个抽样儿童符合 CNS 标准的 FAS 或 PFAS。所有儿童仍然存在 PFAS 风险，因为与这种诊断相关的某些类型的 CNS 功能障碍仅在年龄较大时才能评估。与无此类暴露的儿童相比，在妊娠 3 至 4 周时平均暴露于 1 至 4 份/周的儿童和单次 binge 暴露的儿童发生 FAS/PFAS 面部表型的可能性分别高出 8.5 倍和 2.5 倍。FAS 面部表型的表达程度与 FAS 的所有其他诊断特征均显著相关：生长缺陷、小头畸形和 CNS 功能障碍的测量值。
这些发现表明，低至中度 PAE 或孤立的 binge 暴露可能使一些胎儿面临 FAS/PFAS 的风险。因此，仍建议女性在怀孕期间避免饮酒。
