Warren K R, Bast R J
Office of Scientific Affairs, National Institute on Alcohol Abuse and Alcoholism, Rockville, MD 20852.
Public Health Rep. 1988 Nov-Dec;103(6):638-42.
Historically, mankind has at least suspected that alcohol was somehow connected with undesirable effects on progeny. In the 18th century, physicians became aware that maternal alcohol consumption resulted in excess fetal and neonatal mortality, low birth weight, and many other deleterious effects. Perhaps as a response to the temperance and Prohibition periods, scientists lost sight of or interest in the effects of alcohol in pregnancy. In the late 1960s and early 1970s, the issue surfaced again, and scientists began systematic and in-depth studies of fetal alcohol syndrome (FAS) and alcohol-related birth defects (ARBD). Epidemiologic research now suggests that FAS has outranked Down's syndrome and spina bifida in prevalence and is now the leading known cause of mental retardation. Further, it is the only one of these three that is preventable. Because a safe limit of alcohol consumption in pregnancy is not defined, abstinence during pregnancy is the most prudent preventive measure. Factors such as race, beer drinking, maternal weight gain, and low socioeconomic status are associated with a statistical increase in the incidence of FAS. In families where one child has been diagnosed as having FAS, the incidence rate can be as much as 405-fold higher than the worldwide average. Neurobehavioral deficits can occur in the offspring of drinking mothers in the absence of a diagnosis of full FAS. The deficits differ with age and seem to persist into adulthood. Mental retardation or borderline mental retardation is a nearly ubiquitous neurological deficit in diagnosed FAS. In one study, it occurred in 75 percent of the non-FAS offspring of mothers who continued to drink heavily throughout their pregnancy.From the mid-1970s, having established that alcohol is a teratogen, scientists have been trying to uncover the mechanism by which alcohol exerts its embryotoxic effects. Recent promising neuroanatomical studies have demonstrated that alcohol has a deleterious effect on neuronal migration and hence on the development of the cerebral cortex. Other studies have shown that prenatal alcohol exposure,by adversely affecting hippocampal development,may be responsible for the learning deficits so frequently encountered in FAS children. Other research has implicated prostaglandins in the mechanism of alcohol-related dysmorphology.
从历史上看，人类至少怀疑酒精与对后代的不良影响存在某种关联。在18世纪，医生们意识到母亲饮酒会导致胎儿和新生儿死亡率过高、低出生体重以及许多其他有害影响。或许是对禁酒时期的一种回应，科学家们忽视了酒精对孕期影响的问题，或者对其失去了兴趣。在20世纪60年代末和70年代初，这个问题再次浮出水面，科学家们开始对胎儿酒精综合征（FAS）和与酒精相关的出生缺陷（ARBD）进行系统而深入的研究。流行病学研究如今表明，FAS在患病率上已超过唐氏综合征和脊柱裂，成为目前已知导致智力迟钝的首要原因。此外，它是这三者中唯一可预防的。由于孕期饮酒的安全限量尚未确定，孕期戒酒是最谨慎的预防措施。种族、饮用啤酒、母亲体重增加以及社会经济地位较低等因素与FAS发病率的统计学上升有关。在有一个孩子被诊断患有FAS的家庭中，发病率可能比全球平均水平高出多达405倍。在未被诊断为完全FAS的情况下，饮酒母亲的后代可能会出现神经行为缺陷。这些缺陷因年龄而异，似乎会持续到成年。智力迟钝或边缘智力迟钝是确诊FAS中几乎普遍存在的神经缺陷。在一项研究中，在整个孕期持续大量饮酒的母亲所生的非FAS后代中，有75%出现了这种情况。从20世纪70年代中期开始，在确定酒精是一种致畸剂之后，科学家们一直在试图揭示酒精发挥其胚胎毒性作用的机制。最近有前景的神经解剖学研究表明，酒精对神经元迁移有有害影响，从而对大脑皮层的发育产生影响。其他研究表明，产前接触酒精通过对海马体发育产生不利影响，可能是FAS儿童经常出现学习缺陷的原因。其他研究表明前列腺素与酒精相关的畸形机制有关。
