美国东南部一个县的胎儿酒精谱系障碍：儿童特征和母体风险特征。
Fetal Alcohol Spectrum Disorders in a Southeastern County of the United States: Child Characteristics and Maternal Risk Traits.
机构信息
Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.
Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico.
出版信息
Alcohol Clin Exp Res. 2020 Apr;44(4):939-959. doi: 10.1111/acer.14313. Epub 2020 Apr 15.
OBJECTIVE
To detail the characteristic traits of children with fetal alcohol spectrum disorders (FASDs) and maternal risk factors in a southeastern U.S. County.
METHODS
Independent samples were drawn from 2 different cohorts of first-grade students. All consented children (49.8%) were measured for height, weight, and head circumference, and those ≤ 25th centile entered the study along with a random sample drawn from all enrolled students. Study children were examined for physical growth, dysmorphology, and neurobehavior, and their mothers were interviewed.
RESULTS
Total dysmorphology scores discriminated well the physical traits of children across the FASD continuum: fetal alcohol syndrome (FAS) = 15.8, partial FAS (PFAS) = 10.8, alcohol-related neurobehavioral disorder (ARND) = 5.2, and typically developing controls = 4.4. Additionally, a neurobehavioral battery distinguished children with each FASD diagnosis from controls. Behavioral problems qualified more children for FASD diagnoses than cognitive traits. Significant proximal maternal risk variables were as follows: reports of prepregnancy drinking, drinking in any trimester, and comorbid use of other drugs in lifetime and during pregnancy, especially alcohol and marijuana (14.9% among mothers of children with FASD vs. 0.4% for controls). Distal maternal risks included reports of other health problems (e.g., depression), living unmarried with a partner during pregnancy, and a lower level of spirituality. Controlling for other drug use during pregnancy, having a child diagnosed with a FASD was 17.5 times greater for women who reported usual consumption of 3 drinks per drinking day prior to pregnancy than for nondrinking mothers (p < 0.001, 95% CI = 5.1 to 59.9). There was no significant difference in the prevalence of FASD by race, Hispanic ethnicity, or socioeconomic status. The prevalence of FASD was not lower than 17.3 per 1,000, and weighted estimated prevalence was 49.0 per 1,000 or 4.9%.
CONCLUSION
This site had the second lowest rate in the CoFASP study, yet children with FASD are prevalent.
目的
详细描述美国东南部一个县患有胎儿酒精谱系障碍（FASD）的儿童的特征和母亲的风险因素。
方法
从两个不同的一年级学生队列中抽取独立样本。所有同意接受检查的儿童（49.8%）均接受身高、体重和头围测量，那些身高低于第 25 百分位数的儿童和所有入学儿童中随机抽取的样本一起进入研究。研究儿童接受身体生长、发育异常和神经行为检查，其母亲接受访谈。
结果
总发育异常评分很好地区分了 FASD 连续体中儿童的身体特征：胎儿酒精综合征（FAS）= 15.8，部分 FAS（PFAS）= 10.8，酒精相关神经行为障碍（ARND）= 5.2，和典型发育对照组= 4.4。此外，神经行为测试区分了每个 FASD 诊断的儿童与对照组。行为问题使更多的儿童符合 FASD 诊断标准，而认知特征则不然。显著的近期母亲风险变量如下：报告孕前饮酒、任何孕期饮酒以及一生中、孕期同时使用其他药物，特别是酒精和大麻（FASD 患儿母亲为 14.9%，对照组为 0.4%）。远期母亲风险包括报告其他健康问题（如抑郁）、怀孕期间与伴侣未婚同居以及较低的精神信仰。控制孕期其他药物使用，报告孕前每天通常饮用 3 杯酒的母亲，其子女被诊断为 FASD 的可能性是不饮酒母亲的 17.5 倍（p<0.001，95%CI=5.1 至 59.9）。FASD 的患病率与种族、西班牙裔、社会经济地位无关。FASD 的患病率不低于每 1000 人 17.3 例，加权估计患病率为每 1000 人 49.0 例或 4.9%。
结论
该地区在 CoFASP 研究中的 FASD 发生率为第二低，但 FASD 患儿的发病率仍然较高。
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