Chile Fetal Alcohol Study

大多数在宫内接触大量酒精的儿童不会患上胎儿酒精综合症(FAS)。然而，关于胎儿酒精谱系障碍(FASD)各组成部分发生风险的基于人群的前瞻性数据是有限的。这是一项前瞻性队列研究，在智利首次产前检查期间对9628名妇女进行了筛查，确定了101名每天至少喝4杯酒(暴露)的妇女与101名怀孕期间未报告饮酒(未暴露)的妇女匹配。在怀孕期间收集了详细的酒精消费数据。暴露在暴露状态下的临床医生对8.50岁以下的儿童进行了评估。暴露在暴露状态的儿童中有44.0%(22/50)出现一个或多个中枢神经系统功能异常，而未暴露的儿童中有13.6%(6/44)出现一个或多个功能异常(p=0.002)。暴露组和未暴露组的生长受限发生率分别为27.2%(25/92)和12.5%(12/96)(p=0.02)。直接检查发现17.3%(14/81)的暴露组儿童面部特征异常，而未暴露组为1.1%(1/)(P=0.0002)。在59名接触过病毒的儿童中，有数据可以检测到至少一种异常，其中12名(20.3%)没有异常。从怀孕到确认怀孕期间酗酒(OR=1.48/天，95%CI：1.15~1.91，P=0.002)和确认怀孕后(OR=1.41/天，95%CI：1.01~1.95，P=0.04)和从怀孕到确认怀孕每周饮酒总次数(OR=1.02/杯，95%CI：1.01~1.04，P=0.0009)与异常胎儿结局显著相关。80%的儿童有一种或一种以上与酒精接触有关的异常。造成不良后果风险最大的酒精使用模式是酗酒和每周总摄入量高。功能性神经损伤是最常见的，可能是提醒医生注意产前酒精暴露的唯一迹象。

Most children who are exposed to large quantities of alcohol in utero do not develop fetal alcohol syndrome (FAS). Population-based prospective data on the risk of developing components of fetal alcohol spectrum disorders (FASD), however, are limited.This was a prospective cohort study of 9,628 women screened during their first prenatal appointment in Chile, which identified 101 who consumed at least 4 drinks/d (exposed) matched with 101 women with no reported alcohol consumption during pregnancy (unexposed). Detailed alcohol consumption data were collected during the pregnancy. Children were evaluated up to 8.5 years of age by clinicians masked to exposure status.One or more functional central nervous system abnormalities were present in 44.0% (22/50) of the exposed children compared to 13.6% (6/44) of the unexposed (p = 0.002). Growth restriction was present in 27.2% (25/92) of the exposed and 12.5% (12/96) of the unexposed (p = 0.02). Abnormal facial features were present in 17.3% (14/81) of the exposed children compared to 1.1% (1/89) of the unexposed children (p = 0.0002) by direct examination. Of the 59 exposed children with data available to detect at least 1 abnormality, 12 (20.3%) had no abnormalities. Binge drinking from conception to recognition of pregnancy (OR = 1.48 per day, 95% CI: 1.15 to 1.91, p = 0.002) and after recognition of pregnancy (OR= 1.41 per day, 95% CI: 1.01 to 1.95, p = 0.04) and total number of drinks consumed per week from conception to recognition of pregnancy (OR = 1.02 per drink, 95% CI: 1.01 to 1.04, p = 0.0009) were significantly associated with abnormal child outcome.After exposure to heavy alcohol consumption during pregnancy, 80% of children had 1 or more abnormalities associated with alcohol exposure. Patterns of alcohol use that posed the greatest risk of adverse outcomes were binge drinking and high total weekly intake. Functional neurologic impairment occurred most frequently and may be the only sign to alert physicians to prenatal alcohol exposure.