Under-Recognition of Prenatal Alcohol Effects in Infants of Known Alcohol Abusing Women

摘要

Although roughly 15 percent of pregnant women acknowledge drinking alcohol, clinical recognition of affected children remains problematic. Fetal alcohol syndrome (FAS) is diagnosed from a cluster of physical findings, including restricted growth, microcephaly, and certain craniofacial features, together with neurological and cognitive abnormalities. The neurological deficits may not be evident at birth, and the characteristic facial features sometimes are subtle. This study was a medical record review of 124 women and their infants. The pregnant women, 49 percent of whom came from a substance abuse clinic and the rest of whom were from a general obstetrical clinic, were given a self-administered questionnaire that screens for alcoholism. They also were interviewed directly about the use of alcohol and other substances. Infants were examined by a physician lacking knowledge of whether they had been exposed to alcoholin utero.Alcohol use during pregnancy was documented in 15 percent of the mothers. In 2 of 19 instances, only the pediatrician, and in 5, only the nurse, had noted alcohol use in the record. In only 10 cases was the amount and/or frequency of drinking recorded. All but 5 of the 19 women reported using alcohol. Four of the other five had positive screening test scores. In 20 records, 16 percent of the total, there was no mention of alcohol use by either the pediatrician or the nurse. About one-third of the records noted cocaine use, and 35 percent of mothers reported using this drug. Two of the alcohol-exposed infants were diagnosed by the study examiner as having FAS, as was one infant whose mother reported drinking. None of these infants were diagnosed by the pediatrician. Conversely, none of the three infants of self-reported alcohol users who were noted by the pediatrician as having possible alcohol-related facial features were among those whose mothers were documented users. These features included a flat philtrum and a depressed nasal bridge. Seven infants in all were noted by the study examiner to have possible alcohol-related features. The 11 small-for-gestational-age infants formed 9 percent of the series and included 6 of the 34 infants whose mothers reported using alcohol.The investigators conclude that pediatricians need to know more about the range of potential fetal effects of maternal drinking and must recognize the importance of asking pregnant women about their alcohol intake.J Pediatr 1999;135colon;430ndash;436