理论上讲,所有妇女都应该在其首次产前访问中被询问饮酒的情况,包括酒精摄入量、频度以及在孕前或孕期3个月前饮酒的方式。[13]Chambers CD. Fetal alcohol spectrum disorder. In: Preedy V, Watson R, eds. Comprehensive handbook of alcohol related pathology. London: Elsevier; 2005:349-360.[33]Carson G, Cox LV, Crane J, et al.; Society of Obstetricians and Gynaecologists of Canada. Alcohol use and pregnancy consensus clinical guidelines. J Obstet Gynaecol Can. 2010;32:S1-S31.http://www.ncbi.nlm.nih.gov/pubmed/21172102?tool=bestpractice.com筛查可以帮助医生识别有风险的女性患者(以及未出生的婴儿)并对其进行风险等级评估。如有必要,还可以评估转诊进行适当的治疗。
在所有人群中筛选无症状表现的儿童是不切实际的,但对于高风险人群的目标筛选可能会被用来在已知的有过酒精暴露史的孩子中鉴定患有胎儿酒精谱系障碍的患者。这种病的早期诊断与青少年和成年期的次级障碍发育风险的降低有关系,包括教育中断、毒品和酒精问题、心理健康问题、触犯法律或有期徒刑以及高失业率问题。[44]Streissguth AP, Bookstein FL, Barr HM, et al. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr. 2004;25:228-238.http://www.ncbi.nlm.nih.gov/pubmed/15308923?tool=bestpractice.com
针对孕期使用酒精的筛查试验
所有孕妇都应被询问其酒精摄入史。[33]Carson G, Cox LV, Crane J, et al.; Society of Obstetricians and Gynaecologists of Canada. Alcohol use and pregnancy consensus clinical guidelines. J Obstet Gynaecol Can. 2010;32:S1-S31.http://www.ncbi.nlm.nih.gov/pubmed/21172102?tool=bestpractice.com[61]Royal College of Midwives. Alcohol and pregnancy. Guidance paper. London: Royal College of Midwives; 2010.[62]Koren G, Sarkar M, Rosenbaum C, et al. The maternal drinking history guide: development of a national educational tool. J Popul Ther Clin Pharmacol. 2013;20:e42-e43.http://www.ncbi.nlm.nih.gov/pubmed/23429281?tool=bestpractice.com应询问其饮酒频率和饮酒量并且要做常规记录,最好能使用经过验证的、符合标准的工具。[63]Sarkar M, Burnett M, Carriere S, et al. Screening and recording of alcohol use among women of child-bearing age and pregnant women. Can J Clin Pharmacol. 2009;16:242-263.http://www.ncbi.nlm.nih.gov/pubmed/19372602?tool=bestpractice.com可以使用很多筛选工具(包括TWEAK、T-ACE以及AUDIT),这些工具都采取的是简短问卷调查的形式。不过大部分已被用来鉴定危险饮酒而不是少量饮酒。[13]Chambers CD. Fetal alcohol spectrum disorder. In: Preedy V, Watson R, eds. Comprehensive handbook of alcohol related pathology. London: Elsevier; 2005:349-360.(加拿大公共卫生局资助的)加拿大儿科保健中心协会最近发表了一个可以让健康专业人士对孕妇进行酒精筛选的工具。为了增加这个工具在初级保健机构改变饮酒行为的可能性,指南包括有价值的、3阶段知识转化计划信息。[62]Koren G, Sarkar M, Rosenbaum C, et al. The maternal drinking history guide: development of a national educational tool. J Popul Ther Clin Pharmacol. 2013;20:e42-e43.http://www.ncbi.nlm.nih.gov/pubmed/23429281?tool=bestpractice.com
生物指标筛选
可以在母体的头发或胎便中发现脂肪酸乙脂(FAEE)。[64]Goh YI, Chudley AE, Clarren SK, et al. Development of Canadian screening tools for fetal alcohol spectrum disorder. Can J Clin Pharmacol. 2008;15:e344-e366.http://www.ncbi.nlm.nih.gov/pubmed/18840921?tool=bestpractice.com[65]Kulaga V, Pragst F, Fulga N, et al. Hair analysis of fatty acid ethyl esters in the detection of excessive drinking in the context of fetal alcohol spectrum disorders. Ther Drug Monit 2009;31:261-266.http://www.ncbi.nlm.nih.gov/pubmed/19258930?tool=bestpractice.com母体的头发分析是一个新型的筛选工具,可以发现头发收集前6个月的内酒精使用。[65]Kulaga V, Pragst F, Fulga N, et al. Hair analysis of fatty acid ethyl esters in the detection of excessive drinking in the context of fetal alcohol spectrum disorders. Ther Drug Monit 2009;31:261-266.http://www.ncbi.nlm.nih.gov/pubmed/19258930?tool=bestpractice.com针对脂肪酸乙脂的胎便分析(>2纳摩尔/克)可以发现严重的胎儿酒精暴露。胎便必须要在出生后72小时内收集起来。这个试验无法获得孕早期酒精使用情况。[64]Goh YI, Chudley AE, Clarren SK, et al. Development of Canadian screening tools for fetal alcohol spectrum disorder. Can J Clin Pharmacol. 2008;15:e344-e366.http://www.ncbi.nlm.nih.gov/pubmed/18840921?tool=bestpractice.com
产前超声检查
产前超声检查可被用于严重饮酒的孕妇,来评估胎儿生长参数并发现胎儿的发育缺陷。
面部摄影
面部数码摄影(连同面部诊断软件一起使用),如果他们的面部特征暗示患胎儿酒精综合征,FASD诊断诊所将为他们提供详细的评估。[50]Astley SJ, Stachowiak J, Clarren SK, et al. Application of the fetal alcohol syndrome facial photographic screening tool in a foster care population. J Pediatr. 2002;141:712-717.http://www.ncbi.nlm.nih.gov/pubmed/12410204?tool=bestpractice.com立体图像的匹配也曾被用来分析三维图像,以帮助胎儿酒精综合征的筛选。[53]Grobbelaar R, Douglas TS. Stereo image matching for facial feature measurement to aid in fetal alcohol syndrome screening. Med Eng Phys. 2007;29:459-464.http://www.ncbi.nlm.nih.gov/pubmed/16904364?tool=bestpractice.com
胎儿酒精综合征的筛选清单
一份针对胎儿酒精谱系障碍的清单被用于学龄前儿童的筛选。这份清单有32项,包括面部特征、肌骨骼畸形以及发育。敏感性是100%,特异性94%、阳性预测值92%。[66]Poitra BA, Marion S, Dionne M, et al. A school-based screening program for fetal alcohol syndrome. Neurotoxicol Teratol. 2003;25:725-729.http://www.ncbi.nlm.nih.gov/pubmed/14624972?tool=bestpractice.com