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Background: Fetal alcohol syndrome (FAS), alcoholrelated birth defects (ARBDs), and alcohol-related neurodevelopment disorders (ARNDs) in neonates are often the result of maternal alcohol consumption during pregnancy. Facial characteristics are associated with FAS, but ARBDs and ARNDs are more difficult to diagnose. Fetal exposure to alcohol can cause central nervous system dysfunction, pre-and postnatal growth problems, cardiac defects in neonates, and attention deficit disorders and mental retardation in older children. To date, diagnosis of fetal alcohol effect has depended largely on maternal interview, although clinical tests are becoming more widely used. Fatty acid ethyl esters (FAEEs) are formed in the body by esterification of ethanol with free fatty acids and trans-esterification of glycerides and have been detected in the meconium of newborns. This report estimates the prevalence of fetal alcohol exposure in two populations by detecting FAEEs in meconium. Methods: We analyzed the prevalence of FAEEs in the meconium of two separate groups of neonates by use of solid-phase extraction and analysis by gas chromatography-mass spectrometry in the chemical ionization mode. In the first study, meconium samples were taken anonymously from babies born in a large, regional perinatal center in Hawaii. In the second study, specimens were obtained from infants admitted to six different newborn intensive care units within the state of Utah. Results: In the first study, 73 of 436 (16.7%) meconium specimens tested were considered positive for FAEEs. When broken down into quartiles, the mean total FAEEs measured were 1059, 3133, 6628, and 62115 ng/g. In the second study, 35 of 289 (12.1%) specimens were considered positive. When broken into quartiles, the mean total FAEEs were 1139, 3067, 7674, and 50 143 ng/g. The

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Aims This study aimed to evaluate the performance of ethyl glucuronide (EtG) in hair and fingernails as a long-term alcohol biomarker. Design Cross-sectional survey with probability sampling. Setting Midwestern United States. Participants Participants were 606 undergraduate college students between the ages of 18 and 25 at the time of selection for potential study participation. Measurements EtG concentrations in hair and fingernails were measured by Liquid Chromatography-Tandem Mass Spectrometry at three thresholds (30 picograms (pg) per milligram (mg); 20 pg/mg; and 8 pg/mg). Any weekly alcohol use, increasing-risk drinking, and high-risk drinking on average during the past 12 weeks was assessed by participant interview using the TimeLine Followback. Findings In both hair and fingernails at all three EtG thresholds, sensitivity was greatest for the high-risk drinking group (hair: 0.43, Confidence Interval (CI) = [0.17, 0.69] at 30 pg/mg, 0.71, CI = [0.47, 0.95] at 20 pg/mg; 0.93, CI = [0.79, 1.00] at 8 pg/mg; fingernails: 1.00, CI = [1.00–1.00] at 30, 20 and 8 pg/mg), and specificity was greatest for any alcohol use (hair: 1.00, CI = [1.00, 1.00] at 30 and 20 pg/mg; 0.97, CI = [0.92–0.99] at 8 pg/mg; fingernails: 1.00, CI = [1.00–1.00] at 30, 20, and 8 pg/mg). Areas under the receiver operating characteristic curves were significantly higher for EtG concentration in fingernails than hair for any weekly alcohol use (p = 0.02, DeLong test, two-tailed) and increasing-risk drinking (p = 0.02, DeLong test, two-tailed). Conclusions Ethyl glucuronide, especially in fingernails, may have potential as a quantitative indicator of alcohol use.

Aims: To analyze the efficacy of screening banked newborn dried blood spots (DBS) for detection of phosphatidylethanol (PEth), a direct alcohol biomarker, with the purpose of performing a retrospective assessment of statewide prevalence rates of alcohol consumption in late pregnancy that results in risky prenatal alcohol exposure.Design: Residual DBS samples collected for newborn screening and stored by a state department of public health were examined for concentrations of PEth. The prevalence of prenatal alcohol exposure, as determined by this direct alcohol biomarker, was compared to prevalence rates of alcohol consumption during pregnancy that have been derived from multiple state-based and national studies using maternal self-report surveys.Setting: DBS cards representative of the general newborn population were collected from multiple hospitals across a single midwestern state. Participants:Two hundred fifty anonymous newborn DBS collected for routine metabolic screening in a midwestern state were requested through the Virtual Repository of Dried Blood Spots. Measures:Concentrations of PEth, a highly specific biomarker of alcohol consumption, were analyzed using a liquid chromatography-tandem mass spectrometry method validated by our laboratory. Findings:Of 250 DBS examined, 4% were positive for PEth (PEth ≥ 8 ng/ml) which is indicative of exposure to maternal alcohol consumption during the last month of pregnancy.Conclusions: Detection of PEth from newborn DBS cards can identify prenatal alcohol exposure and also be used for retrospective surveillance of alcohol consumption during the last three to four weeks of pregnancy, using specimens that are collected for routine metabolic screening and stored by many state health departments.