Hair Analysis of Fatty Acid Ethyl Esters in the Detection of Excessive Drinking in the Context of Fetal Alcohol Spectrum Disorders

Abstract

A serious challenge in diagnosing fetal alcohol spectrum disorder (FASD) is the need to document alcohol use during pregnancy. Maternal/paternal alcohol abuse affects the likelihood of fetal alcohol exposure, and hence the occurrence of FASD. The objective of the current study was to document the use of the fatty acid ethyl ester (FAEE) hair test, a biomarker of excessive alcohol use, in parents at risk of having children with FASD and quantify the prevalence of alcohol use in this population. Hair samples submitted for FAEE testing between October 2005 and May 2007 were evaluated (n = 324). Subjects consisted of the parents of at-risk children. Samples were analyzed using a previously published method. Briefly, samples underwent a liquid-liquid extraction, followed by headspace solid phase microextraction, and were then analyzed by gas chromatography-mass spectrometry using deuterated FAEE as internal standards. Limit of detection and limit of quantification values were between 0.01-0.04 ng/mg and 0.04-0.12 ng/mg, respectively. Positive levels for excessive drinking were ascertained using a cutoff level of 0.5 ng/mg, offering 90% sensitivity and specificity. The rate of positive hair samples for excessive drinking was 33.3% (32.4% among women and 35.4% among men) (n = 324). The majority of samples (62%) had cumulative FAEE levels above a level that excludes strict abstinence (0.2 ng/mg) and many (19%) were highly positive (above 1.0 ng/mg). Of 26 FAEE hair tests for which women were reported to be pregnant, 38% had FAEE hair levels above 0.2 ng/mg and 19% tested positive for excessive drinking, with levels above 0.5 ng/mg; 12% had levels above 1.0 ng/mg. The high rate of positive FAEE results demonstrates that the FAEE hair test corroborates the clinical suspicion of alcohol use in parents of children at risk for FASD. Our results suggest that FAEE hair analysis may be a powerful tool in detecting excessive alcohol use in the perinatal period.

Maternal and Neonatal Hair and Breast Milk in The Assessment of Perinatal Exposure to Drugs of Abuse

“…Kulaga and colleagues evaluated the presence of FAEEs in 324 maternal hair samples. The majority of samples (62%) had cumulative FAEEs levels above a level that excludes strict abstinence (0.2 ng/mg) and many (19%) were highly positive (above 1.0 ng/mg) [89]. The results suggest that FAEEs hair analysis may be a powerful tool in detecting excessive alcohol use in the perinatal period.…”

“…The results suggest that FAEEs hair analysis may be a powerful tool in detecting excessive alcohol use in the perinatal period. In this context, hair testing for FAEEs in 26 pregnant women disclosed a 19% positive samples for excessive drinking, with levels above the cut-off of 0.5 ng/mg [89]. However, Morini et al [90] reported that monitoring FAEEs concentration in hair of pregnant women was not useful in detecting ethanol intake lower than 30 g/day.…”

Determination of maternal-fetal biomarkers of prenatal exposure to ethanol: A review

“…Their study found a correlation between FAEE levels in hair samples and the amount of ethanol consumed even after 2 months of subsequent abstinence. Similarly, Kulaga and Koren [69] documented the use of FAEEs hair test in parents at risk of having children with FASD and quantified the prevalence of alcohol use in this population. From a total of 26 pregnant subjects whose hair was analyzed for FAEE, 19% tested positive for excessive drinking, with levels above 0.5 ng/mg.…”

Incorporation of Drug and Substances in Hair

“…Bu amaçla kullanılan yöntemler, artmış karaciğer enzimi aktivitesi, artmış eritrosit ortalama hücre hacmi veya karbonhidrattan eksik transferrin varlığı gibi yöntemlerdir. 2,49,50 Ancak, bu göstergeler patolojik nedenleri de gösterebilmek-tedir.…”