Objective Measures of Prenatal Alcohol Exposure: A Systematic Review

Abstract

CONTEXT: Objective measurement of prenatal alcohol exposure (PAE) is essential for identifying children at risk for adverse outcomes, including fetal alcohol spectrum disorders. Biomarkers have been advocated for use in universal screening programs, but their validity has not been comprehensively evaluated. OBJECTIVE:To systematically review the validity of objective measures of PAE. DATA SOURCES:Thirteen electronic databases and supplementary sources were searched for studies published between January 1990 and October 2015.STUDY SELECTION: Eligible studies were those that evaluated the diagnostic accuracy of objective measures of PAE.DATA EXTRACTION: Three reviewers independently verified study inclusion, quality assessments, and extracted data. RESULTS:Twelve studies met inclusion criteria. Test performance varied widely across studies of maternal blood (4 studies; sensitivity 0%-100%, specificity 79%-100%), maternal hair (2 studies; sensitivity 19%-87%, specificity 56%-86%) maternal urine (2 studies; sensitivity 5%-15%, specificity 97%-100%), and biomarker test batteries (3 studies; sensitivity 22%-50%, specificity 56%-97%). Tests of the total concentration of 4 fatty acid ethyl esters (in meconium: 2 studies; in placenta: 1 study) demonstrated high sensitivity (82%-100%); however, specificity was variable (13%-98%).LIMITATIONS: Risk of bias was high due to self-report reference standards and selective outcome reporting.CONCLUSIONS: Current evidence is insufficient to support the use of objective measures of prenatal alcohol exposure in practice. Biomarkers in meconium and placenta tissue may be the most promising candidates for further large-scale population-based research. a Division of Population Medicine and b Specialist Unit for Review Evidence, Cardiff University, Cardiff, United KingdomMs McQuire developed the draft protocol and search strategy, data extraction sheet, and quality coding criteria; carried out study selection, data extraction, quality assessment, and evidence synthesis; and prepared the initial manuscript and subsequent revisions; Dr Paranjothy developed the initial concept for the study, contributed to development of the protocol, extracted data, verifi ed study inclusion decisions and quality assessments, and reviewed and revised the manuscript; Dr Hurt contributed to development of the protocol, extracted data, verifi ed study inclusion decisions and quality assessments, and reviewed and revised the manuscript; Ms Mann contributed to the design of the search strategy and reviewed and revised the manuscript; Dr Farewell provided statistical advice and reviewed and revised the manuscript; Dr Kemp contributed to development of the protocol and reviewed and revised the manuscript; and all authors approved the fi nal manuscript as submitted.This review has been registered at the PROSPERO international prospective register of systematic reviews (www. crd. york. ac. uk) (identifi er CRD42014015420).

Fetal programming of neuropsychiatric disorders

“…The complexity of symptoms related to prenatal ethanol exposure is at the basis of a new definition of FAS, better defined as "fetal alcohol spectrum disorders" (Cook et al, 2016). All these data clearly indicate the relevance of alcohol-related damage in the prenatal period, and support the search of objective measures for large-scale population-based campaigns aimed at identifying and preventing prenatal alcohol exposure of the developing fetal brain (McQuire et al, 2016).…”

Determining the pattern and prevalence of alcohol consumption in pregnancy by measuring biomarkers in meconium

“…A cut-off concentration of >600 ng/g in meconium is commonly used to indicate alcohol exposure and has been validated in populations with documented heavy alcohol consumption 16. A recent systematic review of alcohol biomarkers by McQuire et al has shown that using a cut-off of 600 ng FAEEs per gram of meconium has a high sensitivity (82%–100%) for detection of significant alcohol consumption in pregnancy but a variable specificity (13%–98%) 21. Assuming that self-reporting in a known alcohol consuming population is accurate, this translates to a positive predictive value of 55%.…”

A Novel 4D Ultrasound Parenting Intervention for Substance Using Pregnant Women in Finland: Participation in Obstetric Care, Fetal Drug Exposure, and Perinatal Outcomes in a Randomized Controlled Trial

“…Meconium testing is considered to be the golden standard for detecting fetal drug exposure (Wabuyele et al 2018). Unfortunately, objective means for detecting prenatal alcohol exposure are still inadequate (McQuire et al 2016). The number of positive meconium tests was relatively small considering the severity of problems related to substance use in the study population, only 7% of the newborns were exposed to drugs.…”