Phosphatidylethanol in Maternal or Neonatal Blood to Detect Alcohol Exposure during Pregnancy: A Systematic Review

Abstract

Background: Alcohol consumption during pregnancy, even at low doses, may damage the fetus. Pregnant women tend to underreport their alcohol consumption generating the need for sensitive and specific biomarkers, among which PEth has emerged due to its high specificity and possibility to be measured in both maternal and neonatal blood. The aim of this study is to systematically review the latest 20 years of literature for depicting the state of the art, the limitations, and the prospects of PEth for estimating alcohol consumption during pregnancy. Materials and methods: A systematic search, adhering to PRISMA guidelines, of the latest 20 years of literature through “MeSH” and “free-text” protocols in the databases PubMed, SCOPUS, and Web of Science, with time limits 1 January 2002–1 March 2022, was performed. The inclusion criteria were as follows: PEth used for detecting alcohol consumption during pregnancy, quantified in blood through liquid chromatography coupled to mass spectrometry, and full texts in the English language. Opinion papers, editorials, and narrative reviews were excluded. Results: Sixteen (16) papers were included in the present review (0.81% of total retrieved records). All the included records were original articles, of which there were seven prospective cohort/longitudinal studies, six cross-sectional studies, two observational-descriptive studies, and one retrospective study. All studies assayed PEth in at least one biological matrix; seven (7) studies quantified PEth in maternal blood, seven studies in newborn blood, and only two studies in both maternal and neonatal blood. In several included papers, PEth proved more sensitive than self-reports for identifying pregnant women with an active alcohol intake with the diagnostic efficiency improving with the increase of the maternal alcohol intake. Conclusions: Further studies, performed on wider and well-stratified populations, are needed to drive any definitive conclusion. PEth is a promising marker for monitoring alcohol use in pregnancy; however, at the present time, its use is still limited mainly by the absence of a globally agreed interpretative cut-off, the paucity of data regarding its specificity/sensitivity, and the lack of standardization on the diagnostic efficiency of the different isoforms.

Molecular Toxicology and Pathophysiology of Comorbid Alcohol Use Disorder and Post-Traumatic Stress Disorder Associated with Traumatic Brain Injury

“…Through metabonomic analysis of the changes in the body caused by AUD or alcohol dependence, some trait or state markers are found; these provide very important objective biomarkers for forensic and clinical toxicology [75,76]. For example, phosphatidylethanol is a promising marker for monitoring alcohol use in pregnancy [77], while salivary exoglycosidases and deglycosylation processes can be biochemical markers for chronic alcohol consumption and dependence [78].…”

Average alcohol consumption and binge drinking during pregnancy – characteristics of the women who drink and the association with miscarriage and fertility

“…Phosphatidylethanol (PEth), a phospholipid formed in the presence of ethanol, may be detected in maternal blood up to 6 weeks after low to moderate alcohol consumption and can be used to confirm maternal alcohol use in blood from the fetus when in doubt of, i.e., diagnoses 36 . A review from 2022 concluded that PEth has higher sensitivity than selfreported alcohol consumption, but further studies are needed 37 . Fatty acid ethyl esters (FAEEs) measured in meconium have also been argued to be more sensitive than selfreports 38 , and Ethyl glucuronide (EtG) and FAEEs have been suggested to be admissible for clinical use in the detection of PAE 39 .…”