Prevalence of Fetal Ethanol Exposure in a Regional Population-Based Sample by Meconium Analysis of Fatty Acid Ethyl Esters

Abstract

Challenges in identifying children exposed prenatally to ethanol necessitate the development of a biomarker for neonates at risk for fetal alcohol spectrum disorder. Meconium fatty acid ethyl esters (FAEE), products of nonoxidative ethanol metabolism, have been established as a novel biomarker of fetal ethanol exposure. We present the first application of this biomarker to a population-based sample in Canada. Six-hundred eighty-two meconium specimens were anonymously collected in the region of Grey Bruce, Ontario, Canada. Meconium FAEE were extracted by liquid-liquid and solid-phase extraction and analyzed by gas chromatography with flame-ionization detection confirmed by gas chromatography with mass spectrometry. We measured ethyl palmitate (E16:0), ethyl palmitoleate (E16:1), ethyl stearate (E18:0), ethyl oleate (E18:1), ethyl linoleate (E18:2), ethyl linolenate (E18:3), and ethyl arachidonate (E20:4). Seventeen of 682 meconium samples tested positive for significant prenatal ethanol exposure (>2.0 nmol/g). FAEE analysis detected fivefold more ethanol-exposed pregnancies than standard postpartum questionnaires in this population (2.5% versus 0.5%) (P < 0.001). The prevalence of ethanol-exposed pregnancies was consistent with Centers for Disease Control and Prevention estimates of "frequent" prenatal drinking and previously published estimates of fetal alcohol spectrum disorder disease prevalence in the general North American population. The FAEE concentrations of negative (95% confidence interval, 0.38-0.49 nmol/g) versus positive (95% confidence interval, 7.74-151.28 nmol/g) samples were distinct, further demonstrating the specificity of this biomarker in determining significant prenatal ethanol exposure. Meconium FAEE analysis demonstrates a fivefold increase in sensitivity over currently used methods of self-report-based screening in Ontario for the detection of ethanol-exposed pregnancies in a clinical setting.

Exposição pré-natal ao etanol: toxicidade, biomarcadores e métodos de detecção

“…O etanol, assim como a maioria das outras drogas, atravessa a placenta por difusão passiva. Esses fatores, somados à fácil coleta, fazem do mecônio uma ótima matriz para identificar exposições intrauterinas 34,35 . O cabelo tem sido considerado uma matriz alternativa para avaliação de EEAG.…”

“…Foi proposto o uso de TLFB combinado com os outros questionários para aumentar a efetividade do screening 35 . Porém, esse screening nem sempre corresponde à realidade da exposição 34,41 e serve para fornecer informações sobre o consumo de álcool materno e sobre uma possível intervenção.…”

Les marqueurs de l'éthylisme chronique. Focus sur les approches immuno-chimiques

“…Dans le sang, les FAEE sont détectables 24 heures après l'arrêt de la consommation d'éthanol [15] et donc l'analyse pratique des FAEE est limitée à leur caractérisation dans les cheveux, la plupart du temps en complément de l'EtG [16]. Par contre, la caractérisation de l'alcoolisme foetal à partir des FAEE dans le méconium semble promise à un avenir certain, tant cette approche apparaît comme pertinente [17] puisqu'elle permet un recul sur environ 3 mois avant l'accouchement.…”

Determination of eight fatty acid ethyl esters in meconium samples by headspace solid‐phase microextraction and gas chromatography–mass spectrometry

“…Prenatal ethanol exposure can be associated with fetal alcohol spectrum disorder (FASD), a condition marked by a complex pattern of behavioral and cognitive abnormalities [1,2]. FASD can be avoided if drinking during pregnancy is detected.…”