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Kovács MV, Lages YVM, Vieira BS, Charchat-Fichman H, Landeira-Fernandez J, Krahe TE. Neuropsychological evaluation of children and adolescents with fetal alcohol spectrum disorders in the Brazilian population. APPLIED NEUROPSYCHOLOGY. CHILD 2023:1-13. [PMID: 37967155 DOI: 10.1080/21622965.2023.2279202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Fetal Alcohol Spectrum Disorder (FASD) is a collective name for lifelong physical and neurodevelopmental problems caused by the gestational consumption of alcohol affecting fetal development. In Brazil, the lack of awareness among healthcare professionals, and the scarcity of suitable diagnostic tools and trained clinicians, can contribute to the underestimation of FASD prevalence and severity. The present review aims to map and analyze studies conducted in Brazil on children and adolescents with FASD or a history of prenatal alcohol exposure (PAE). Additionally, it intends to report the psychometric properties of the neurodevelopmental assessment tools applied in the selected articles. Searches were carried out in the databases Scielo, LILACS, PePSIC, EMBASE, PsycINFO, Web of Science, selecting original clinical studies that have investigated the neurodevelopment of this population. From a total of 175 studies, ten articles fit the inclusion criteria in which 18 instruments were identified. The most reported deficits were related to language, general intelligence quotient (IQ), adaptive behavior, attention, and visual perception. Our results point to the need for more clinical research on FASD in Brazil, as well as for the standardization and validation of neurodevelopmental assessment tools for the accurate diagnosis of FASD in Brazil.
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Affiliation(s)
- Martina V Kovács
- Departamento de Psicologia, Laboratório de Neurociência do Comportamento, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yury V M Lages
- Departamento de Psicologia, Laboratório de Neurociência do Comportamento, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Breno S Vieira
- Departamento de Psicologia, Laboratório de Neurociência do Comportamento, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Helenice Charchat-Fichman
- Departamento de Psicologia, Laboratório de Neurociência do Comportamento, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - J Landeira-Fernandez
- Departamento de Psicologia, Laboratório de Neurociência do Comportamento, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thomas E Krahe
- Departamento de Psicologia, Laboratório de Neurociência do Comportamento, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
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Fetal lung development via quantitative biomarkers from diffusion MRI and histological validation in rhesus macaques. J Perinatol 2022; 42:866-872. [PMID: 34686834 PMCID: PMC9023595 DOI: 10.1038/s41372-021-01236-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/28/2021] [Accepted: 10/05/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To demonstrate sensitivity of diffusion-weighted MRI (DW-MRI) to pulmonary cellular-space changes during normal in utero development using fetal rhesus macaques, compared to histological biomarkers. STUDY DESIGN In vivo/ex vivo DW-MRI was acquired in 26 fetal rhesus lungs (early-canalicular through saccular stages). Apparent diffusion coefficients (ADC) from MRI and tissue area density (H&E), alveolar type-II cells (ABCA3), and epithelial cells (TTF1) from histology were compared between gestational stages. RESULTS In vivo/ex vivo ADC correlated with each other (Spearman ρ = 0.47, P = 0.038; Bland-Altman bias = 0.0835) and with area-density (in vivo ρ = -0.56, P = 0.011; ex vivo ρ = -0.83, P < 0.0001). In vivo/ex vivo ADC increased exponentially toward saturation with gestational stage (R2 = 0.49/0.49), while area-density decreased exponentially (R2 = 0.53). ABCA3 and TTF1 stains demonstrated expected fetal cellular development. CONCLUSIONS Fetal DW-MRI provides a non-invasive biomarker for pulmonary structural maturation, with a strong correlation to histological markers during tissue development in rhesus macaques. This method has strong potential for assessing human fetal development, particularly in patients with pulmonary hypoplasia.
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Cheng CT, Ostrea Jr EM, Alviedo JNB, Banadera FP, Thomas RL. Fatty acid ethyl esters in meconium: A biomarker of fetal alcohol exposure and effect. Exp Biol Med (Maywood) 2021; 246:380-386. [PMID: 33210553 PMCID: PMC7885053 DOI: 10.1177/1535370220971562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/15/2020] [Indexed: 11/16/2022] Open
Abstract
To determine if meconium fatty acid ethyl esters (FAEE) in rat pups is a good biomarker of prenatal exposure and effect to alcohol, three groups of pregnant rats were studied: one control (pair fed) and two treatment groups given 25% alcohol at 2.2 or 5.5 g-1 kg-1 d-1. The pups were delivered on day 20 and, for each dam, were separated into a male and female group. The body, brain, intestines, and placenta of the pups were obtained, weighed, and stored at -20°C. The pups' intestines (as surrogate of meconium) from each group were pooled, and meconium was analyzed by gas chromatography/mass spectroscopy for FAEE. The meconium showed the following FAEE: ethyl palmitate, ethyl stearate, and ethyl linolenate and were only found in the alcohol-treated group and with high specificity but low sensitivity. Mean body weight of the pups was lower in the treatment groups compared to the control groups. Ethyl palmitate concentration correlated negatively to the pups' mean body and brain weights. Therefore, ethyl palmitate, stearate, and linolenate, in meconium of rat pups prenatally exposed to alcohol, are useful biomarkers of prenatal alcohol exposure, with ethyl palmitate a good biomarker of adverse effect on the pups' body and brain weight.
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Affiliation(s)
- Charlie T Cheng
- Hutzel Women’s Hospital and Children’s Hospital of Michigan, Detroit, MI 48201, USA
| | - Enrique M Ostrea Jr
- Hutzel Women’s Hospital and Children’s Hospital of Michigan, Detroit, MI 48201, USA
| | - Joseph NB Alviedo
- Hutzel Women’s Hospital and Children’s Hospital of Michigan, Detroit, MI 48201, USA
| | - Felix P Banadera
- Hutzel Women’s Hospital and Children’s Hospital of Michigan, Detroit, MI 48201, USA
| | - Ronald L Thomas
- Hutzel Women’s Hospital and Children’s Hospital of Michigan, Detroit, MI 48201, USA
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Koren G, Cohen R. Quantifying fetal alcohol exposure by meconium fatty acid ethyl esters (FAEE); association with adverse fetal outcomes and population estimates of fetal alcohol exposure. Drug Metab Rev 2019; 51:524-532. [PMID: 31595802 DOI: 10.1080/03602532.2019.1671859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Fetal Alcohol Spectrum Disorder (FASD) describes the wide range of adverse physical, behavioral and cognitive effects resulting from ethanol exposure during embryonic and fetal development. Identification of children suffering from FASD is often difficult, as abuse of ethanol during pregnancy is a heavily stigmatized behavior that receives little prenatal screening attention in routine care. Over the last 3 decades, measurement of the ethanol metabolites fatty acid ethyl esters (FAEE) has emerged as a useful tool to detect in the neonatal period fetal alcohol exposure starting from mid gestation. This review aims at updating clinicians and researchers on the validity and utility of this biological marker in two aspects: The association with adverse fetal outcomes and in generating population estimates of fetal alcohol exposure.
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Affiliation(s)
- Gideon Koren
- Motherisk Israel Program, Division of Clinical Pharmacology, Shamir Hospital, Zrifin, Israel.,Adelson Faculty of Medicine, Ariel University, Ariel, Israel.,Department of Physiology/Pharmacology, Western University, Ontario, Canada
| | - Rana Cohen
- Motherisk Israel Program, Division of Clinical Pharmacology, Shamir Hospital, Zrifin, Israel
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Prevalence of Fetal Alcohol Exposure by Analysis of Meconium Fatty Acid Ethyl Esters; A National Canadian Study. Sci Rep 2019; 9:2298. [PMID: 30783158 PMCID: PMC6381181 DOI: 10.1038/s41598-019-38856-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/09/2019] [Indexed: 01/02/2023] Open
Abstract
Our study aimed to estimate the prevalence of heavy fetal alcohol exposure through the analysis of meconium FAEEs as an objective biomarker of fetal exposure. We conducted a study on meconium samples collected nationwide through the Maternal-Infant Research on Environmental Chemicals (MIREC) Study Group. FAEE in meconium was quantified by an established headspace solid-phase microextraction coupled with gas chromatography-mass spectrometry (SPME GC-MS). Out of 1315 samples collected in 10 Canadian obstetric units coast to coast between 2008-2011, the estimated prevalence of positive meconium FAEE ranged between 1.16% and 2.40%, translating into at least 1800 new cases of FASD in Canada each year. Positive maternal self- reports of heavy alcohol use were tenfold lower (0.24%). Use of meconium FAEE revealed tenfold more cases of heavy exposure to maternal drinking than did maternal reports. The use of objective measures of maternal alcohol exposure is critical in accurately estimating risks and in monitoring effective prevention of FASD.
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English LL, Mugyenyi G, Nightingale I, Kiwanuka G, Ngonzi J, Grunau BE, MacLeod S, Koren G, Delano K, Kabakyenga J, Wiens MO. Prevalence of Ethanol Use Among Pregnant Women in Southwestern Uganda. Matern Child Health J 2017; 20:2209-15. [PMID: 27299903 DOI: 10.1007/s10995-016-2025-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction The prevalence of ethanol use in many Sub-Saharan African countries is high, but little research exists on use during pregnancy. The objective of this study was to assess the prevalence and predictors of ethanol use among pregnant women in Southwestern Uganda. Methods This descriptive, cross-sectional study was conducted in the maternity ward at Mbarara Regional Referral Hospital (MRRH). All pregnant women giving birth at MRRH between September 23, 2013 and November 23, 2013 were eligible for enrollment. The primary outcome was the proportion of women with ethanol use during pregnancy as determined by self-report. Secondary outcomes included the proportion with positive fatty acid ethyl ester (FAEE) results (indicating ethanol use) and positive TWEAK questionnaire results (indicating possible problem drinking). Predictors of ethanol use were assessed and stratified by patterns of ethanol intake. Results Overall, 505 mother-child dyads enrolled in the study. The proportion of women who reported any ethanol use during pregnancy was 16 % (n = 81, 95 % CI 13-19 %) and the prevalence of heavy drinking 6.3 % (n = 32, 95 % CI 3.8-7.9 %). The strongest predictor of use during pregnancy was pre-pregnancy use, with maternal education as a protective factor. Few neonates (n = 11, 2 %) tested positive for FAEE > 2.00 nmol/g in meconium. The TWEAK questionnaire captured 75 % of women who reported moderate/heavy drinking and aligned more with self-reported ethanol use than meconium results. Conclusions The substantial prevalence and clear predictors of ethanol use suggest that legislative action and educational interventions to increase awareness of potential harms could assist in efforts to decrease use during pregnancy in Southwestern Uganda.
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Affiliation(s)
- L L English
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - G Mugyenyi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - I Nightingale
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, Canada
| | - G Kiwanuka
- Department of Biochemistry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - J Ngonzi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - B E Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - S MacLeod
- Child and Family Research Institute, BC Children's Hospital, Vancouver, Canada
| | - G Koren
- Motherisk, Toronto Hospital for Sick Children, Toronto, Canada
| | - K Delano
- Motherisk, Toronto Hospital for Sick Children, Toronto, Canada
| | - J Kabakyenga
- Institute for Maternal Child Heath, Mbarara University of Science and Technology, Mbarara, Uganda
| | - M O Wiens
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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Dukes K, Tripp T, Petersen J, Robinson F, Odendaal H, Elliott A, Willinger M, Hereld D, Raffo C, Kinney HC, Groenewald C, Angal J, Young R, Burd L. A modified Timeline Followback assessment to capture alcohol exposure in pregnant women: Application in the Safe Passage Study. Alcohol 2017; 62:17-27. [PMID: 28755748 DOI: 10.1016/j.alcohol.2017.02.174] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 12/14/2022]
Abstract
Prenatal alcohol exposure (PAE) has been linked to poor pregnancy outcomes, yet there is no recognized standard for PAE assessment, and the specific effects of quantity, frequency, and timing remain largely unknown. The Safe Passage Study was designed to investigate the role of PAE in a continuum of poor peri- and postnatal outcomes. The objective of this manuscript is to describe the rationale for, and feasibility of, modifications to the traditional Timeline Followback (TLFB) for collecting PAE information in a large cohort of pregnant women. Participants from the Northern Plains region (in the United States) and Cape Town, South Africa, were followed prospectively using a modified 30-day TLFB interview, administered up to five times, to obtain detailed PAE information. Required modifications for our population included capturing information regarding sharing, type/brand, container size, and duration, in order to accurately record the amount of alcohol consumed. PAE status was defined for 99.9% of the 11,892 enrolled pregnancies at least once during pregnancy and for 92% across all trimesters. Of 53,823 drinks reported, 98% had all items necessary for standard drink computation. Sharing was reported for 74% of drinks in Cape Town, South Africa and for 10% in the Northern Plains. Compared to referent values from the traditional TLFB, 74% and 67% of drinks had different alcohol-by-volume and container size, respectively. Furthermore, a statistically significant difference was found between the number of containers reported and the number of standard drinks computed, using information from the modified TLFB. This is the first study of this size to wholly encompass all of these changes into a single measure in order to more accurately calculate daily consumption and assess patterns over time. The methods used to collect PAE information and create alcohol exposure measures likely increased the accuracy of standard drinks reported and could be generalized to other populations.
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Affiliation(s)
- Kimberly Dukes
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA.
| | - Tara Tripp
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA
| | - Julie Petersen
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA
| | - Fay Robinson
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA
| | - Hein Odendaal
- Stellenbosch University, Department of Obstetrics and Gynecology, Francie van Zijl Avenue, Tygerberg 7505, South Africa
| | - Amy Elliott
- Sanford Research, Center for Health Outcomes and Prevention Research, 2301 E. 60th Street North, Sioux Falls, SD 57104, USA
| | - Marian Willinger
- National Institute of Child Health and Human Development, 31 Center Drive, Building 31, Room 2A32, Bethesda, MD 20892-2425, USA
| | - Dale Hereld
- National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Lane, Rockville, MD 20852, USA
| | - Cheryl Raffo
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA
| | - Hannah C Kinney
- Boston Children's Hospital, Department of Pathology, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Coen Groenewald
- Stellenbosch University, Department of Obstetrics and Gynecology, Francie van Zijl Avenue, Tygerberg 7505, South Africa
| | - Jyoti Angal
- Sanford Research, Center for Health Outcomes and Prevention Research, 2301 E. 60th Street North, Sioux Falls, SD 57104, USA
| | - Rebecca Young
- DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148, USA
| | - Larry Burd
- University of North Dakota, Fetal Alcohol Syndrome Center, School of Medicine & Health Sciences, 501 North Columbia Road, Grand Forks, ND 58203-9037, USA
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Bager H, Christensen LP, Husby S, Bjerregaard L. Biomarkers for the Detection of Prenatal Alcohol Exposure: A Review. Alcohol Clin Exp Res 2017; 41:251-261. [PMID: 28098942 DOI: 10.1111/acer.13309] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 12/03/2016] [Indexed: 01/06/2023]
Abstract
Alcohol exposure during pregnancy can cause adverse effects to the fetus, because it interferes with fetal development, leading to later physical and mental impairment. The most common clinical tool to determine fetal alcohol exposure is maternal self-reporting. However, a more objective and useful method is based on the use of biomarkers in biological specimens alone or in combination with maternal self-reporting. This review reports on clinically relevant biomarkers for detection of prenatal alcohol exposure (PAE). A systematic search was performed to ensure a proper overview in existing literature. Studies were selected to give an overview on clinically relevant neonatal and maternal biomarkers. The direct biomarkers fatty acid ethyl esters (FAEEs), ethyl glucuronide (EtG), ethyl sulfate, and phosphatidylethanol (PEth) were found to be the most appropriate biomarkers in relation to detection of PAE. To review each biomarker in a clinical context, we have compared the advantages and disadvantages of each biomarker, in relation to its window of detectability, ease of collection, and the ease and cost of analysis of each biomarker. The biomarkers PEth, FAEEs, and EtG were found to be applicable for detection of even low levels of alcohol exposure. Meconium is an accessible matrix for determination of FAEEs and EtG, and blood an accessible matrix for determination of PEth.
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Affiliation(s)
- Heidi Bager
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
| | - Lars Porskjaer Christensen
- Department of Chemical Engineering, Biotechnology and Environmental Technology, University of Southern Denmark, Odense M, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
| | - Lene Bjerregaard
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
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Gauthier TW, Brown LAS. In utero alcohol effects on foetal, neonatal and childhood lung disease. Paediatr Respir Rev 2017; 21:34-37. [PMID: 27613232 PMCID: PMC5303127 DOI: 10.1016/j.prrv.2016.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/11/2016] [Indexed: 02/07/2023]
Abstract
Maternal alcohol use during pregnancy exposes both premature and term newborns to the toxicity of alcohol and its metabolites. Foetal alcohol exposure adversely effects the lung. In contrast to the adult "alcoholic lung" phenotype, an inability to identify the newborn exposed to alcohol in utero has limited our understanding of its effect on adverse pulmonary outcomes. This paper will review advances in biomarker development of in utero alcohol exposure. We will highlight the current understanding of in utero alcohol's toxicity to the developing lung and immune defense. Finally, we will present recent clinical evidence describing foetal alcohol's association with adverse pulmonary outcomes including bronchopulmonary dysplasia, viral infections such as respiratory syncytial virus and allergic asthma/atopy. With research to define alcohol's effect on the lung and translational studies accurately identifying the exposed offspring, the full extent of alcohol's effects on clinical respiratory outcomes of the newborn or child can be determined.
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McQuire C, Paranjothy S, Hurt L, Mann M, Farewell D, Kemp A. Objective Measures of Prenatal Alcohol Exposure: A Systematic Review. Pediatrics 2016; 138:peds.2016-0517. [PMID: 27577579 DOI: 10.1542/peds.2016-0517] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 11/24/2022] Open
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.
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Affiliation(s)
| | | | | | - Mala Mann
- Specialist Unit for Review Evidence, Cardiff University, Cardiff, United Kingdom
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Gauthier TW, Guidot DM, Kelleman MS, McCracken CE, Brown LAS. Maternal Alcohol Use During Pregnancy and Associated Morbidities in Very Low Birth Weight Newborns. Am J Med Sci 2016; 352:368-375. [PMID: 27776718 DOI: 10.1016/j.amjms.2016.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/09/2016] [Accepted: 06/28/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND We hypothesized that maternal alcohol use occurs in pregnancies that end prematurely and that in utero alcohol exposure is associated with an increased risk of morbidities of premature newborns. METHODS In an observational study of mothers who delivered very low birth weight newborns (VLBW) ≤1,500 g, maternal alcohol use was determined via a standardized administered questionnaire. We compared the effect of maternal drinking on the odds of developing late-onset sepsis (LOS), bronchopulmonary dysplasia (BPD), death, BPD or death, days on oxygen or any morbidity (either LOS, BPD or death). The effect of drinking amounts (light versus heavy) was also evaluated. RESULTS A total of 129 subjects who delivered 143 VLBW newborns were enrolled. Approximately 1 in 3 (34%) subjects reported drinking alcohol during the first trimester ("exposed"). Within the exposed group, 15% reported drinking ≥7drinks/week ("heavy") and 85% of the subjects reported drinking <7drinks/week ("light"). When controlling for maternal age, drug or tobacco use during pregnancy and neonatal gestational age, any drinking increased the odds of BPD or death and any morbidity. Furthermore, light or heavy drinking increased the odds of BPD or death and any morbidity, whereas heavy drinking increased the odds of LOS. CONCLUSIONS In utero alcohol exposure during the first trimester occurred in 34% of VLBW newborns. Maternal drinking in the first trimester was associated with significantly increased odds of neonatal morbidity. Further studies are warranted to determine the full effect of in utero alcohol exposure on the adverse outcomes of VLBW premature newborns.
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Affiliation(s)
| | - David M Guidot
- Department of Medicine, Emory University, Atlanta, Georgia; Atlanta VA Medical Center, Decatur, Georgia
| | | | | | - Lou Ann S Brown
- Department of Pediatrics, Emory University, Atlanta, Georgia
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Linask KK, Han M. Acute alcohol exposure during mouse gastrulation alters lipid metabolism in placental and heart development: Folate prevention. ACTA ACUST UNITED AC 2016; 106:749-60. [PMID: 27296863 PMCID: PMC5094567 DOI: 10.1002/bdra.23526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/29/2016] [Accepted: 04/28/2016] [Indexed: 12/20/2022]
Abstract
Background Embryonic acute exposure to ethanol (EtOH), lithium, and homocysteine (HCy) induces cardiac defects at the time of exposure; folic acid (FA) supplementation protects normal cardiogenesis (Han et al., 2009, 2012; Serrano et al., 2010). Our hypothesis is that EtOH exposure and FA protection relate to lipid and FA metabolism during mouse cardiogenesis and placentation. Methods On the morning of conception, pregnant C57BL/6J mice were placed on either of two FA‐containing diets: a 3.3 mg health maintenance diet or a high FA diet of 10.5 mg/kg. Mice were injected a binge level of EtOH, HCy, or saline on embryonic day (E) 6.75, targeting gastrulation. On E15.5, cardiac and umbilical blood flow were examined by ultrasound. Embryonic cardiac tissues were processed for gene expression of lipid and FA metabolism; the placenta and heart tissues for neutral lipid droplets, or for medium chain acyl‐dehydrogenase (MCAD) protein. Results EtOH exposure altered lipid‐related gene expression on E7.5 in comparison to control or FA‐supplemented groups and remained altered on E15.5 similarly to changes with HCy, signifying FA deficiency. In comparison to control tissues, the lipid‐related acyl CoA dehydrogenase medium length chain gene and its protein MCAD were altered with EtOH exposure, as were neutral lipid droplet localization in the heart and placenta. Conclusion EtOH altered gene expression associated with lipid and folate metabolism, as well as neutral lipids, in the E15.5 abnormally functioning heart and placenta. In comparison to controls, the high FA diet protected the embryo and placenta from these effects allowing normal development. Birth Defects Research (Part A) 106:749–760, 2016. © 2016 The Authors Birth Defects Research Part A: Clinical and Molecular Teratology Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Kersti K Linask
- Department of Pediatrics, USF Morsani College of Medicine, Tampa and St. Petersburg, Florida.
| | - Mingda Han
- Department of Pediatrics, USF Morsani College of Medicine, Tampa and St. Petersburg, Florida
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Placental Fatty Acid ethyl esters are elevated with maternal alcohol use in pregnancies complicated by prematurity. PLoS One 2015; 10:e0126552. [PMID: 25978403 PMCID: PMC4433254 DOI: 10.1371/journal.pone.0126552] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/03/2015] [Indexed: 11/30/2022] Open
Abstract
The accumulation of fatty acid ethyl esters (FAEEs) in meconium of term newborns has been described as one potential biomarker of maternal alcohol use during pregnancy. FAEEs accumulate in multiple alcohol-exposed fetal tissues and in the placenta. Limited research has focused on the identification of the premature newborn exposed to alcohol in utero. We hypothesized that maternal alcohol use occurs in a significant proportion of premature deliveries and that this exposure can be detected as elevated placental FAEEs. The goals of this study were to 1) determine the prevalence of maternal alcohol use in the premature newborn and 2) investigate whether placental FAEEs could identify those newborns with fetal alcohol exposure. This prospective observational study evaluated 80 placentas from 80 women after premature delivery. Subjects were interviewed for alcohol intake and placental FAEEs were quantified via GC/MS. Receiver Operator Characteristic (ROC) Curves were generated to evaluate the ability of placental FAEEs to predict maternal drinking during pregnancy. Adjusted ROC curves were generated to adjust for gestational age, maternal smoking, and illicit drug use. 30% of the subjects admitted to drinking alcohol during pregnancy and approximately 14% answered questions indicative of problem drinking (designated AUDIT+). The specific FAEEs ethyl stearate and linoleate, as well as combinations of oleate + linoleate + linolenate (OLL) and of OLL + stearate, were significantly (p<0.05) elevated in placentas from AUDIT+ pregnancies. Adjusted ROC Curves generated areas under the curve ranging from 88–93% with negative predictive values of 97% for AUDIT+ pregnancies. We conclude that nearly one third of premature pregnancies were alcohol-exposed, and that elevated placental FAEEs hold great promise to accurately determine maternal alcohol use, particularly heavy use, in pregnancies complicated by premature delivery.
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Cabarcos P, Álvarez I, Tabernero MJ, Bermejo AM. Determination of direct alcohol markers: a review. Anal Bioanal Chem 2015; 407:4907-25. [DOI: 10.1007/s00216-015-8701-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/26/2015] [Accepted: 04/13/2015] [Indexed: 12/15/2022]
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Neonatal sensitization to ethanol-induced breathing disruptions as a function of late prenatal exposure to the drug in the rat: Modulatory effects of ethanol's chemosensory cues. Physiol Behav 2015; 139:412-22. [DOI: 10.1016/j.physbeh.2014.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 10/01/2014] [Accepted: 10/22/2014] [Indexed: 11/24/2022]
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Cabarcos P, Tabernero MJ, Otero JL, Míguez M, Bermejo AM, Martello S, De Giovanni N, Chiarotti M. Quantification of fatty acid ethyl esters (FAEE) and ethyl glucuronide (EtG) in meconium for detection of alcohol abuse during pregnancy: Correlation study between both biomarkers. J Pharm Biomed Anal 2014; 100:74-78. [PMID: 25137651 DOI: 10.1016/j.jpba.2014.07.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/30/2014] [Accepted: 07/23/2014] [Indexed: 10/25/2022]
Abstract
This article presents results from 47 meconium samples, which were analyzed for fatty acid ethyl esters (FAEE) and ethyl glucuronide (EtG) for detection of gestational alcohol consumption. A validated microwave assisted extraction (MAE) method in combination with GC-MS developed in the Institute of Forensic Science (Santiago de Compostela) was used for FAEE and the cumulative concentration of ethyl myristate, ethyl palmitate and ethyl stearate with a cut-off of 600ng/g was applied for interpretation. A simple method for identification and quantification of EtG has been evaluated by ultrasonication followed solid phase extraction (SPE). Successful validation parameters were obtained for both biochemical markers of alcohol intake. FAEE and EtG concentrations in meconium ranged between values lower than LOD and 32,892ng/g or 218ng/g respectively. We have analyzed FAEE and EtG in the same meconium aliquot, enabling comparison of the efficiency of gestational ethanol exposure detection. Certain agreement between the two biomarkers was found as they are both a very specific alcohol markers, making it a useful analysis for confirmation.
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Affiliation(s)
- Pamela Cabarcos
- Institute of Forensic Science, Forensic Toxicology Service, Faculty of Medicine, University of Santiago de Compostela, C/San Francisco s/n, 15782 Santiago de Compostela, Spain.
| | - María Jesús Tabernero
- Institute of Forensic Science, Forensic Toxicology Service, Faculty of Medicine, University of Santiago de Compostela, C/San Francisco s/n, 15782 Santiago de Compostela, Spain
| | - José Luís Otero
- Department of Biostatistics, School of Medicine, University of Santiago de Compostela, Spain
| | - Martha Míguez
- Institute of Forensic Science, Forensic Toxicology Service, Faculty of Medicine, University of Santiago de Compostela, C/San Francisco s/n, 15782 Santiago de Compostela, Spain
| | - Ana María Bermejo
- Institute of Forensic Science, Forensic Toxicology Service, Faculty of Medicine, University of Santiago de Compostela, C/San Francisco s/n, 15782 Santiago de Compostela, Spain
| | - Simona Martello
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, Rome, L.go F. Vito 1, 00168 Rome, Italy
| | - Nadia De Giovanni
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, Rome, L.go F. Vito 1, 00168 Rome, Italy
| | - Marcello Chiarotti
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, Rome, L.go F. Vito 1, 00168 Rome, Italy
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Bryanton J, Gareri J, Boswall D, McCarthy MJ, Fraser B, Walsh D, Freeman B, Koren G, Bigsby K. Incidence of prenatal alcohol exposure in Prince Edward Island: a population-based descriptive study. CMAJ Open 2014; 2:E121-6. [PMID: 25077128 PMCID: PMC4084744 DOI: 10.9778/cmajo.20140011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is a leading preventable cause of neurodevelopmental disability in North America. The stigma associated with alcohol use and abuse during pregnancy makes it difficult to obtain information on prenatal alcohol use through self-reporting. We assessed the incidence of prenatal alcohol exposure in Prince Edward Island to facilitate future public health initiatives addressing FASD. METHODS Prenatal alcohol exposure was examined via population-based collection of meconium and analysis of fatty acid ethyl esters (FAEEs). Fatty acid ethyl esters are nonoxidative metabolites of ethanol that are produced in the fetus. Meconium FAEE concentrations of 2.0 nmol/g or greater are indicative of frequent prenatal alcohol exposure during the last 2 trimesters of pregnancy. Samples were collected from 1307 neonates between Nov. 8, 2010, and Nov. 8, 2011, in hospitals in PEI, or from those born to mothers who resided in PEI but gave birth in Halifax, Nova Scotia. Samples were frozen and shipped for analysis. Fatty acid ethyl esters were analyzed by gas chromatography-mass spectrometry and quantified by means of deuterated internal standards. RESULTS Of the 1307 samples collected, 1271 samples were successfully analyzed. Positive results for FAEEs were obtained in 3.1% (n = 39) of samples collected within the first 24 hours after birth. INTERPRETATION Not all neonates exposed to heavy prenatal alcohol in utero will exhibit FASD; based on current estimates of predictive value for disease by exposure, our findings suggest that 1.3% of neonates born in PEI during this 1-year period will have FASD. In its application to an entire provincial birth cohort, this study successfully implemented a public health-centred approach for evaluating population-based risk of FASD, with implications for practice across Canada.
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Affiliation(s)
- Janet Bryanton
- School of Nursing, University of Prince Edward Island, Charlottetown, PEI
| | - Joey Gareri
- Motherisk Program, The Hospital for Sick Children, Toronto, Ont
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont
| | | | - Mary Jean McCarthy
- School of Nursing, University of Prince Edward Island, Charlottetown, PEI
| | | | | | | | - Gideon Koren
- Motherisk Program, The Hospital for Sick Children, Toronto, Ont
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont
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