A comparison of the prevalence of prenatal alcohol exposure obtained via maternal self-reports versus meconium testing: a systematic literature review and meta-analysis

Lange, Shannon; Shield, Kevin D.; Koren, Gideon; Rehm, Jürgen; Popova, Svetlana

doi:10.1186/1471-2393-14-127

Cited by 130 publications

(99 citation statements)

References 46 publications

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“…In relation to EtG, different cut-offs have been proposed (30 and 50 ng/mg) to disclosing intrauterine exposure to ethanol but EtG lacks a universally established cut-off value at the present time [10][11][12]. However, the degree of agreement between detection of ethanol metabolites in neonatal meconium and maternal self-reported ethanol intake during pregnancy remains unclear [4][5][6][7][8][9][13][14][15][16][17][18][19]. It has been shown that reliance on maternal self-reporting is associated with a high probability of error, with substantial underreporting [14,18,20,21].…”

Section: Introductionmentioning

confidence: 98%

Fetal exposure to ethanol: relationship between ethyl glucuronide in maternal hair during pregnancy and ethyl glucuronide in neonatal meconium

Joya¹,

Marchei

Salat-Batlle³

et al. 2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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Section: Introductionmentioning

confidence: 98%

Fetal exposure to ethanol: relationship between ethyl glucuronide in maternal hair during pregnancy and ethyl glucuronide in neonatal meconium

Joya¹,

Marchei

Salat-Batlle³

et al. 2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…This raises the possibility that pregnant women who report drinking modest amounts of alcohol could be detected by the self-report reference standard but not the index test. 103 This explanation is not likely to account for findings in the present review, however, because the majority of studies investigated moderate to heavy self-reported PAE. CI, confi dence interval; LC/MS/MS liquid chromatography tandem mass spectrometry; LR+, positive likelihood ratio; LR-, negative likelihood ratio; NPV, negative predictive value; PPV, positive predictive value; sens, sensitivity; spec, specifi city.…”

Section: Limitations Of the Evidencementioning

confidence: 65%

Objective Measures of Prenatal Alcohol Exposure: A Systematic Review

McQuire¹,

Paranjothy²,

Hurt³

et al. 2016

Pediatrics

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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).

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“…Furthermore, in Ontario (Canada) the close follow-up of a baby identified as 'at risk' for alcohol-related disabilities facilitated early detection of developmental delays and initiation of interventions [7]. In a study comparing the prevalence of prenatal alcohol exposure obtained via maternal self-reports versus meconium testing, the pooled prevalence of alcohol exposure by meconium testing was 4.26 (95% Confidence Interval 1.34-13.57) times the pooled prevalence as measured by maternal self-reports [1]. A decision analytic model was developed to assess the cost-effectiveness of analyzing meconium.…”

Section: Fatty Acid Ethyl Esters (Faee)mentioning

confidence: 99%

“…In order to diagnose a child with FAS or FASD, maternal alcohol consumption during pregnancy needs to be proven. This makes the diagnosis of FAS and FASD a difficult one since self-reported questionnaires underreport the use of alcohol and are therefore biased [1]. Further, research regarding the harmful effects of alcohol during pregnancy is mostly performed with such questionnaires, so results of this kind of research is doubtful.…”

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confidence: 99%

Direct biomarkers to determine alcohol consumption during pregnancy, which one to use?

Wassenaar¹,

Koch²

2015

J Appl Bioanal

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BackgroundAlcohol consumption during pregnancy, even probably social alcohol consumption, can lead to (severe) fetal damage, such as fetal alcohol syndrome (FAS) or fetal alcohol spectrum disorder (FASD). In order to diagnose a child with FAS or FASD, maternal alcohol consumption during pregnancy needs to be proven. This makes the diagnosis of FAS and FASD a difficult one since self-reported questionnaires underreport the use of alcohol and are therefore biased [1]. Further, research regarding the harmful effects of alcohol during pregnancy is mostly performed with such questionnaires, so results of this kind of research is doubtful. Implementation of a reliable objective marker for alcohol detection would therefore be invaluable. Alcohol markers can be divided into two categories: direct and indirect biomarkers. Indirect biomarkers such as liver enzymes and carbohydrate deficient transferrin, are neither specific nor sensitive enough to be used for detection of alcohol consumption during pregnancy (beyond the scope of this article). Direct biomarkers are chemically derived from ethanol and are way more reliable to detect alcohol consumption during pregnancy. Three biomarkers can be used to detect alcohol in pregnant women: Fatty Acid Ethyl Esters (FAEE), ethyl glucuronide (EtG) / ethyl sulfate (EtS) and phosphatidylethanol (PEth) [2]. Fatty Acid Ethyl Esters (FAEE)FAEE are produced by an enzymatic esterification of ethanol with free endogenous fatty acids, triglycerides, lipoproteins and phospholipids by means of two enzymes, FAEE synthase and acyl-CoA/ethanol O-acyl-transferase (AEAT). The FAEE group has more than 20 different compounds including ethyl laurate (E12), ethyl myristate (E14), ethyl palmitate (E16), ethyl palmitoleate (E16:1), ethyl stearate (E18), ethyl oleate (E18:1), ethyl linoleate (E18:3), ethyl arachidonate (E20:4) and ethyl docosahexanoate (E22:6). All have a lipophilic character. In addition, they are stable at neutral pH. FAEE do not cross the placenta into the fetal circulation, and because they can be detected in fetal matrices, must be produced in the fetus itself from the ethanol which crosses the placenta [2]. FAEE can be measured in blood for 24-44 hours, so it is still, such as ethanol in blood and breathing air, only a snapshot of the alcohol exposition to a child. For chronic exposition hair or meconium can be used. Newborn's hair will cover the last 16 weeks of pregnancy and meconium the last 20-24 weeks of pregnancy, the latter also having a greater ease of collection. Meconium comprises the neonates first several bowel movements, identified most commonly by its dark green-black color and lack of odor. Meconium formation begins at approximately 12 weeks of gestation (i.e. at the end of the first trimester), when fetal swallowing of amniotic fluid is initiated [2]. FAEE can be quantified in meconium by means of gas chromatography coupled with either flame ionization or mass spectrometry (GC-MS). MS allows measurement of lower levels, which makes MS in favor of FID when quantifyi...

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A comparison of the prevalence of prenatal alcohol exposure obtained via maternal self-reports versus meconium testing: a systematic literature review and meta-analysis

Cited by 130 publications

References 46 publications

Fetal exposure to ethanol: relationship between ethyl glucuronide in maternal hair during pregnancy and ethyl glucuronide in neonatal meconium

Fetal exposure to ethanol: relationship between ethyl glucuronide in maternal hair during pregnancy and ethyl glucuronide in neonatal meconium

Objective Measures of Prenatal Alcohol Exposure: A Systematic Review

Direct biomarkers to determine alcohol consumption during pregnancy, which one to use?

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