Biomarkers for detection of prenatal alcohol exposure: A critical review of fatty acid ethyl esters in meconium

Burd, Larry; Höfer, R

doi:10.1002/bdra.20464

Cited by 72 publications

(61 citation statements)

References 38 publications

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“…110 Meconium testing only captures PAE late in the second and third trimesters of pregnancy and therefore may fail to identify a large proportion of infants at risk for alcohol-related harm. 60 In addition, currently available biomarkers have insufficient sensitivity to detect low levels of PAE, which is the most prevalent pattern of consumption among pregnant women. 1 An objective test that measures alcohol itself in breath, urine, or blood could detect lowlevel use.…”

Section: Discussionmentioning

confidence: 99%

“…72,75 To reduce the risk of bias, data were excluded from 1 study that looked at the agreement between self-reported drinking in the first trimester and meconium testing 75 because meconium does not begin to accumulate until the second and third trimesters. 60 We also excluded data from another study that compared self-reported PAE during the second trimester with postnatal tests of maternal EtG, EtS, GGT, CDT, and PEth in dried infant blood spots because of the short detection window of these biomarkers. 72 Of the remaining studies, 2 had an unclear risk of bias, and 3 had a high risk of bias.…”

Section: Methodological Quality Of Included Studiesmentioning

confidence: 99%

“…Our findings are broadly consistent with findings from existing nonsystematic reviews, which suggest the need for improved objective measures of PAE. 49,52,60 However, because of the diverse nature of the data and a limited number of studies per index test, it was not possible to address some of the objectives listed in our original protocol. For example, we were not able to conduct the intended meta-analyses to answer questions about the relative impact of study characteristics on test accuracy.…”

Section: Limitations Of the Reviewmentioning

confidence: 99%

See 2 more Smart Citations

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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Section: Discussionmentioning

confidence: 99%

Section: Methodological Quality Of Included Studiesmentioning

confidence: 99%

Section: Limitations Of the Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Objective Measures of Prenatal Alcohol Exposure: A Systematic Review

McQuire¹,

Paranjothy²,

Hurt³

et al. 2016

Pediatrics

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“…Another drawback in focusing on this biomarker is that FAEEs have been detected in the meconium from infants who have not been exposed to alcohol (Chan et al 2003), leading to false positives. Thus, further research is needed on the usefulness of FAEEs as a biomarker for prenatal alcohol exposure, and other biomarkers for maternal consumption of alcohol should be pursued (Burd and Hofer 2008;Datta et al 2008). …”

Section: Indirect and Direct Biomarkersmentioning

confidence: 99%

Metabolomics and fetal alcohol spectrum disorder

Goldberg

Aliani

2018

Biochem. Cell Biol.

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Fetal alcohol spectrum disorder (FASD) is a major public health issue that encompass an array of physical, neurological, and behavioral effects due to alcohol consumption during pregnancy. The classical biomarkers of FASD that are currently used lack sensitivity and specificity, and as such there is an opportunity through the use of novel metabolomics analysis to identify new biomarkers to identify those at risk for FASD, which could more effectively aid in early intervention. The focus of this minireview is to identify current work that is being done in the field of metabolomics in FASD in utero, and to highlight promising metabolites that could act as biomarkers in the future. We will conclude with suggestions for further research, as there is a large gap of knowledge in this particular area of metabolomics.

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“…A detecção precoce da exposição pré-natal ao álcool, combinada com o monitoramento contínuo do progresso físico e mental do neonato, pode facilitar a intervenção, potencializando o desenvolvimento da criança, e prevenir doenças secundárias 33 . Dessa forma, é importante que o biomarcador de exposição pré-natal ao etanol seja específico e sensível, útil para identificar os neonatos com risco de DEAF 34 .…”

Section: Detecção Da Exposição Pré-natal Ao Etanolunclassified

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

Cassini¹,

Linden²

2011

Rev. psiquiatr. clín.

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ResumoContexto: A exposição pré-natal ao etanol pode produzir diversos efeitos adversos no desenvolvimento fetal denominados doença espectral do alcoolismo fetal (DEAF). A detecção precoce de exposição ao etanol permite que medidas preventivas sejam tomadas para minimizar os efeitos adversos da exposição. Objetivos: O presente trabalho teve como objetivo revisar os principais efeitos tóxicos do etanol no neonato e os biomarcadores de exposição ao álcool. Métodos: Foi realizada uma pesquisa bibliográfica na base de dados PubMed utilizando os descritores "effects maternal ethanol exposure" e "biomarkers ethanol prenatal exposure", além de referências cruzadas dos artigos selecionados. Resultados: Diversos efeitos adversos no desenvolvimento fetal têm sido descritos, especialmente os prejuízos no sistema nervoso central. Os biomarcadores de exposição mais citados na literatura são os etil ésteres de ácidos graxos (EEAG), etil glicuronídeo (EtG) e etil sulfato (EtS) utilizando mecônio e cabelo como matriz biológica. Conclusão: A detecção precoce de exposição ao álcool na vida intrauterina pode ser realizada e é um instrumento para prevenir efeitos secundários, porque possibilita a intervenção farmacológica e educacional na criança com DEAF. Cassini C, Linden R / Rev Psiq Clín. 2011;38(3):116-21Palavras-chave: Exposição pré-natal ao etanol, doença espectral do alcoolismo fetal, biomarcadores de exposição ao etanol. AbstractBackground: Prenatal exposure to ethanol can produce a complex set of effects on fetal development, which is denominated fetal alcohol spectrum disorder (FASD). Early detection of ethanol exposure can allow the prevention of some relevant adverse effects associated to FASD. Objectives: The aim of this work was to review the main toxic effects of ethanol on the neonate and the available biomarkers of prenatal alcohol exposure. Methods: A bibliographic search was performed in PubMed employing the terms "effects maternal ethanol exposure" and "biomarkers ethanol prenatal exposure" and cross references. Results: Many adverse effects on fetal development were described, especially deficits in the central nervous system. The biomarkers of ethanol exposure more widely described were fatty acid ethyl esters (FAEEs), ethyl glucuronide (EtG) and ethyl sulphate (EtS), being meconium and hair the most common biological matrices for laboratorial evaluation. Discussion: The early detection of alcohol exposure in intra-uterine life is useful to prevent the secondary effects of FASD through pharmacologic and educational intervention in affected children.

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Biomarkers for detection of prenatal alcohol exposure: A critical review of fatty acid ethyl esters in meconium

Cited by 72 publications

References 38 publications

Objective Measures of Prenatal Alcohol Exposure: A Systematic Review

Objective Measures of Prenatal Alcohol Exposure: A Systematic Review

Metabolomics and fetal alcohol spectrum disorder

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

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