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Assessing maternal alcohol consumption in pregnancy: does phosphatidylethanol measured from day 5 newborn blood spot
Elizabeth M A Henderson1,2, David Tappin3, David Young4
1Neonatology, Princess Royal Maternity, Glasgow, UK elizabeth.henderson@ggc.scot.nhs.uk.
Insights
Phosphatidylethanol (PEth) in newborn blood spots does not reliably detect prenatal alcohol exposure (PAE) based on maternal reports. This method may not accurately identify children at risk for fetal alcohol spectrum disorder (FASD).
Area of Science:
- Biochemistry and Toxicology
- Maternal and Child Health
- Neonatal Screening
Background:
- Prenatal alcohol exposure (PAE) is a leading cause of preventable birth defects and neurodevelopmental disorders, collectively known as fetal alcohol spectrum disorder (FASD).
- Accurate ascertainment of PAE is challenging, hindering early intervention efforts.
- Phosphatidylethanol (PEth), a specific biomarker of alcohol consumption, can be measured in dried blood spots (DBS), a sample type routinely collected for newborn screening.
Purpose of the Study:
- To evaluate the utility of measuring PEth in infant DBS collected on day 5 of life as a biomarker for prenatal alcohol exposure.
- To compare PEth concentrations in infant DBS with maternal self-reported alcohol consumption during pregnancy.
Main Methods:
- An observational, population-based study was conducted in a large maternity unit.
- Infant DBS samples were collected for PEth analysis, alongside direct, confidential postnatal interviews with mothers regarding alcohol use during pregnancy.
- Maternal interviews and infant PEth concentrations were compared to assess correlation.
Main Results:
- Of 502 analyzed DBS samples, 43% had PEth ≥8 ng/mL and 29.5% had PEth ≥20 ng/mL.
- The sensitivity of PEth ≥8 ng/mL for detecting modest maternal alcohol use after 36 weeks' gestation was 50%, and for PEth ≥20 ng/mL it was 36.4%.
- These findings indicate a low correlation between PEth levels and self-reported alcohol consumption.
Conclusions:
- PEth measurement in DBS collected on day 5 of life is not a reliable method for identifying modest prenatal alcohol exposure after 36 weeks' gestation when compared to maternal self-report.
- The current approach using PEth in routine newborn screening may not effectively identify infants at risk for FASD due to PAE.
- Further research is needed to develop more sensitive and accurate methods for detecting PAE in early infancy.
Objective:
Prenatal alcohol exposure (PAE) places children at risk of fetal alcohol spectrum disorder (FASD) but ascertainment of PAE is problematic. Early intervention for children at risk of FASD may help mitigate long-term difficulties. Phosphatidylethanol (PEth), a metabolite of alcohol, is incorporated into red cell membranes and can be measured in dried blood spot (DBS) cards. In the UK, DBS samples are collected on day 5 for routine newborn screening. We sought to examine if PEth measured from DBS correlates with postnatal maternal self-report of alcohol consumption in pregnancy.
Design:
Observational population-based study. Comparison of infant PEth concentration and self-report of maternal alcohol use during pregnancy.
Setting:
Large maternity unit in Glasgow, Scotland.
Participants:
All singleton mother-infant dyads delivered during each fourth consecutive 24-hour period.
Interventions:
Mother: direct, confidential, immediate postnatal interview by a single researcher examining alcohol use during pregnancy. Infant: one extra DBS collected coincident with routine newborn screening if bleeding continued.
Results:
92.5% of eligible mothers agreed to participate. 510 DBS were obtained of which 502 were successfully analysed. 216 (43%) samples contained PEth at a concentration of ≥8 ng/mL and 148 (29.5%) at ≥20 ng/mL. The sensitivity of PEth ≥8 ng/mL and ≥20 ng/mL in identifying women who self-reported modest alcohol use after 36 weeks' gestation was 50% and 36.4%, respectively.
Conclusion:
PEth measured from DBS obtained on day 5 of life does not reliably identify modest PAE after 36 weeks' gestation from maternal self-report.
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