Anonymous Diaper-Based Meconium Collection for Ethyl Glucuronide Analysis: A Pilot Feasibility Study

Prenatal alcohol exposure (PAE) is a major public health concern, yet maternal self-reporting remains unreliable. Meconium accumulates alcohol metabolites during the second half of gestation, and ethyl glucuronide (EtG) is considered a stable and specific biomarker of late-pregnancy alcohol exposure. Diapers containing meconium may serve as a noninvasive method for collecting anonymous biological samples, which could help reduce participation bias in studies of this sensitive subject. This pilot study assessed the feasibility of anonymously collecting meconium-containing diapers for subsequent quantitative EtG analysis after extended periods of frozen storage and international transport, and examined intra-pair consistency in samples from the same newborn. Mothers collected their newborns' diapers, which were then divided into two aliquots (A and B) by a study assistant and stored at -80 °C until analysis. Out of 178 samples collected from 105 infants, 137 samples were analyzable. Eleven samples exceeded the limit of quantification (10 ng/g), while two samples (one pair) surpassed the 30 ng/g cutoff, indicating significant PAE. EtG concentrations showed high intra-pair agreement, supporting the robustness of the biomarker and analytical method. Anonymous diaper-based meconium collection is feasible but operationally demanding. Although the low participation rate and methodological factors, including sample loss, precluded true prevalence estimation, making it exploratory, the detection of quantifiable EtG in 8% of analyzable samples suggests that PAE remains an issue.