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Identifying Alcohol-Exposed Pregnancies through Biomarkers

Moderate-to-heavy alcohol use by pregnant women is known to be harmful to the developing fetus. Currently, there is no specific laboratory marker to indicate fetal alcohol syndrome. Obtaining such a marker could lead to the identification and treatment of women at risk for an alcohol-exposed pregnancy, who may not otherwise provide this information because of the stigma associated with prenatal alcohol use. Also, research has shown that early identification of children with fetal alcohol exposure reduces secondary disabilities resulting from the condition. Possible biomarkers include maternal blood and meconium (first stool of the newborn infant) testing. The studies described below were designed to devise and test sensitive and specific biomarkers to help identify alcohol-exposed pregnancies and/or newborns exposed to alcohol prenatally.

Funded Projects

University Hospital of Cleveland-Cleveland, Ohio
It is estimated that 1% of all newborns are affected by prenatal alcohol exposure. However, identifying alcohol-exposed newborns is difficult. Currently, there is no systematic approach, nor definitive laboratory tool that can be used for such identification. A biological marker, fatty acid ethyl esters (FAEE), would allow earlier identification and intervention for affected infants, and recognition of women at risk for alcohol abuse. This also facilitates research on dose-response relationships between alcohol exposure and alcohol-related birth defects. The project proposed that FAEE in meconium is a useful biological marker for exposure of low-to-moderate maternal alcohol use during pregnancy, and for identification of a group of infants at high risk for poor neurodevelopmental outcomes. The study sought to validate FAEE in meconium as a biomarker of prenatal exposure to alcohol.

University of Maryland-Baltimore, Maryland
The purpose of this study was to investigate the use of biochemical tests and ultrasound findings to identify women who abuse alcohol and are at risk for having a child affected adversely by prenatal alcohol exposure. Criteria, derived from alcohol-use questionnaires, biochemical markers and ultrasound studies, were developed to identify at-risk, pregnant women who needed special counseling or intervention. This information was correlated with infant development indices taken at birth and at 6 and 12 months of age to predict the prenatal risk for fetal alcohol syndrome (FAS) and other prenatal alcohol-related conditions. Eliminating or reducing alcohol consumption during pregnancy would have a significant effect on the incidence of fetal alcohol syndrome and other prenatal alcohol-related conditions.

Massachusetts General Hospital-Boston, Massachusetts
The goals of this project were to: (1) identify women at risk for having an alcohol-exposed pregnancy through a combination of questionnaire screening and biochemical markers of alcohol use, and (2) motivate the women at risk to decrease their alcohol intake through brief intervention meetings and results of their blood marker levels throughout their pregnancies. Previous studies show that certain blood markers can be used to identify alcohol-using pregnant women more accurately than women's self-reported use. This study used a combination of blood markers and self-report to identify women at risk of having an alcohol-exposed pregnancy. Pregnant women receiving prenatal care at obstetric clinics at several sites in the Boston area received a questionnaire to determine if they are risk drinkers. The women who were not identified as risk drinkers on the questionnaire served as the comparison group for the study. Women who were identified as risk drinkers were asked to provide a blood sample, and a series of blood markers of alcohol use were assessed. Women with positive blood markers were then asked to participate in a series of brief interventions and agreed to ongoing monitoring of and feedback on the blood markers throughout their pregnancy. Infant outcomes were assessed on all women participating in the study and the role of specific markers on the achievement of alcohol abstinence or reduction was also explored.

Related Publications

Fatty acid ethyl esters: Quantitative biomarkers for maternal alcohol consumption
J Pediatr. 2005;146:824-830
Bearer CF, Santiago LM, O'Riordan MA, Buck K, Lee S, Singer LT
[Read summary]

Biomarkers of alcohol use in pregnancy
Alcohol Research & Health 2005;1:38-43
Bearer CF, Stoler JM, Cook JD, Carpenter SJ
[Read article]

Biomarkers in paediatric research and practice
Archives of Disease in Childhood 2005;90:594-600
Lanphear B, Bearer CF
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The maternal ADH genetic profile as a risk indicator for FAS and FASD
Clin Chem 2004;50:A67
Cook JD, O'Kane JL, McArdle P, Yu Y, Owusu R, Squibb KS, Powell JL
[No article summary available]

Children's behavior and physiology and how it affects exposure to environmental contaminants
Pediatrics 2004;113(4 Suppl):996-1006
Moya J, Bearer CF, Etzel R
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Recognition of facial features of fetal alcohol syndrome in the newborn
American Journal of Medical Genetics Part C (Semin. Med. Genet.) 2004;127C:21-27
Stoler JM, Holmes LB
[Read summary]

Meconium as a biological marker of prenatal exposure
Ambulatory Pediatrics 2003;3:40-4.
Bearer CF
[Read summary]

Validation of a new biomarker of fetal exposure to alcohol
J Pediatr 2003;143(4):463-469
Bearer CF, Jacobson JL, Jacobson SW, Barr D, Croxford J, Molteno CD, Viljoen DL, Marais AS, Chiodo LM, Cwik AS
[Read summary]

Biochemical markers of alcohol use in pregnant women
Clin Biochem 2003;36:9-19
Cook JD
[Read summary]