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Canning J, Strawbridge RJ, Miedzybrodzka Z, Marioni RE, Melbye M, Porteous DJ, Hurles ME, Sattar N, Sudlow CLM, Collins R, Padmanabhan S, Pell JP. Methods applied to neonatal dried blood spot samples for secondary research purposes: a scoping review. Crit Rev Clin Lab Sci 2024:1-24. [PMID: 38855982 DOI: 10.1080/10408363.2024.2360996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/24/2024] [Indexed: 06/11/2024]
Abstract
This scoping review aimed to synthesize the analytical techniques used and methodological limitations encountered when undertaking secondary research using residual neonatal dried blood spot (DBS) samples. Studies that used residual neonatal DBS samples for secondary research (i.e. research not related to newborn screening for inherited genetic and metabolic disorders) were identified from six electronic databases: Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline, PubMed and Scopus. Inclusion was restricted to studies published from 1973 and written in or translated into English that reported the storage, extraction and testing of neonatal DBS samples. Sixty-seven studies were eligible for inclusion. Included studies were predominantly methodological in nature and measured various analytes, including nucleic acids, proteins, metabolites, environmental pollutants, markers of prenatal substance use and medications. Neonatal DBS samples were stored over a range of temperatures (ambient temperature, cold storage or frozen) and durations (two weeks to 40.5 years), both of which impacted the recovery of some analytes, particularly amino acids, antibodies and environmental pollutants. The size of DBS sample used and potential contamination were also cited as methodological limitations. Residual neonatal DBS samples retained by newborn screening programs are a promising resource for secondary research purposes, with many studies reporting the successful measurement of analytes even from neonatal DBS samples stored for long periods of time in suboptimal temperatures and conditions.
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Affiliation(s)
- Jordan Canning
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Rona J Strawbridge
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
- Division of Cardiovascular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Zosia Miedzybrodzka
- Department of Medical Genetics, Ashgrove House, NHS Grampian, Aberdeen, UK
- Medical Genetics Group, School of Medicine, Medical Sciences, Nutrition and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Riccardo E Marioni
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Mads Melbye
- Danish Cancer Institute, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway
| | - David J Porteous
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Matthew E Hurles
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Naveed Sattar
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Cathie L M Sudlow
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Health Data Research UK, London, UK
| | - Rory Collins
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sandosh Padmanabhan
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
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Barry CV, Chrysanthopoulou SA, Tallo V, Jarilla B, Vargas Z, McDonald E, Gundogan F, Friedman JF. The Impact of Prenatal Alcohol Exposure on Longitudinal Growth, Nutritional Status, and Insulin-Like Growth Factor 1 in Early Childhood in Leyte, the Philippines. J Pediatr 2024; 269:113977. [PMID: 38401788 PMCID: PMC11096041 DOI: 10.1016/j.jpeds.2024.113977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/24/2024] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE To assess the impact and potential mechanistic pathways of prenatal alcohol exposure (PAE) on longitudinal growth and nutritional status in early childhood. STUDY DESIGN A cohort of 296 mother-infant dyads (32% with PAE vs 68% unexposed) were recruited in Leyte, the Philippines, and followed from early gestation through 24 months of age. PAE was assessed using serum phosphatidylethanol (PEth) captured twice prenatally and in cord blood and supplemented with self-reported alcohol consumption. Linear mixed models were used to examine longitudinal effects of PAE on growth from birth through 2 years including key potential mediating factors (placental histopathology, and infant serum leptin and Insulin-like Growth Factor 1 [IGF-1]). RESULTS After adjusting for potential confounders, we found that PAE was significantly associated with a delayed blunting of linear growth trajectories (height-for-age z-score, body length) and weight (weight-for-age z-score, body weight) that manifested between 4 and 6 months and continued through 12-24 months. PAE was also associated with a decreased rate of mid-upper-arm circumference growth from birth to 12 months, and a lower mean IGF-1 levels at birth and 6 months. CONCLUSION This study demonstrates a delayed impact of PAE on growth that manifested around 6 months of age, underscoring the importance of routine clinical monitoring in early childhood. Furthermore, the findings supported prior animal model findings that suggest a mechanistic role for IGF-1 in PAE-induced growth delay.
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Affiliation(s)
- Christopher V Barry
- Warren Alpert Medical School of Brown University, Providence, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Blanca Jarilla
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Zorimel Vargas
- Center for International Health Research, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Emily McDonald
- Center for International Health Research, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI
| | - Fusun Gundogan
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, RI; Women and Infants' Hospital, Care New England, Providence, RI
| | - Jennifer F Friedman
- Warren Alpert Medical School of Brown University, Providence, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI; Center for International Health Research, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI
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Maxwell JR, DiDomenico J, Roberts MH, Marquez LE, Rai R, Weinberg J, Jacobson SW, Stephen J, Bakhireva LN. Impact of low-level prenatal alcohol exposure and maternal stress on autonomic regulation. Pediatr Res 2024; 95:350-358. [PMID: 37674025 PMCID: PMC11089775 DOI: 10.1038/s41390-023-02799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/07/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) impacts the neurodevelopment of the fetus, including the infant's ability to self-regulate. Heart rate variability (HRV), that is, the beat-to-beat variability in heart rate, is a non-invasive measurement that can indicate autonomic nervous system (ANS) function/dysfunction. METHODS The study consisted of a subset of our ENRICH-2 cohort: 80 participants (32 PAE and 48 Controls) who had completed three visits during pregnancy. The participants completed a comprehensive assessment of PAE and other substances throughout pregnancy and assessments for stress, anxiety, and depression in the third trimester. At 24 h of age, infant HRV was assessed in the hospital during the clinically indicated heel lance; 3- to 5-min HRV epochs were obtained during baseline, heel lancing, and recovery episodes. RESULTS Parameters of HRV differed in infants with PAE compared to Controls during the recovery phase of the heel lance (respiratory sinus arrhythmia (RSA) and high-frequency (HF), p < 0.05). Increased maternal stress was also strongly associated with abnormalities in RSA, HF, and low-frequency / high-frequency (LF/HF, p's < 0.05). CONCLUSIONS Alterations in ANS regulation associated with PAE and maternal stress may reflect abnormal development of the hypothalamic-pituitary-adrenal axis and have long term implications for infant responsiveness and self-regulation. IMPACT Previous studies have focused on effects of moderate to heavy prenatal alcohol exposure (PAE) on autonomic dysregulation, but little is known about the effects of lower levels of PAE on infant self-regulation and heart rate variability (HRV). Prenatal stress is another risk factor for autonomic dysregulation. Mild PAE impacts infant self-regulation, which can be assessed using HRV. However, the effect of prenatal stress is stronger than that of mild PAE or other mental health variables on autonomic dysregulation.
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Affiliation(s)
- Jessie R Maxwell
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, Mexico.
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, Mexico.
| | - Jared DiDomenico
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Melissa H Roberts
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Lidia Enriquez Marquez
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Rajani Rai
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Joanne Weinberg
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Julia Stephen
- The Mind Research Network, a Division of Lovelace Biomedical Research Institute, University of New Mexico, Albuquerque, NM, Mexico
| | - Ludmila N Bakhireva
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
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Abstract
The medical disorders of alcoholism rank among the leading public health problems worldwide and the need for predictive and prognostic risk markers for assessing alcohol use disorders (AUD) has been widely acknowledged. Early-phase detection of problem drinking and associated tissue toxicity are important prerequisites for timely initiations of appropriate treatments and improving patient's committing to the objective of reducing drinking. Recent advances in clinical chemistry have provided novel approaches for a specific detection of heavy drinking through assays of unique ethanol metabolites, phosphatidylethanol (PEth) or ethyl glucuronide (EtG). Carbohydrate-deficient transferrin (CDT) measurements can be used to indicate severe alcohol problems. Hazardous drinking frequently manifests as heavy episodic drinking or in combinations with other unfavorable lifestyle factors, such as smoking, physical inactivity, poor diet or adiposity, which aggravate the metabolic consequences of alcohol intake in a supra-additive manner. Such interactions are also reflected in multiple disease outcomes and distinct abnormalities in biomarkers of liver function, inflammation and oxidative stress. Use of predictive biomarkers either alone or as part of specifically designed biological algorithms helps to predict both hepatic and extrahepatic morbidity in individuals with such risk factors. Novel approaches for assessing progression of fibrosis, a major determinant of prognosis in AUD, have also been made available. Predictive algorithms based on the combined use of biomarkers and clinical observations may prove to have a major impact on clinical decisions to detect AUD in early pre-symptomatic stages, stratify patients according to their substantially different disease risks and predict individual responses to treatment.
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Affiliation(s)
- Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Seinäjoki, Finland.
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Kable JA, Jones KL. Identifying Prenatal Alcohol Exposure and Children Affected by It: A Review of Biomarkers and Screening Tools. Alcohol Res 2023; 43:03. [PMID: 37260694 PMCID: PMC10229137 DOI: 10.35946/arcr.v43.1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
PURPOSE Early identification of prenatal alcohol exposure (PAE) and of those in need of services resulting from this exposure is an important public health concern. This study reviewed the existing literature on potential biomarkers and screening tools of PAE and its impact. SEARCH METHODS Electronic databases were searched for articles published between January 1, 1996, and November 30, 2021, using the following search terms: ("fetal alcohol" or "prenatal alcohol" or "FASD" or "alcohol-related neurodevelopmental disorder" or "ARND" or "ND-PAE") and ("screening" or "identification" or "biomarker"). Duplicate articles were electronically eliminated. Titles and abstracts were reviewed for appropriateness, and selected articles were retrieved for further analysis. Additional articles were added that were referenced in the reviewed articles or identified from expert knowledge. Information about the characteristics of the sample, the biomarker or screening tool, and the predictive validity outcome data were abstracted. A narrative analysis of the studies was then performed on the data. SEARCH RESULTS A total of 3,813 articles were initially identified, and 1,215 were removed as duplicates. Of the remaining articles, 182 were identified as being within the scope of the review based on title and abstract inspection, and 181 articles were successfully retrieved. Of these, additional articles were removed because they were preclinical (3), were descriptive only (13), included only self-report of PAE (42), included only mean group comparison (17), were additional duplicates (2), focused on cost analysis (9), missed predictive validity data (24), or for other reasons (23). The remaining articles (n = 48) were abstracted. An additional 13 manuscripts were identified from these articles, and two more from expert knowledge. A total of 63 articles contributed to the review. DISCUSSION AND CONCLUSIONS Biomarkers and screening tools of PAE and its impact fall short of ideal predictive validity characteristics. Higher specificity than sensitivity was found for many of the biomarkers and screening tools used to identify PAE and its impact, suggesting that current methods continue to under-identify the full range of individuals impacted by PAE. Exceptions to this were found in recent investigations using microRNAs related to growth and vascular development, proteomic changes associated with PAE, and combinations of markers estimating levels of various cytokines. Replications of these findings are needed across other samples to confirm the limited data available. Future research on biomarkers and screening tools should attend to feasibility and scalability of implementation. This article also recommends a systematic process of evaluation to improve early identification of individuals impacted by PAE so that harm reduction and habilitative care efforts can be implemented.
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Affiliation(s)
- Julie A. Kable
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kenneth Lyons Jones
- Department of Pediatrics, University of California San Diego, La Jolla, California
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Meombe Mbolle A, Thapa S, Bukiya AN, Jiang H. High-resolution imaging in studies of alcohol effect on prenatal development. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2023; 3:10790. [PMID: 37593366 PMCID: PMC10433240 DOI: 10.3389/adar.2023.10790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Fetal alcohol syndrome represents the leading known preventable cause of mental retardation. FAS is on the most severe side of fetal alcohol spectrum disorders that stem from the deleterious effects of prenatal alcohol exposure. Affecting as many as 1 to 5 out of 100 children, FASD most often results in brain abnormalities that extend to structure, function, and cerebral hemodynamics. The present review provides an analysis of high-resolution imaging techniques that are used in animals and human subjects to characterize PAE-driven changes in the developing brain. Variants of magnetic resonance imaging such as magnetic resonance microscopy, magnetic resonance spectroscopy, diffusion tensor imaging, along with positron emission tomography, single-photon emission computed tomography, and photoacoustic imaging, are modalities that are used to study the influence of PAE on brain structure and function. This review briefly describes the aforementioned imaging modalities, the main findings that were obtained using each modality, and touches upon the advantages/disadvantages of each imaging approach.
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Affiliation(s)
- Augustine Meombe Mbolle
- Department Medical Engineering, College of Engineering and Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Shiwani Thapa
- Department Pharmacology, Addiction Science and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Anna N. Bukiya
- Department Pharmacology, Addiction Science and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Huabei Jiang
- Department Medical Engineering, College of Engineering and Morsani College of Medicine, University of South Florida, Tampa, FL, United States
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Hasken JM, Marais AS, de Vries MM, Kalberg WO, Buckley D, Parry CD, Seedat S, May PA. Assessing the sensitivity and specificity of phosphatidylethanol (PEth) cutoffs to identify alcohol exposed pregnancies. Curr Res Toxicol 2023; 4:100105. [PMID: 37102125 PMCID: PMC10123138 DOI: 10.1016/j.crtox.2023.100105] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023] Open
Abstract
In the literature on alcohol use biomarkers, there has been debate as to what a valid and/or utilitarian cut off level should be for various research applications. In this manuscript, we assessed the sensitivity and specificity of multiple cutoff values for phosphatidylethanol (PEth) from bloodspots relative to self-report, the Alcohol Use Disorder Identification Test (AUDIT) scores, and another alcohol use biomarker ethyl glucuronide (EtG) from fingernails in a sample of 222 pregnant women in the Western Cape Province of South Africa. Receiver operating characteristic (ROC) curves were used to assess the area under the curve (AUC) and assess PEth cutoff values of ≥2, ≥4, ≥8, ≥14, and ≥20 nanograms per milliliter (ng/ml). The highest AUC value was attained when PEth was compared to an AUDIT score of 1 or more. Depending on the cutoff used to determine alcohol consumption, PEth identified 47%-70% of the individuals as alcohol-consuming while 62.6%-75.2% were identified by self-reported measures, and 35.6% were identified by EtG. In this sample, sensitivity and accuracy were highest at less stringent PEth cutoffs when compared to self-report, AUDIT score of 1 or more, 5 or more, 8 or more, and EtG ≥ 8 picograms per milligram (pg/mg). For research purposes, less stringent cutoffs, such as PEth ≥ 8 ng/ml, may be considered a valid, positive cutoff for identifying women who consume alcohol during pregnancy in this population. A cutoff of PEth ≥ 20 ng/ml may miss individuals who reported consuming alcohol (false negatives).
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Affiliation(s)
- Julie M. Hasken
- University of North Carolina at Chapel Hill, Nutrition Research Institute, Kannapolis, NC, United States
| | - Anna-Susan Marais
- Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - Marlene M. de Vries
- Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - Wendy O. Kalberg
- Center on Alcohol, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, United States
| | - David Buckley
- Center on Alcohol, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, United States
| | - Charles D.H. Parry
- Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
- Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Soraya Seedat
- Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - Philip A. May
- University of North Carolina at Chapel Hill, Nutrition Research Institute, Kannapolis, NC, United States
- Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
- Center on Alcohol, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, United States
- Corresponding author at: University of North Carolina at Chapel Hill, Nutrition Research Institute, Kannapolis, NC, United States.
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8
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Henderson EMA, Tappin D, Young D, Favretto D, Mactier H. Assessing maternal alcohol consumption in pregnancy: does phosphatidylethanol measured from day 5 newborn blood spot cards have any value? An observational, population-based study. Arch Dis Child 2023; 108:36-41. [PMID: 36288922 DOI: 10.1136/archdischild-2022-324394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/30/2022] [Indexed: 02/04/2023]
Abstract
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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Affiliation(s)
- Elizabeth M A Henderson
- Neonatology, Princess Royal Maternity, Glasgow, UK .,Paediatric Intensive Care, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - David Tappin
- Department of Child Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - David Young
- Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Donata Favretto
- Department of Health Science, University of Florence, Forensic Toxicology Division, Florence, Italy
| | - Helen Mactier
- Neonatology, Princess Royal Maternity, Glasgow, UK.,Department of Child Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Franceschetto L, Perilli M, Cinquetti A, Giraudo C, Gardi M, Cecchetto G, Viel G. Phosphatidylethanol in Maternal or Neonatal Blood to Detect Alcohol Exposure during Pregnancy: A Systematic Review. Life (Basel) 2022; 12:life12101528. [PMID: 36294962 PMCID: PMC9604963 DOI: 10.3390/life12101528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/23/2022] [Accepted: 09/27/2022] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Alcohol consumption during pregnancy, even at low doses, may damage the fetus. Pregnant women tend to underreport their alcohol consumption generating the need for sensitive and specific biomarkers, among which PEth has emerged due to its high specificity and possibility to be measured in both maternal and neonatal blood. The aim of this study is to systematically review the latest 20 years of literature for depicting the state of the art, the limitations, and the prospects of PEth for estimating alcohol consumption during pregnancy. MATERIALS AND METHODS A systematic search, adhering to PRISMA guidelines, of the latest 20 years of literature through "MeSH" and "free-text" protocols in the databases PubMed, SCOPUS, and Web of Science, with time limits 1 January 2002-1 March 2022, was performed. The inclusion criteria were as follows: PEth used for detecting alcohol consumption during pregnancy, quantified in blood through liquid chromatography coupled to mass spectrometry, and full texts in the English language. Opinion papers, editorials, and narrative reviews were excluded. RESULTS Sixteen (16) papers were included in the present review (0.81% of total retrieved records). All the included records were original articles, of which there were seven prospective cohort/longitudinal studies, six cross-sectional studies, two observational-descriptive studies, and one retrospective study. All studies assayed PEth in at least one biological matrix; seven (7) studies quantified PEth in maternal blood, seven studies in newborn blood, and only two studies in both maternal and neonatal blood. In several included papers, PEth proved more sensitive than self-reports for identifying pregnant women with an active alcohol intake with the diagnostic efficiency improving with the increase of the maternal alcohol intake. CONCLUSIONS Further studies, performed on wider and well-stratified populations, are needed to drive any definitive conclusion. PEth is a promising marker for monitoring alcohol use in pregnancy; however, at the present time, its use is still limited mainly by the absence of a globally agreed interpretative cut-off, the paucity of data regarding its specificity/sensitivity, and the lack of standardization on the diagnostic efficiency of the different isoforms.
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Affiliation(s)
- Lisa Franceschetto
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Matteo Perilli
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Alessandro Cinquetti
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Chiara Giraudo
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy
| | - Mario Gardi
- Unit of Urology, Sant’Antonio Hospital, University Hospital of Padua, 35100 Padua, Italy
| | - Giovanni Cecchetto
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
| | - Guido Viel
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via G. Falloppio 50, 35121 Padova, Italy
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10
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Montag AC, Chambers CD, Jones KL, Dassanayake PS, Andra SS, Petrick LM, Arora M, Austin C. Prenatal alcohol exposure can be determined from baby teeth: Proof of concept. Birth Defects Res 2022; 114:797-804. [PMID: 35686682 PMCID: PMC9378437 DOI: 10.1002/bdr2.2054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/06/2022] [Accepted: 05/23/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE), leading to fetal alcohol spectrum disorders (FASD), is a serious public health issue in the United States and globally. Diagnosis of FASD is crucial in obtaining appropriate care, but it is not always possible when PAE cannot be documented. METHODS Deciduous teeth from a child with known PAE and a child with known absence of PAE were analyzed using liquid chromatography-isotope dilution tandem mass spectrometry (LC-IDMS/MS) in a multiple-reaction monitoring mode for direct markers and LC-high resolution MS in positive and negative mode with hydrophilic interaction liquid chromatography and reverse-phase chromatography, respectively, for indirect markers. RESULTS Direct markers of PAE (ethyl glucuronide and ethyl sulfate) were detected in prenatal and postnatal dentine from a case tooth but not from a control tooth. Indirect biomarker analysis indicated a dysregulation of amino acids and an increase in cholesterol sulfate in the case compared to the control tooth. CONCLUSIONS This proof-of-concept study demonstrates for the first time that direct biomarkers of PAE are detectable and measurable in deciduous teeth which begin forming in utero and are typically naturally shed between 5 and 12 years of age. Further examination of these novel biomarkers may allow diagnosis of FASD where documentation of PAE is otherwise unavailable. Furthermore, because teeth grow incrementally, defined growth zones can be sampled allowing for identification of gestational timing of PAE to help better understand mechanisms underlying alcohol's disruption of perinatal development.
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Affiliation(s)
- Annika C Montag
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
- Department Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Kenneth Lyons Jones
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Priyanthi S Dassanayake
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Syam S Andra
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lauren M Petrick
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christine Austin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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11
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Mahnke AH, Roberts MH, Leeman L, Ma X, Bakhireva LN, Miranda RC. Prenatal opioid-exposed infant extracellular miRNA signature obtained at birth predicts severity of neonatal opioid withdrawal syndrome. Sci Rep 2022; 12:5941. [PMID: 35396369 PMCID: PMC8993911 DOI: 10.1038/s41598-022-09793-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/29/2022] [Indexed: 11/09/2022] Open
Abstract
Prenatal opioid exposure (POE) is commonly associated with neonatal opioid withdrawal syndrome (NOWS), which is characterized by a broad variability in symptoms and severity. Currently there are no diagnostic tools to reliably predict which infants will develop severe NOWS, while risk stratification would allow for proactive decisions about appropriate clinical monitoring and interventions. The aim of this prospective cohort study was to assess if extracellular microRNAs (miRNAs) in umbilical cord plasma of infants with POE could predict NOWS severity. Participants (n = 58) consisted of pregnant women receiving medications for opioid use disorder and their infants. NOWS severity was operationalized as the need for pharmacologic treatment and prolonged hospitalization (≥ 14 days). Cord blood miRNAs were assessed using semi-quantitative qRT-PCR arrays. Receiver operating characteristic curves and area under the curve (AUC) were estimated. The expression of three miRNAs (miR-128-3p, miR-30c-5p, miR-421) predicted need for pharmacologic treatment (AUC: 0.85) and prolonged hospitalization (AUC: 0.90). Predictive validity improved after two miRNAs (let-7d-5p, miR-584-5p) were added to the need for pharmacologic treatment model (AUC: 0.94) and another two miRNAs (let-7b-5p, miR-10-5p) to the prolonged hospitalization model (AUC: 0.99). Infant cord blood extracellular miRNAs can proactively identify opioid-exposed neonates at high-risk for developing severe NOWS.
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Affiliation(s)
- Amanda H Mahnke
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, 8447 Riverside Parkway, Bryan, TX, 77807-3260, USA.
| | - Melissa H Roberts
- Department of Pharmacy Practice and Administrative Sciences, Substance Use Research and Education (SURE) Center, University of New Mexico College of Pharmacy, Albuquerque, NM, 87131, USA
| | - Lawrence Leeman
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM, 87106, USA.,Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, 87106, USA
| | - Xingya Ma
- Department of Pharmacy Practice and Administrative Sciences, Substance Use Research and Education (SURE) Center, University of New Mexico College of Pharmacy, Albuquerque, NM, 87131, USA
| | - Ludmila N Bakhireva
- Department of Pharmacy Practice and Administrative Sciences, Substance Use Research and Education (SURE) Center, University of New Mexico College of Pharmacy, Albuquerque, NM, 87131, USA.,Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM, 87106, USA.,Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, 87106, USA
| | - Rajesh C Miranda
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, 8447 Riverside Parkway, Bryan, TX, 77807-3260, USA
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12
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DiBattista A, Ogrel S, MacKenzie AE, Chakraborty P. Quantitation of phosphatidylethanols in dried blood spots to determine rates of prenatal alcohol exposure in Ontario. Alcohol Clin Exp Res 2021; 46:243-251. [PMID: 34939205 DOI: 10.1111/acer.14766] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/04/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Estimating rates of prenatal alcohol exposure (PAE) in a population is necessary to ensure that proper medical and social supports and interventions are in place. This study sought to estimate PAE in Ontario, Canada by quantifying phosphatidylethanol (PEth) homologues in over 2000 residual neonatal dried blood spots (DBS). METHODS A random selection of 2011 residual DBS collected over a 1-week time period were anonymized and extracted. A targeted liquid chromatography-mass spectrometry method was used to quantify 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphoethanol (PEth (16:0/18:1) or POPEth), the clinically accepted biomarker, and six additional PEth homologues. A POPEth level above the United States Drug Testing Laboratories (USDTL) cutoff up to 4 weeks predelivery was indicative of PAE. All PEth homologues were correlated to one another and logistic regression was used to determine the association between PAE status and infant characteristics. RESULTS The estimated rate of PAE in Ontario, up to the last 4 weeks of gestation, was 15.5% (POPEth >28.5 nM). Most PEth homologues were moderately to strongly correlated to one another. A low birth weight and preterm birth were both associated with PAE, while being small for gestational age had lower odds of PAE. CONCLUSIONS The results of this study suggest that PAE may be more prevalent in Ontario than previous estimates by self-report or meconium testing. These findings support the need to consider the effectiveness of current interventions and the design of new interventions to address this significant public health issue.
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Affiliation(s)
- Alicia DiBattista
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Svetlana Ogrel
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Alex E MacKenzie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Pranesh Chakraborty
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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13
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Lupo PJ, Petrick LM, Hoang TT, Janitz AE, Marcotte EL, Schraw JM, Arora M, Scheurer ME. Using primary teeth and archived dried spots for exposomic studies in children: Exploring new paths in the environmental epidemiology of pediatric cancer. Bioessays 2021; 43:e2100030. [PMID: 34106479 DOI: 10.1002/bies.202100030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 12/14/2022]
Abstract
It is estimated that 300,000 children 0-14 years of age are diagnosed with cancer worldwide each year. While the absolute risk of cancer in children is low, it is the leading cause of death due to disease in children in high-income countries. In spite of this, the etiologies of pediatric cancer are largely unknown. Environmental exposures have long been thought to play an etiologic role. However, to date, there are few well-established environmental risk factors for pediatric malignancies, likely due to technical barriers in collecting biological samples prospectively in pediatric populations for direct measurements. In this review, we propose the use of novel or underutilized biospecimens (dried blood spots and teeth) and molecular approaches for exposure assessment (epigenetics, metabolomics, and somatic mutational profiles). Future epidemiologic studies of pediatric cancer should incorporate novel exposure assessment methodologies, data on molecular features of tumors, and a more complete assessment of gene-environment interactions.
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Affiliation(s)
- Philip J Lupo
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Lauren M Petrick
- The Senator Frank R. Lautenberg Environmental Health Science Laboratory, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thanh T Hoang
- Epidemiology Branch, National Institutes of Health, Department of Health and Human Services, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Amanda E Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Erin L Marcotte
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jeremy M Schraw
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Manish Arora
- The Senator Frank R. Lautenberg Environmental Health Science Laboratory, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael E Scheurer
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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14
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Finanger T, Spigset O, Gråwe RW, Andreassen TN, Løkken TN, Aamo TO, Bratt GE, Tømmervik K, Langaas VS, Finserås K, Salvesen KÅB, Skråstad RB. Phosphatidylethanol as Blood Biomarker of Alcohol Consumption in Early Pregnancy: An Observational Study in 4,067 Pregnant Women. Alcohol Clin Exp Res 2021; 45:886-892. [PMID: 33586791 DOI: 10.1111/acer.14577] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The teratogenic effects of alcohol are well documented, but there is a lack of screening methods to detect alcohol use during pregnancy. Phosphatidylethanol 16:0/18:1 (PEth) is a specific and sensitive biomarker reflecting alcohol intake up to several weeks after consumption. The aim of this study was to investigate the prevalence of positive PEth values as an indicator of early prenatal alcohol exposure in a general population of pregnant women. METHODS Rhesus typing is routinely performed in Norway in all pregnancies around gestational week 12. Rhesus-negative women have an additional test taken around week 24. Blood samples submitted to St. Olav University Hospital in Trøndelag, Norway, for Rhesus typing during the period September 2017 to October 2018 were collected. A total of 4,533 whole blood samples from 4,067 women were analyzed for PEth (limit of quantification of 0.003 µM). RESULTS Fifty-eight women had a positive PEth sample. Of these, 50 women were positive around gestational week 12, 3 women were positive around week 24, and in 5 cases, the timing was unknown. There were no significant differences in proportions of women with positive PEth values related to age, or rural versus urban residency. CONCLUSION In an unselected pregnant population in Norway, 1.4% had a positive PEth sample around gestational week 12, whereas 0.4% had a positive sample around week 24. The use of PEth as an alcohol biomarker should be further investigated as a diagnostic tool in the antenatal setting.
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Affiliation(s)
- Trine Finanger
- Clinic of Substance Use and Addiction Medicine, St. Olav University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology - NTNU, Trondheim, Norway
| | - Olav Spigset
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.,Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Rolf W Gråwe
- Department of Research and Development, Division of Mental Health, St. Olav University Hospital, Trondheim, Norway.,Department of Mental Health, Norwegian University of Science and Technology - NTNU, Trondheim, Norway
| | - Trine N Andreassen
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Trine N Løkken
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Trond O Aamo
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Guro E Bratt
- Clinic of Laboratory Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Kristin Tømmervik
- Clinic of Substance Use and Addiction Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Vibeke S Langaas
- Department of Immunology and Transfusion Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Kristin Finserås
- Department of Immunology and Transfusion Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Kjell Å B Salvesen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.,Department of Obstetrics and Gynecology, St. Olav University Hospital, Trondheim, Norway
| | - Ragnhild B Skråstad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.,Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
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15
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Bakhireva LN. Growing potential and remaining uncertainties in assessing prenatal alcohol exposure in dry blood spots. Pediatr Res 2020; 88:159-160. [PMID: 32375164 PMCID: PMC7390674 DOI: 10.1038/s41390-020-0936-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Ludmila N. Bakhireva
- College of Pharmacy Substance Use Research and Education (SURE) Center, University of New Mexico, Albuquerque, NM,Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM,Division of Epidemiology and Statistics, Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM
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16
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Baldwin AE, Hayes N, Ostrander E, Magri R, Sass N, Dos Anjos Mesquita M, Martínez M, Juliani MC, Cabral P, Fleming M. Phosphatidylethanol Levels in Postpartum Women and Their Newborns in Uruguay and Brazil. Alcohol Clin Exp Res 2020; 44:1292-1299. [PMID: 32441809 DOI: 10.1111/acer.14339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/16/2020] [Accepted: 03/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is increasing interest in the development of newborn screening tests to identify children at risk of fetal alcohol spectrum disorder (FASD) in order to provide these children with early intervention. Phosphatidylethanol (PEth) has emerged as a potential universal newborn screening candidate. METHODS The aim of this report was to present the results of a study designed to compare PEth levels in 1,140 postpartum women and their newborn infants in Montevideo, Uruguay, and Sao Paulo, Brazil. Self-report alcohol use during pregnancy data was collected, along with both maternal and newborn dried blood spot samples for PEth analysis. RESULTS The average age and parity of the women in the sample were 26 years of age and 2.3 pregnancies. For the Uruguay sample (n = 611), 45.8% of postpartum women had PEth levels ≥ 8 ng/ml with a mean positive PEth of 43.6 ng/ml. In contrast, 86.8% of the newborns had PEth levels ≥ 8 ng/ml, with a mean positive PEth of 77.4 ng/ml. For the Brazil sample (n = 529), 33.2% of women had PEth levels ≥ 8 ng/ml with a mean positive PEth of 31 ng/ml. In contrast, 76.9% of the Brazil newborns had PEth levels ≥ 8 ng/ml and 43.9% with a mean positive PEth of 61.1 ng/ml. PEth levels were significantly higher in newborns compared with their postpartum mothers in both the Uruguay and Brazil samples. Self-reported third-trimester alcohol was 6% in the Uruguay sample and 9.1% in the Brazil sample compared with positive maternal PEth levels in 45.8% and 33.2%, respectively. CONCLUSIONS Clinicians may want to consider newborn PEth screening in high-risk populations where prenatal alcohol use is common. The mechanism underlying significantly higher PEth levels in newborns compared with their mothers is not known.
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Affiliation(s)
- Aileen E Baldwin
- United States Drug Testing Laboratories, Inc., (AEB), Des Plaines, Illinois
| | - Nicole Hayes
- UCLA Counseling and Psychological Services, (NH), University of California Los Angeles, Los Angeles, California
| | - Erika Ostrander
- Department of Psychiatry and Behavioral Sciences, (EO, MF), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Raquel Magri
- Facultad de Medicina, (RM), Universidad de la República, Montevideo, Uruguay
| | - Nelson Sass
- Universidade Federal de São Paulo, (NS), Clínica Obstétrica da Maternidade Escola de Vila Nova Cachoeirinha, São Paulo, Brazil
| | | | - Monica Martínez
- Facultad de Odontologia, (MM), Universidad de la República, Montevideo, Uruguay
| | | | - Pablo Cabral
- Hospital General de las Fuerzas Armadas de Uruguay, (MCJ, PC), Montevideo, Uruguay
| | - Michael Fleming
- Department of Psychiatry and Behavioral Sciences, (EO, MF), Northwestern University Feinberg School of Medicine, Chicago, Illinois
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17
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Bortolotti F, Raffaelli R, Di Simone N, Semprebon M, Mirandola M, Simonetto C, De Marchi F, Trevisan MT, Carli G, Dorizzi RM, Scambia G, Franchi M, Tagliaro F. CDT reference values for monitoring chronic alcohol abuse in pregnancy. Clin Chim Acta 2020; 507:156-160. [PMID: 32302685 DOI: 10.1016/j.cca.2020.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIM Carbohydrate Deficient Transferrin (CDT) is one of the most used biomarkers for monitoring alcohol use in pregnancy. However, its effective application in this context is hampered by the demonstrated physiological progressive increase during pregnancy (even in abstinent women) of CDT values, which in the third trimester can reach values close or exceeding the cut-offs usually adopted in clinical and forensic diagnostics. The present work was aimed at the re-assessment of CDT reference values in pregnancy. MATERIALS AND METHODS The CDT analysis was performed by a validated HPLC-UV Vis method on 284 serum samples of women with a physiological pregnancy and on 370 sera of non-pregnant woman from the general population (control group). All the samples were tested also for GGT for excluding alcohol abuse. The statistical analysis was performed using the MedCalc® Statistical Software. RESULTS The re-definition of the specific reference concentrations was carried out according to the Horn and Pesce Robust Method. The resulting CDT upper reference values were 1.45%, 2.01% and 2.05% in the first, second, and third trimester, respectively. CONCLUSIONS In order to prevent the development of maternal and fetal prenatal alcohol exposure complications, the use of alcohol biomarkers, including CDT, has been proposed. However, this biomarker, in the monitoring of alcohol use in pregnancy, has so far been applied adopting the same cut-off used for general population without taking into consideration the progressive physiological increase of its value throughout the pregnancy. In the present study, a specific re-assessment of the CDT reference concentrations of each trimester is reported.
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Affiliation(s)
- Federica Bortolotti
- Dept. of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy.
| | - Ricciarda Raffaelli
- Dept. of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Nicoletta Di Simone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita' Cattolica del S Cuore, Rome, Italy
| | - Michela Semprebon
- Dept. of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - Mariateresa Mirandola
- Dept. of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Chiara Simonetto
- Dept. of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Francesca De Marchi
- Dept. of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Maria Teresa Trevisan
- Laboratory of Clinical Chemistry and Microbiology, Hospital G. Fracastoro, Verona, Italy
| | - Giovanna Carli
- Service of Forensic Medicine, Integrated University Hospital of Verona, Verona, Italy
| | - Romolo M Dorizzi
- Dept. of Pathology, Transfusion & Laboratory Medicine, AUSL Romagna, Cesena, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita' Cattolica del S Cuore, Rome, Italy
| | - Massimo Franchi
- Dept. of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Franco Tagliaro
- Dept. of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy; Institute of Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia
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18
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Stevens S, Anstice N, Cooper A, Goodman L, Rogers J, Wouldes TA. Multiple Tools Are Needed for the Detection of Prenatal Alcohol Exposure: Findings From a Community Antenatal Setting. Alcohol Clin Exp Res 2020; 44:1001-1011. [PMID: 32142175 DOI: 10.1111/acer.14309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/05/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although the toxic effects of prenatal alcohol exposure (PAE) on children are well established, there is emerging evidence about the dynamics and associated demographics of drinking patterns across pregnancy, with risky drinking more likely to take place in the period before pregnancy awareness. This study investigated the use of complementary measurement tools in the understanding of alcohol use across pregnancy and reports on the rates and patterns of alcohol use in a community antenatal setting. METHODS Data on alcohol consumption before and after awareness of pregnancy were collected via multiple measurement tools: anonymous lifestyle questionnaire, TWEAK (Tolerance, Worried, Eye-opener, Amnesia, K/Cut down) screener questionnaire, and Substance Use Inventory interviews across multiple pregnancy timepoints. Additionally, phosphatidylethanol (PEth), a direct biomarker of alcohol metabolism, collected from newborns' dried blood spot cards, was analyzed. RESULTS The TWEAK screener was more likely to identify risky drinking behavior than the lifestyle questionnaire. When pregnancy was unplanned, women were more likely to find out they are pregnant significantly later (p < 0.001) and consume alcohol at moderate-heavy levels (p = 0.03), prolonging the risk to the fetus. There was an association between maternal self-reported alcohol use on the lifestyle questionnaire and Substance Use Inventory interviews, but no association between maternal reports of alcohol use and PEth results (p = 0.72). Women self-reported moderate-heavy alcohol use in early pregnancy only and a positive PEth screen indicated PAE in late pregnancy, suggesting that these methods may identify different groups of women. CONCLUSIONS Multiple measurement tools and methods are needed to identify PAE at different points across pregnancy. Prospective sensitive interviewing is better suited to detecting PAE in early pregnancy, but not later when social desirability bias is stronger, and the use of an objective biomarker, such a PEth, may be useful for identifying the risk of PAE in late pregnancy.
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Affiliation(s)
- Suzanne Stevens
- From the, Department of Psychological Medicine, (SS, JR, TAW), University of Auckland, Auckland, New Zealand
| | - Nicola Anstice
- Discipline of Optometry and Vision Science, (NA), University of Canberra, Canberra, ACT, Australia.,School of Optometry and Vision Science, (NA, LG), University of Auckland, Auckland, New Zealand
| | - Aimee Cooper
- Faculty of Medical and Health Sciences, (AC), University of Auckland, Auckland, New Zealand
| | - Lucy Goodman
- School of Optometry and Vision Science, (NA, LG), University of Auckland, Auckland, New Zealand
| | - Jennifer Rogers
- From the, Department of Psychological Medicine, (SS, JR, TAW), University of Auckland, Auckland, New Zealand
| | - Trecia A Wouldes
- From the, Department of Psychological Medicine, (SS, JR, TAW), University of Auckland, Auckland, New Zealand
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19
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Abstract
BACKGROUND Prenatal alcohol exposure (PAE) can result in detrimental developmental complications. The objective of this study was to estimate the most recent PAE prevalence data for the state of West Virginia (WV) and associated factors. METHOD In all, 1830 newborn residual dried blood spots (DBS) in the WV Newborn Screening Repository were analyzed for phosphatidylethanol (PETH). Data were matched with Project WATCH data (94% match, N = 1729). RESULTS The prevalence of late pregnancy PAE was 8.10% (95%CI: 6.81, 9.38) for all births, 7.61% (95%CI: 6.26, 8.97) for WV residents only, and ranged from 2.27 to 17.11% by region. The significant factors associated with PAE included smoking (OR: 2.03, 95% CI: 1.40, 2.94), preterm births (OR: 1.88; 95% CI: 1.23, 2.89), birth weight of ≤2000 g vs. >3000 g (OR: 2.62, 95%CI: 1.19, 5.79), no exclusive breastfeeding intention (OR: 1.45, 95% CI: 1.02, 2.04), and not exclusively breastfeeding before discharge (OR: 1.61; 95% CI: 1.09, 2.38). CONCLUSION The prevalence of PAE is higher than previously shown for the state. Accurate and timely estimates are vital to inform public health workers, policymakers, researchers, and clinicians to develop and promote effective prevention strategies to lower PAE prevalence and provide targeted interventions and treatment services for infants affected by PAE.
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20
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Naik V, Lunde-Young R, Ramirez J, Lee J, Ramadoss J. Distribution of Phosphatidylethanol in Maternal and Fetal Compartments After Chronic Gestational Binge Alcohol Exposure. Alcohol Clin Exp Res 2020; 44:264-271. [PMID: 31758563 PMCID: PMC6980962 DOI: 10.1111/acer.14250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 11/15/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Phosphatidylethanol (PEth) is a promising biomarker for gestational alcohol exposure. Studies show PEth accumulation in maternal and fetal blood following alcohol exposure; however, distribution of specific PEth homologues (16:0/18:1, 16:0/18:2, 16:0/20:4) in maternal and fetal blood is unknown. Additionally, PEth levels in highly vulnerable FASD targets in maternal and fetal compartments remain unexplored. We hypothesized that all 3 major PEth homologues will be detectable in the maternal and fetal blood, the maternal uterine artery (a reproductive tissue that delivers oxygen and nutrients to fetoplacental unit), and fetal brain regions following gestational binge alcohol exposure and that homologue distribution profiles will be tissue-specific. METHODS Pregnant rats received once-daily orogastric gavage of alcohol (Alcohol; BAC 216 mg/dl@4.5g/kg/d; BAC 289 mg/dl@6g/kg/d) or iso-caloric maltose dextrin (Pair-fed control) from gestation days (GD) 5 to 20 or 21. Following chronic exposure, maternal and fetal tissues were analyzed for PEth homologue concentrations utilizing LC-MS/MS technology. RESULTS All 3 PEth homologues were detected in alcohol-exposed maternal blood, fetal blood, maternal uterine artery, and fetal brain regions (hippocampus, cerebral cortex, and cerebellum). In both maternal and fetal blood, respectively, PEth 16:0/18:2 was more abundant compared to 16:0/18:1 (p < 0.0001,~66%,↑; p = 0.0159, 20.4%↑) and 16:0/20:4 (p = 0.0072,~25%↑; p = 0.0187, 19.4%↑). Maternal PEth 16:0/20:4 was ~ 42% higher than 16:0/18:1 (p = 0.0015). Maternal PEth 16:0/18:2 and 16:0/20:4 were ~ 25%↑ and ~ 20%↑ higher than in fetal blood (p < 0.05). No homologue differences were detected in the maternal uterine artery. In all fetal brain regions, PEth 16:0/18:1 was significantly higher (p < 0.0001) than 16:0/18:2 (~48 to 78%↑) and 16:0/20:4 (~31 to 62%↑) concentrations. PEth 16:0/20:4 was ~ 18% higher than 16:0/18:1 (p < 0.05) in the fetal hippocampus and cortex. CONCLUSION All major PEth homologues were detected in maternal and fetal blood following chronic gestational binge alcohol exposure; homologue distribution profiles were tissue-specific. This study also provides insights into PEth accumulation in critical FASD targets, specifically the maternal uterine artery and fetal brain.
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Affiliation(s)
- Vishal Naik
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA
| | - Raine Lunde-Young
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA
| | - Josue Ramirez
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA
| | - Jehoon Lee
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA
| | - Jayanth Ramadoss
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA
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Berrigan P, Andrew G, Reynolds JN, Zwicker JD. The cost-effectiveness of screening tools used in the diagnosis of fetal alcohol spectrum disorder: a modelled analysis. BMC Public Health 2019; 19:1746. [PMID: 31881876 PMCID: PMC6935188 DOI: 10.1186/s12889-019-8110-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Fetal Alcohol Spectrum Disorder (FASD) is characterized by physical and neurological abnormalities resulting from prenatal alcohol exposure. Though diagnosis may help improve patient outcomes, the diagnostic process can be costly. Subsequently, screening children suspected of FASD prior to diagnostic testing has been suggested, to avoid administering testing to children who are unlikely to receive a diagnosis. The present study set out to assess the cost-effectiveness of currently recommended FASD screening tools. METHODS The screenings tools evaluated were chosen from Children's Healthcare Canada's National Screening Toolkit for Children and Youth Identified and Potentially Affected by FASD and include meconium testing of fatty acid ethyl esters (meconium testing) and the neurobehavioral screening tool (NST). An economic model was constructed to assess cost-effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of findings. Costs reflect 2017 Canadian dollars and the perspective is the public healthcare system. RESULTS Both screening tools evaluated resulted in reduced costs and fewer diagnosed years of life than a no screening strategy in which all children suspected of FASD receive diagnostic testing. The model predicts that screening newborns with meconium testing results in a reduced cost of $89,186 per 100 individuals screened and 38 fewer diagnosed years of life by age 18, corresponding to an incremental cost-effectiveness ratio (ICER) of $2359. Screening children with the NST resulted in a reduced cost of $183,895 per 100 individuals screened and 77 fewer diagnosed years of life by age 18, corresponding to an ICER of $2390. CONCLUSION Findings suggest that screening is associated with less use of healthcare recourses but also fewer years of life with an FASD diagnosis over a no screening strategy. Since diagnosis can be key to children receiving timely and appropriate health and educational services, cost-savings must be weighed against the fewer years of life with a diagnosis associated with screening.
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Affiliation(s)
- Patrick Berrigan
- School of Public Policy, University of Calgary, 906 8th Avenue SW, 5th Floor, Calgary, Alberta, T2P 1H9, Canada.
| | - Gail Andrew
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 5th Floor, 11405 - 87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada.,Glenrose FASD Clinic, Alberta Health Services, 10230 111 Avenue NW, Edmonton, Alberta, T5G 0B7, Canada
| | - James N Reynolds
- Department of Biomedical and Molecular Sciences, Queen's University, Botterell Hall, Room 563, 18 Stuart Street, Kingston, Ontario, K7L 3N6, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, 906 8th Avenue SW, 5th Floor, Calgary, Alberta, T2P 1H9, Canada.,Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
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22
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Nguyen VL, Fitzpatrick M. Should phosphatidylethanol be currently analysed using whole blood, dried blood spots or both? ACTA ACUST UNITED AC 2019; 57:617-622. [DOI: 10.1515/cclm-2018-0667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/09/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Phosphatidylethanol (PEth) are phospholipids produced through non-oxidative ethanol metabolism. They accumulate in red blood cells and have been traditionally analysed in whole blood as potential biomarkers for moderate to long-term alcohol consumption. More recently, their analysis in dried blood spots has been gaining favour, namely, due to the ease in sampling, transport and storage conditions required. This paper aims at providing a short comparative review between analysing PEth in whole blood and dried blood spots and the potential pitfalls that researchers may face when setting up PEth testing for clinical use.
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Maxwell S, Thompson S, Zakko F, Bracero LA. Screening for prenatal alcohol exposure and corresponding short-term neonatal outcomes. Reprod Toxicol 2019; 85:6-11. [PMID: 30664987 DOI: 10.1016/j.reprotox.2019.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/19/2018] [Accepted: 01/17/2019] [Indexed: 01/07/2023]
Abstract
Detection of prenatal alcohol exposure (PAE) is important for early intervention and treatment. The main purpose of this study was to compare 1.) PAE rates using the biomarker, phosphatidylethanol (PEth), in umbilical cord (UC) blood vs. ethyl glucuronide (EtG) in UC tissue, the standard of care, and 2.) Pregnancy characteristics and neonatal outcomes in newborns positive vs. negative for PAE biomarkers. We examined records of neonates born over a two-year span receiving UC-PEth dried blood spots testing at the time of delivery in addition to standard of care PAE screening (n = 146). UC-PEth testing had a higher PAE detection rate (26%) vs. UC tissue EtG (0%, p < 0.01). PAE was not associated with any neonatal dysmorphic features or short-term adverse outcomes. The absence of significant clinical findings for identifying PAE in neonates reinforces alcohol biomarker necessity. We conclude that UC-PEth may be a valuable test for assessing PAE at birth and in identifying infants at risk for developing fetal alcohol spectrum disorder.
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Affiliation(s)
- Stefan Maxwell
- Pediatrix Medical Group and Department of Pediatrics, Charleston Area Medical Center, Charleston, WV, USA.
| | - Stephanie Thompson
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA
| | - Fadi Zakko
- Department of Pediatrics, Charleston Area Medical Center, Charleston, WV, USA
| | - Luis A Bracero
- Department of Obstetrics and Gynecology, West Virginia University-Charleston Division, Charleston Area Medical Center, Charleston, WV, USA
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24
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Berg T, Eliassen E, Jørgenrud B, Kabashi S, Petukhov A, Bogstrand ST. Determination of phosphatidylethanol 16:0/18:1 in whole blood by 96-well supported liquid extraction and UHPLC-MS/MS. J Clin Lab Anal 2018; 33:e22631. [PMID: 30047172 DOI: 10.1002/jcla.22631] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/20/2018] [Accepted: 07/05/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Phosphatidylethanols (PEths) are specific, direct alcohol biomarkers that can be determined in human blood to distinguish between heavy and social drinking. PEth 16:0/18:1 is among the most predominant PEth homologues in human blood. The aim of the study was to develop a high throughput and sensitive UHPLC-MS/MS method for the determination of PEth 16:0/18:1 in whole blood. METHODS Whole blood samples were prepared by 96-well supported liquid extraction (SLE). Extracted samples were analyzed for PEth 16:0/18:1 by reversed phase UHPLC-MS/MS. RESULTS The developed UHPLC-MS/MS method was fully validated in whole blood with PEth 16:0/18:1-D5 as internal standard. Intermediate precision and intermediate accuracy were within ≤± 12% and ≤± 17%, respectively, at PEth 16:0/18:1 concentrations of 1.4-2112 ng/mL (2.0-3004 nmol/L). Limit of quantification (LOQ) was 1.7 ng/mL (2.4 nmol/L). CONCLUSION For the first time, 96-well SLE was used for preparation of a PEth homologue in biological samples. A mixture of tert-butyl methyl ether and 2-propanol (5:1, v:v) was chosen as organic eluent based on an evaluation of extraction recovery, purity of extracts, and evaporation time. The developed UHPLC-MS/MS method can be used for high throughput analyses and sensitive determinations of PEth 16:0/18:1 in whole blood.
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Affiliation(s)
- Thomas Berg
- Section of Drug Abuse Research, Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway
| | - Elin Eliassen
- Section of Drug Abuse Research, Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway
| | - Benedicte Jørgenrud
- Section of Drug Abuse Research, Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway
| | - Saranda Kabashi
- Section of Drug Abuse Research, Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway
| | - Alexey Petukhov
- Moscow Scientific Practical Center of Drug Addiction, Moscow Municipal Department of Healthcare, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Stig Tore Bogstrand
- Section of Drug Abuse Research, Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway.,Lovisenberg Diaconal University College, Oslo, Norway
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25
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Bukiya AN, Dopico AM. Fetal Cerebral Circulation as Target of Maternal Alcohol Consumption. Alcohol Clin Exp Res 2018; 42:1006-1018. [PMID: 29672868 PMCID: PMC5984173 DOI: 10.1111/acer.13755] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/08/2018] [Indexed: 12/29/2022]
Abstract
Alcohol (ethanol [EtOH]) is one of the most widely used psychoactive substances worldwide. Alcohol consumption during pregnancy may result in a wide range of morphological and neurodevelopmental abnormalities termed fetal alcohol spectrum disorders (FASD), with the most severe cases diagnosed as fetal alcohol syndrome (FAS). FAS and FASD are not readily curable and currently represent the leading preventable causes of birth defect and neurodevelopmental delay in the United States. The etiology of FAS/FASD remains poorly understood. This review focuses on the effects of prenatal alcohol exposure (PAE) on fetal cerebrovascular function. A brief introduction to the epidemiology of alcohol consumption and the developmental characteristics of fetal cerebral circulation is followed by several sections that discuss current evidence documenting alcohol-driven alterations of fetal cerebral blood flow, artery function, and microvessel networks. The material offers mechanistic insights at the vascular level itself into the pathophysiology of PAE.
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Affiliation(s)
- Anna N Bukiya
- Department of Pharmacology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Alex M Dopico
- Department of Pharmacology, University of Tennessee Health Science Center, Memphis, Tennessee
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26
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Study of measurement of the alcohol biomarker phosphatidylethanol (PEth) in dried blood spot (DBS) samples and application of a volumetric DBS device. Clin Chim Acta 2018; 479:38-42. [DOI: 10.1016/j.cca.2018.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/04/2018] [Accepted: 01/04/2018] [Indexed: 12/21/2022]
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Bakhireva LN, Garrison L, Shrestha S, Sharkis J, Miranda R, Rogers K. Challenges of diagnosing fetal alcohol spectrum disorders in foster and adopted children. Alcohol 2018; 67:37-43. [PMID: 29316477 DOI: 10.1016/j.alcohol.2017.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 05/08/2017] [Accepted: 05/08/2017] [Indexed: 12/26/2022]
Abstract
Fetal Alcohol Spectrum Disorders (FASD) might be 10-15 times more prevalent among foster/adopted children compared to the general population; however, many of these children remain undiagnosed or misdiagnosed. The lack of confirmed prenatal alcohol exposure (PAE) may be a key barrier to diagnosis. Our sample included 681 patients evaluated for FASD, according to the University of Washington 4-Digit Diagnostic Code, at a pediatric specialty clinic. Guardianship status and other patient characteristics were evaluated by multinomial logistic regression as potential predictors of being classified into one of the following FASD groups: 1) full or partial Fetal Alcohol Syndrome (FAS/pFAS; n = 97); 2) Static Encephalopathy/Alcohol-Exposed (SE/AE) or Neurobehavioral Disorder/Alcohol-Exposed (ND/AE) (n = 135); and 3) some features of FASD (equivalent to pFAS, SE/AE or ND/AE phenotypes) but unknown PAE (n = 449). Median age at assessment was 7.0 years, non-Hispanic White constituted the predominant racial/ethnic group (49.5%), and the majority (81.8%) lacked involvement from a biological parent/relative. Many patients (66.0%) had some features of FASD but lacked reliable PAE information. Children classified into the 'some features/unknown PAE' group had higher median age of assessment (8 years) compared to other groups (6 years; p < 0.001). No association was observed between race/ethnicity or child's sex and FASD outcomes (p > 0.05). Adopted/foster children were 2.8 times as likely (95% CI: 1.6; 4.8) to be classified into the 'some features/unknown PAE' group compared to children living with a parent/relative after adjusting for covariates. This study's findings indicate that adopted/foster children are more likely to have unknown PAE and not receive a FASD diagnosis, potentially denying them access to specialized services, treatment, and rehabilitation.
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Affiliation(s)
- Ludmila N Bakhireva
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA; Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
| | - Laura Garrison
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - Shikhar Shrestha
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - Janet Sharkis
- Texas Office for Prevention of Developmental Disabilities, Texas Health and Human Services Commission, Austin, TX, USA
| | - Rajesh Miranda
- Department of Neuroscience & Experimental Therapeutics, Texas A&M University, Bryan, TX, USA
| | - Karen Rogers
- PALs Developmental Center, Lubbock, TX, USA; Texas Tech University Health Sciences Center, Lubbock, TX, USA
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28
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May PA, Hasken JM, De Vries MM, Marais AS, Stegall JM, Marsden D, Parry CDH, Seedat S, Tabachnick B. A utilitarian comparison of two alcohol use biomarkers with self-reported drinking history collected in antenatal clinics. Reprod Toxicol 2018; 77:25-32. [PMID: 29425712 DOI: 10.1016/j.reprotox.2018.02.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Alcohol use is reported accurately among pregnant women in some populations. METHODS Self-reported alcohol use via the AUDIT and 90-day recall for 193 women from antenatal clinics was compared to biomarker results: phosphatidylethanol (PEth) from bloodspots and ethyl glucuronide (EtG) in fingernails. RESULTS AUDIT was positive for 67.9% of respondents, and 65.3% directly reported drinking. Individual biomarkers detected less drinking (PEth = 57.0%, EtG = 38.9%) than self-report. But 64.8% had drinking-positive values (>8 ng) on one or both biomarkers, which was not significantly different from self-report. Biomarkers indicated that 3.1% -6.8% of drinkers denied drinking. Combined biomarker sensitivity was 95% -80% and specificity 49% -76% for drinking in the previous 7-90 days. Combined biomarker results have their best yield (89.6%) and accuracy (78.8%) when measuring 90 day drinking. CONCLUSIONS Women reported their alcohol use accurately, and the combined use of PEth and EtG is supported.
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Affiliation(s)
- Philip A May
- University of North Carolina at Chapel Hill, Nutrition Research Institute, United States; Stellenbosch University, Faculty of Medicine and Health Sciences, Stellenbosch 7600, South Africa.
| | - Julie M Hasken
- University of North Carolina at Chapel Hill, Nutrition Research Institute, United States
| | - Marlene M De Vries
- Stellenbosch University, Faculty of Medicine and Health Sciences, Stellenbosch 7600, South Africa
| | - Anna-Susan Marais
- Stellenbosch University, Faculty of Medicine and Health Sciences, Stellenbosch 7600, South Africa
| | - Julie M Stegall
- University of North Carolina at Chapel Hill, Nutrition Research Institute, United States
| | - Daniel Marsden
- Fulbright U.S. Student, 2015, Stellenbosch University, Faculty of Medicine and Health Sciences, Stellenbosch 7600, South Africa
| | - Charles D H Parry
- Stellenbosch University, Faculty of Medicine and Health Sciences, Stellenbosch 7600, South Africa; Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, Cape Town, 7501, South Africa
| | - Soraya Seedat
- Stellenbosch University, Faculty of Medicine and Health Sciences, Stellenbosch 7600, South Africa
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29
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May PA, Chambers CD, Kalberg WO, Zellner J, Feldman H, Buckley D, Kopald D, Hasken JM, Xu R, Honerkamp-Smith G, Taras H, Manning MA, Robinson LK, Adam MP, Abdul-Rahman O, Vaux K, Jewett T, Elliott AJ, Kable JA, Akshoomoff N, Falk D, Arroyo JA, Hereld D, Riley EP, Charness ME, Coles CD, Warren KR, Jones KL, Hoyme HE. Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities. JAMA 2018; 319:474-482. [PMID: 29411031 PMCID: PMC5839298 DOI: 10.1001/jama.2017.21896] [Citation(s) in RCA: 464] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Fetal alcohol spectrum disorders are costly, life-long disabilities. Older data suggested the prevalence of the disorder in the United States was 10 per 1000 children; however, there are few current estimates based on larger, diverse US population samples. OBJECTIVE To estimate the prevalence of fetal alcohol spectrum disorders, including fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder, in 4 regions of the United States. DESIGN, SETTING, AND PARTICIPANTS Active case ascertainment methods using a cross-sectional design were used to assess children for fetal alcohol spectrum disorders between 2010 and 2016. Children were systematically assessed in the 4 domains that contribute to the fetal alcohol spectrum disorder continuum: dysmorphic features, physical growth, neurobehavioral development, and prenatal alcohol exposure. The settings were 4 communities in the Rocky Mountain, Midwestern, Southeastern, and Pacific Southwestern regions of the United States. First-grade children and their parents or guardians were enrolled. EXPOSURES Alcohol consumption during pregnancy. MAIN OUTCOMES AND MEASURES Prevalence of fetal alcohol spectrum disorders in the 4 communities was the main outcome. Conservative estimates for the prevalence of the disorder and 95% CIs were calculated using the eligible first-grade population as the denominator. Weighted prevalences and 95% CIs were also estimated, accounting for the sampling schemes and using data restricted to children who received a full evaluation. RESULTS A total of 6639 children were selected for participation from a population of 13 146 first-graders (boys, 51.9%; mean age, 6.7 years [SD, 0.41] and white maternal race, 79.3%). A total of 222 cases of fetal alcohol spectrum disorders were identified. The conservative prevalence estimates for fetal alcohol spectrum disorders ranged from 11.3 (95% CI, 7.8-15.8) to 50.0 (95% CI, 39.9-61.7) per 1000 children. The weighted prevalence estimates for fetal alcohol spectrum disorders ranged from 31.1 (95% CI, 16.1-54.0) to 98.5 (95% CI, 57.5-139.5) per 1000 children. CONCLUSIONS AND RELEVANCE Estimated prevalence of fetal alcohol spectrum disorders among first-graders in 4 US communities ranged from 1.1% to 5.0% using a conservative approach. These findings may represent more accurate US prevalence estimates than previous studies but may not be generalizable to all communities.
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Affiliation(s)
- Philip A. May
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill
- University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, Albuquerque
| | - Christina D. Chambers
- University of California San Diego School of Medicine, La Jolla
- Rady Children's Hospital–San Diego, San Diego, California
| | - Wendy O. Kalberg
- University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, Albuquerque
| | | | - Haruna Feldman
- University of California San Diego School of Medicine, La Jolla
| | - David Buckley
- University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, Albuquerque
| | - David Kopald
- University of California San Diego School of Medicine, La Jolla
| | - Julie M. Hasken
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill
| | - Ronghui Xu
- University of California San Diego School of Medicine, La Jolla
| | | | - Howard Taras
- University of California San Diego School of Medicine, La Jolla
| | | | | | | | | | - Keith Vaux
- University of California San Diego School of Medicine, La Jolla
| | - Tamison Jewett
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Amy J. Elliott
- Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota
| | | | | | - Daniel Falk
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Judith A. Arroyo
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Dale Hereld
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Edward P. Riley
- San Diego State University, Center for Behavioral Teratology, San Diego, California
| | - Michael E. Charness
- VA Boston Healthcare System, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Kenneth R. Warren
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Kenneth Lyons Jones
- University of California San Diego School of Medicine, La Jolla
- Rady Children's Hospital–San Diego, San Diego, California
| | - H. Eugene Hoyme
- University of Arizona College of Medicine, Tucson
- Sanford Research, University of South Dakota Sanford School of Medicine, Vermillion
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Moore KE, Santiago Rivera OJ, Anderson B, Johnson JE, Hahn JA, Kurth ME, Reddy MK, Schonbrun YC, Stein MD. Phosphatidylethanol Levels Among Incarcerated Women: The Influence of Pre-incarceration Alcohol Consumption and Length of Abstinence. Alcohol Clin Exp Res 2018; 42:500-507. [PMID: 29281858 DOI: 10.1111/acer.13587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Phosphatidylethanol (PEth) is a direct biomarker for alcohol that is formed shortly after alcohol use and may remain detectable in blood for weeks after alcohol consumption. There is little research on alcohol use factors that influence PEth elimination, especially among women. METHODS Data were collected from 116 alcohol use-disordered women who were recently incarcerated. We used a 2-part model with logistic and linear components to examine whether alcohol consumption in the 2 weeks prior to incarceration and days since last alcoholic drink (operationalized as abstinence days prior to incarceration + days incarcerated) were associated with PEth detectability (>8 ng/ml) and level (ng/ml) in blood. RESULTS Participants reported drinking an average of 10 drinks per day in the 2 weeks prior to incarceration. Days since last drink was negatively associated with PEth level (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.93; 0.99) and being PEth detectable (OR = 0.96, 95% CI = 0.91; 0.99). Quantity of alcohol consumed prior to jail admission was associated with PEth detection (OR = 1.08; 95% CI = 1.03; 1.16), but not PEth level. CONCLUSIONS Days since last alcoholic drink and drinks per day both influenced PEth detectability, but only days since last drink predicted PEth level among a large sample of women with alcohol use disorder in the criminal justice system.
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Affiliation(s)
- Kelly E Moore
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | | | - Bradley Anderson
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island
| | - Jennifer E Johnson
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, Michigan
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Megan E Kurth
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island
| | - Madhavi K Reddy
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Yael C Schonbrun
- Department of Psychiatry and Human Behavior, Brown University Medical School and Butler Hospital, Providence, Rhode Island
| | - Michael D Stein
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
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Shrestha S, Jimenez E, Garrison L, Pribis P, Raisch DW, Stephen JM, Bakhireva LN. Dietary Intake Among Opioid- and Alcohol-Using Pregnant Women. Subst Use Misuse 2018; 53. [PMID: 28635522 PMCID: PMC5607070 DOI: 10.1080/10826084.2016.1265563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Substance abuse in nonpregnant adults has been associated with increased intake in calories and decreased intake of nutrient-dense foods; however, studies examining dietary intake in opioid-using and alcohol-using pregnant women are lacking. OBJECTIVE The objective of this study was to evaluate dietary intake in opioid-using pregnant women with or without concurrent light-to-moderate alcohol use as compared to abstaining controls. METHODS This prospective birth cohort included 102 pregnant women classified into four study groups: controls (n = 27), medication-assisted treatment (MAT; n = 26), alcohol (ALC; n = 22), and concurrent use of both substances (MAT + ALC; n = 27). Percentage differences in macro- and micronutrient intake were estimated from the food frequency questionnaire and compared among the study groups. Proportions of participants with intakes below the estimated average requirements (EAR) based on diet and diet with supplements were estimated. RESULTS Three exposed groups had lower prevalence of multivitamin use in periconceptional period (11.5-31.8%) than controls (44.4%). Unadjusted mean energy intake was significantly higher in the MAT + ALC group compared to controls, while micronutrient intake per 1000 kcal was the highest in the control group for almost all of the micronutrients analyzed. After adjustment for energy intake and sociodemographic characteristics, MAT group had lower estimated dietary intake of iron (-15.0%, p = 0.04) and folate (-16.8%, p = 0.04) compared to controls. A high proportion of participants in all study groups had dietary intake below the EAR for vitamin E, iron, and folate. CONCLUSION Results highlight the need for targeted dietary interventions for opioid-using pregnant women.
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Affiliation(s)
- Shikhar Shrestha
- a Department of Pharmacy Practice and Administrative Sciences , University of New Mexico College of Pharmacy , Albuquerque , New Mexico , USA
| | - Elizabeth Jimenez
- b Center for Education Policy Research , University of New Mexico , Albuquerque , New Mexico , USA.,c Pacific Institute for Research and Evaluation , Albuquerque , New Mexico , USA
| | - Laura Garrison
- a Department of Pharmacy Practice and Administrative Sciences , University of New Mexico College of Pharmacy , Albuquerque , New Mexico , USA
| | - Peter Pribis
- d Department of Individual, Family & Community Education , University of New Mexico College of Education , Albuquerque , New Mexico , USA
| | - Dennis W Raisch
- a Department of Pharmacy Practice and Administrative Sciences , University of New Mexico College of Pharmacy , Albuquerque , New Mexico , USA
| | - Julia M Stephen
- e The Mind Research Network and Lovelace Biomedical and Environmental Research Institute , Albuquerque , New Mexico , USA.,f Department of Neurosciences , University of New Mexico , Albuquerque , New Mexico , USA
| | - Ludmila N Bakhireva
- a Department of Pharmacy Practice and Administrative Sciences , University of New Mexico College of Pharmacy , Albuquerque , New Mexico , USA.,g Department of Family and Community Medicine , University of New Mexico , Albuquerque , New Mexico , USA
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32
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Howlett H, Gray WK, Dismore L, Mackenzie S, Langley K, Davidson C, Rankin J. A survey of attitudes, beliefs and practice regarding alcohol use and screening in pregnancy: an opportunity for support and education? J Res Nurs 2017. [DOI: 10.1177/1744987117745579] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Providing antenatal and postnatal support for women who drink alcohol in pregnancy is only possible if those at risk can be identified. However, screening will only be helpful if women feel comfortable with the method used. We conducted a survey of pregnant women and their partners to investigate self-reported beliefs and practice regarding drinking during pregnancy and the acceptability of screening. Pregnant women and their partners attending antenatal clinics in North-East England were asked to complete a short survey regarding their alcohol consumption in pregnancy, their beliefs about safe levels of alcohol in pregnancy and whether they would be happy to have their blood or their baby’s meconium analysed for alcohol biomarkers. The data were summarised using descriptive statistics and thematic analysis. A total of 171 pregnant women and 41 partners participated. Of the pregnant women, 153 (89.5%) felt women should abstain from alcohol consumption, although only 70 (40.9%) reported not drinking in pregnancy. Of 96 women who reported drinking in pregnancy and reported when they stopped, all but six (6.3%) stopped drinking when they found out they were pregnant. Of women and partners who recorded an answer, 177 (87.2%) said they would consent to blood biomarker analysis. Confusion over what level of alcohol is safe and using screening as an opportunity for education and support emerged as key themes from free-text responses. Most women viewed screening for alcohol in pregnancy positively, although its acceptability in the small number of women who continue to drink is unclear.
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Affiliation(s)
- Helen Howlett
- Nurse & Midwife Researcher, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, UK
| | - William K Gray
- Senior Research Associate and Statistician, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, UK
| | - Lorelle Dismore
- Assistant Psychologist, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, UK
| | - Shonag Mackenzie
- Consultant Obstetrician, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, UK
| | - Kate Langley
- Medical Student, The Medical School, Newcastle University, UK
| | | | - Judith Rankin
- Professor of Maternal & Perinatal Epidemiology, Institute of Health and Society, Newcastle University, UK
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Lowe J, Qeadan F, Leeman L, Shrestha S, Stephen JM, Bakhireva LN. The effect of prenatal substance use and maternal contingent responsiveness on infant affect. Early Hum Dev 2017; 115:51-59. [PMID: 28898707 PMCID: PMC5681393 DOI: 10.1016/j.earlhumdev.2017.09.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/24/2017] [Accepted: 09/05/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The effects of prenatal substance exposure on neurobehavioral outcomes are inherently confounded by the effects of the postnatal environment, making it difficult to disentangle their influence. The goal of this study was to examine the contributing effects of prenatal substance use and parenting style (operationalized as contingent responding during the play episodes of the Still-face paradigm [SFP]) on infant affect. METHODS A prospective cohort design was utilized with repeated assessment of substance use during pregnancy and the administration of the SFP, which measures infant response to a social stressor, at approximately 6months of age. Subjects included 91 dyads classified into four groups: 1) Control (n=34); 2) Medication assisted therapy for opioid dependence (MAT; n=19); 3) Alcohol (n=15); 4) Alcohol+MAT (n=23). Mean % of positive infant affect and mean % of maternal responsiveness (watching, attention seeking, and contingent responding) was compared among the five SFP episodes across the four study groups by MANOVA. Mixed effects modelling was used to estimate the contributing effects of the study groups and maternal responsiveness on infant affect. RESULTS Maternal contingent responding was associated with increase (β̂=0.84; p<0.0001) and attention seeking with decrease (β̂=-0.78; p<0.0001) in infant positive affect. The combined effect of prenatal exposures and covariates explained 15.8% of the variability in infant positive affect, while the model including contingent responding and covariates explained 67.1% of the variability. CONCLUSIONS Higher maternal responsiveness was a much stronger predictor of infant behavior than prenatal exposures, providing the basis for future intervention studies focusing on specific parenting strategies.
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Affiliation(s)
- Jean Lowe
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Fares Qeadan
- Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Lawrence Leeman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA; Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
| | - Shikhar Shrestha
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Julia M Stephen
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Ludmila N Bakhireva
- Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA; Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA; Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA.
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34
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Herrera MC, Konda KA, Leon SR, Brown B, Calvo GM, Salvatierra HJ, Caceres CF, Klausner JD, Deiss R. Do Subjective Alcohol Screening Tools Correlate with Biomarkers Among High-Risk Transgender Women and Men Who Have Sex with Men in Lima, Peru? AIDS Behav 2017; 21:253-261. [PMID: 29043467 PMCID: PMC7392030 DOI: 10.1007/s10461-017-1933-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Alcohol abuse can influence sexual risk behavior; however, its measurement is not straightforward. This study compared self-reported alcohol use, via the AUDIT and CAGE, with levels of phosphatidylethanol (Peth), a phospholipid biomarker that forms with chronic, heavy drinking, among high-risk MSM and TW in Lima, Peru. Chi square, Fisher's exact, Wilcoxon ranksum tests compared the instruments. Receiver operating curves determined sensitivity and specificity of the self-reported measures. Among 69 MSM and 17 TW, PEth was positive for 86% (95% CI 77-93%) of participants, while 67% reported binge-drinking in the last 2 weeks. The AUDIT classified 25% as hazardous drinkers while CAGE identified 6% as problem drinkers. Self-reported binge drinking was more sensitive than the AUDIT for PEth positivity (71% vs. 27%, p = 0.022). Among high-risk MSM and TW in Lima, validated, self-report measures of alcohol abuse underestimated biological measures. Further research correlating bio-markers and self-reported alcohol abuse measures is needed.
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Affiliation(s)
- M C Herrera
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
- Department of Pediatrics, University of California, San Francisco, CA, USA.
| | - K A Konda
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Center for Interdisciplinary Research in Sexuality, Society, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - B Brown
- Department of Social Medicine and Population Health, UCR School of Medicine, Riverside, CA, USA
| | - G M Calvo
- Center for Interdisciplinary Research in Sexuality, Society, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - H J Salvatierra
- Alberto Barton Health Center, Health Directorate of Callao, Lima, Peru
| | - C F Caceres
- Center for Interdisciplinary Research in Sexuality, Society, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J D Klausner
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - R Deiss
- Division of Global Public Health, UCSD School of Medicine, San Diego, CA, USA
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35
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Afshar M, Burnham EL, Joyce C, Clark BJ, Yong M, Gaydos J, Cooper RS, Smith GS, Kovacs EJ, Lowery EM. Cut-Point Levels of Phosphatidylethanol to Identify Alcohol Misuse in a Mixed Cohort Including Critically Ill Patients. Alcohol Clin Exp Res 2017; 41:1745-1753. [PMID: 28792620 PMCID: PMC5626634 DOI: 10.1111/acer.13471] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/02/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Although alcohol misuse is associated with deleterious outcomes in critically ill patients, its detection by either self-report or examination of biomarkers is difficult to obtain consistently. Phosphatidylethanol (PEth) is a direct alcohol biomarker that can characterize alcohol consumption patterns; however, its diagnostic accuracy in identifying misuse in critically ill patients is unknown. METHODS PEth values were obtained in a mixed cohort comprising 122 individuals from medical and burn intensive care units (n = 33), alcohol detoxification unit (n = 51), and healthy volunteers (n = 38). Any alcohol misuse and severe misuse were referenced by Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C scores separately. Mixed-effects logistic regression analysis was performed, and the discrimination of PEth was evaluated using the area under the receiver-operating characteristic (ROC) curve. RESULTS The area under the ROC curve for PEth was 0.927 (95% CI: 0.877, 0.977) for any misuse and 0.906 (95% CI: 0.850, 0.962) for severe misuse defined by AUDIT. By AUDIT-C, the area under the ROC curves was 0.948 (95% CI: 0.910, 0.956) for any misuse and 0.913 (95% CI: 0.856, 0.971) for severe misuse. The PEth cut-points of ≥250 and ≥400 ng/ml provided optimal discrimination for any misuse and severe misuse, respectively. The positive predictive value for ≥250 ng/ml was 88.7% (95% CI: 77.5, 95.0), and the negative predictive value was 86.7% (95% CI: 74.9, 93.7). PEth ≥ 400 ng/ml achieved similar values, and similar results were shown for AUDIT-C. In a subgroup analysis of critically ill patients only, test characteristics were similar to the mixed cohort. CONCLUSIONS PEth is a strong predictor and has good discrimination for any and severe alcohol misuse in a mixed cohort that includes critically ill patients. Cut-points at 250 ng/ml for any, and 400 ng/ml for severe, are favorable. External validation will be required to establish these cut-points in critically ill patients.
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Affiliation(s)
- Majid Afshar
- Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Health Sciences Campus, Maywood, IL
- Alcohol Research Program, Stritch School of Medicine, Loyola University Health Sciences Campus, Maywood, IL
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago Health Sciences Campus, Maywood, IL
| | - Ellen L. Burnham
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Cara Joyce
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago Health Sciences Campus, Maywood, IL
| | - Brendan J. Clark
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Meagan Yong
- Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Health Sciences Campus, Maywood, IL
- Alcohol Research Program, Stritch School of Medicine, Loyola University Health Sciences Campus, Maywood, IL
| | - Jeannette Gaydos
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Richard S. Cooper
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago Health Sciences Campus, Maywood, IL
| | - Gordon S. Smith
- Shock Trauma and Anesthesiology Research (STAR) – Organized Research Center, Department of Surgery, University of Maryland, Baltimore, Maryland
| | - Elizabeth J. Kovacs
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Erin M. Lowery
- Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Health Sciences Campus, Maywood, IL
- Alcohol Research Program, Stritch School of Medicine, Loyola University Health Sciences Campus, Maywood, IL
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36
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Andreassen TN, Havnen H, Spigset O, Falch BMH, Skråstad RB. High Throughput UPLC®-MSMS Method for the Analysis of Phosphatidylethanol (PEth) 16:0/18:1, a Specific Biomarker for Alcohol Consumption, in Whole Blood. J Anal Toxicol 2017; 42:33-41. [DOI: 10.1093/jat/bkx075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/15/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Hilde Havnen
- Department of Clinical Pharmacology, St. Olav University Hospital, 7006 Trondheim, Norway
| | - Olav Spigset
- Department of Clinical Pharmacology, St. Olav University Hospital, 7006 Trondheim, Norway
- Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Ragnhild Bergene Skråstad
- Department of Clinical Pharmacology, St. Olav University Hospital, 7006 Trondheim, Norway
- Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, Trondheim, Norway
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37
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Phosphatidylethanol (PEth) as a Biomarker of Alcohol Consumption in HIV-Infected Young Russian Women: Comparison to Self-Report Assessments of Alcohol Use. AIDS Behav 2017; 21:1938-1949. [PMID: 28421353 DOI: 10.1007/s10461-017-1769-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Alcohol use is particularly deleterious for HIV-infected individuals and thus accurate assessment of alcohol consumption is crucial in this population. Phosphatidylethanol (PEth) provides an objective assessment of drinking and can be compared to self-reported alcohol assessments to detect underreporting. The purpose of this study was to identify underreporting and its potential predictors in an HIV-infected sample of young Russian women. The current study examined the concordance between a quantitative measure of PEth and self-reported recent alcohol consumption in a prospective sample of HIV-infected young women (N = 204) receiving medical care in Saint Petersburg, Russia. At baseline, 53% of participants who denied drinking in the prior 30 days tested positive for PEth (i.e., underreporters), although this rate decreased significantly at a three-month follow-up assessment. Further exploration did not identify consistent predictors of underreporting status. Quantitative PEth levels showed, at best, modest overlap to self-reported alcohol consumption among those reporting alcohol use (e.g., Spearman's r = 0.27 between PEth and total drinks past-30 days at baseline). Objective measures of alcohol consumption demonstrate modest overlap with self-report measures of use in HIV-infected young Russian women. Incorporating objective and quantifiable biological markers are essential for valid assessments of alcohol use.
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38
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Bakhireva LN, Sharkis J, Shrestha S, Miranda-Sohrabji TJ, Williams S, Miranda RC. Prevalence of Prenatal Alcohol Exposure in the State of Texas as Assessed by Phosphatidylethanol in Newborn Dried Blood Spot Specimens. Alcohol Clin Exp Res 2017; 41:1004-1011. [DOI: 10.1111/acer.13375] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/07/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ludmila N. Bakhireva
- Department of Pharmacy Practice and Administrative Sciences; University of New Mexico College of Pharmacy; Albuquerque New Mexico
- Department of Family and Community Medicine; University of New Mexico; Albuquerque New Mexico
| | - Janet Sharkis
- Texas Office for Prevention of Developmental Disabilities ; Austin Texas
| | - Shikhar Shrestha
- Department of Pharmacy Practice and Administrative Sciences; University of New Mexico College of Pharmacy; Albuquerque New Mexico
| | | | - Sonnie Williams
- Department of Pharmacy Practice and Administrative Sciences; University of New Mexico College of Pharmacy; Albuquerque New Mexico
| | - Rajesh C. Miranda
- Department of Neuroscience and Experimental Therapeutics; Texas A&M Health Science Center, College of Medicine; Bryan Texas
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39
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Bager H, Christensen LP, Husby S, Bjerregaard L. Biomarkers for the Detection of Prenatal Alcohol Exposure: A Review. Alcohol Clin Exp Res 2017; 41:251-261. [PMID: 28098942 DOI: 10.1111/acer.13309] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 12/03/2016] [Indexed: 01/06/2023]
Abstract
Alcohol exposure during pregnancy can cause adverse effects to the fetus, because it interferes with fetal development, leading to later physical and mental impairment. The most common clinical tool to determine fetal alcohol exposure is maternal self-reporting. However, a more objective and useful method is based on the use of biomarkers in biological specimens alone or in combination with maternal self-reporting. This review reports on clinically relevant biomarkers for detection of prenatal alcohol exposure (PAE). A systematic search was performed to ensure a proper overview in existing literature. Studies were selected to give an overview on clinically relevant neonatal and maternal biomarkers. The direct biomarkers fatty acid ethyl esters (FAEEs), ethyl glucuronide (EtG), ethyl sulfate, and phosphatidylethanol (PEth) were found to be the most appropriate biomarkers in relation to detection of PAE. To review each biomarker in a clinical context, we have compared the advantages and disadvantages of each biomarker, in relation to its window of detectability, ease of collection, and the ease and cost of analysis of each biomarker. The biomarkers PEth, FAEEs, and EtG were found to be applicable for detection of even low levels of alcohol exposure. Meconium is an accessible matrix for determination of FAEEs and EtG, and blood an accessible matrix for determination of PEth.
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Affiliation(s)
- Heidi Bager
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
| | - Lars Porskjaer Christensen
- Department of Chemical Engineering, Biotechnology and Environmental Technology, University of Southern Denmark, Odense M, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
| | - Lene Bjerregaard
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
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40
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Gauthier TW, Brown LAS. In utero alcohol effects on foetal, neonatal and childhood lung disease. Paediatr Respir Rev 2017; 21:34-37. [PMID: 27613232 PMCID: PMC5303127 DOI: 10.1016/j.prrv.2016.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/11/2016] [Indexed: 02/07/2023]
Abstract
Maternal alcohol use during pregnancy exposes both premature and term newborns to the toxicity of alcohol and its metabolites. Foetal alcohol exposure adversely effects the lung. In contrast to the adult "alcoholic lung" phenotype, an inability to identify the newborn exposed to alcohol in utero has limited our understanding of its effect on adverse pulmonary outcomes. This paper will review advances in biomarker development of in utero alcohol exposure. We will highlight the current understanding of in utero alcohol's toxicity to the developing lung and immune defense. Finally, we will present recent clinical evidence describing foetal alcohol's association with adverse pulmonary outcomes including bronchopulmonary dysplasia, viral infections such as respiratory syncytial virus and allergic asthma/atopy. With research to define alcohol's effect on the lung and translational studies accurately identifying the exposed offspring, the full extent of alcohol's effects on clinical respiratory outcomes of the newborn or child can be determined.
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Gardiner AS, Gutierrez HL, Luo L, Davies S, Savage DD, Bakhireva LN, Perrone-Bizzozero NI. Alcohol Use During Pregnancy is Associated with Specific Alterations in MicroRNA Levels in Maternal Serum. Alcohol Clin Exp Res 2016; 40:826-37. [PMID: 27038596 PMCID: PMC4825401 DOI: 10.1111/acer.13026] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/25/2016] [Indexed: 12/12/2022]
Abstract
Background Given the challenges of confirming prenatal alcohol exposure (PAE) during pregnancy using currently established biomarkers of alcohol consumption, we examined whether serum microRNAs (miRNAs) may serve as stable biomarkers for PAE. Alterations in the levels of specific circulating miRNAs have been associated with various disease states and in animal models of fetal alcohol spectrum disorder. Methods Pregnant women in this prospective study were recruited from substance abuse and general maternity clinics affiliated with the University of New Mexico. Serum was collected at the time of admission for delivery from 14 subjects who reported ≥1 binge‐drinking episode or ≥3 drinks/wk during pregnancy and 16 subjects who reported abstinence during pregnancy and tested negative for 5 ethanol biomarkers. Total RNA was isolated from serum and used for microarray analysis. Results False discovery rate‐corrected analyses of covariance revealed that 55 miRNAs were significantly altered between the 2 groups. Hierarchical clustering using only the significantly altered miRNAs grouped samples into alcohol‐consuming and non‐alcohol‐consuming individuals. Discriminant analysis then identified miRs‐122*, ‐126, ‐216b, ‐221*, ‐3119, ‐3942‐5p, ‐4704‐3p, ‐4743, ‐514‐5p, and ‐602 as the top 10 discriminators between the 2 groups. Ingenuity Pathway Analysis of putative miRNA targets illustrated that miRNAs identified in this study are involved in biological pathways that mediate the effects of alcohol, such as brain‐derived neurotrophic factor, ERK1/2, and PI3K/AKT signaling. Conclusions This is the first report of alterations in serum miRNA expression that are associated with alcohol use during human pregnancy. These results suggest that serum miRNAs could be useful as biomarkers of alcohol exposure.
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Affiliation(s)
- Amy S Gardiner
- Department of Neurosciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Hilda L Gutierrez
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Li Luo
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Suzy Davies
- Department of Neurosciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Daniel D Savage
- Department of Neurosciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Ludmila N Bakhireva
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Nora I Perrone-Bizzozero
- Department of Neurosciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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42
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Montag AC, Hull AD, Yevtushok L, Zymak-Zakutnya N, Sosyniuk Z, Dolhov V, Jones KL, Wertelecki W, Chambers CD. Second-Trimester Ultrasound as a Tool for Early Detection of Fetal Alcohol Spectrum Disorders. Alcohol Clin Exp Res 2016; 40:2418-2425. [PMID: 27688069 DOI: 10.1111/acer.13232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/02/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Early detection of fetal alcohol spectrum disorders (FASDs) is desirable to allow earlier and more comprehensive interventions to be initiated for the mother and infant. We examined prenatal ultrasound as an early method of detecting markers of the physical features and neurobehavioral deficits characteristic of FASD. METHODS A longitudinal cohort of pregnant women in Ukraine was recruited as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders. Women were enrolled into a moderately to heavy-alcohol-exposed group or a low- or no-alcohol exposure group and were followed to pregnancy outcome. In the second trimester, a fetal ultrasound was performed to measure transverse cerebellar diameter, occipital frontal diameter (OFD), caval-calvarial distance, frontothalamic distance (FTD), interorbital distance (IOD), outer orbital diameter, and orbital diameter (OD). Live born infants received a dysmorphological examination and a neurobehavioral evaluation using the Bayley Scales of Infant Development. These data were used to classify infants with respect to FASD. Comparisons were made on the ultrasound measures between those with and without features of FASD, adjusting for gestational age at ultrasound and maternal smoking. RESULTS A total of 233 mother/child dyads were included. Children classified as FASD had significantly longer IOD and lower FTD/IOD, OFD/IOD, and FTD/OD ratios (p < 0.05). Children with a Bayley score <85 had significantly shorter FTD, longer IOD, lower OFD/IOD, and FTD/IOD ratios (p < 0.05). In general, mean differences were small. Ultrasound variables alone predicted <10% of the variance in the FASD outcome. CONCLUSIONS Some ultrasound measurements were associated with FASD, selected facial features of the disorder, and lower neurobehavioral scores. However, mean differences were relatively small, making it difficult to predict affected children based solely on these measures. It may be advantageous to combine these easily obtained ultrasound measures with other data to aid in identifying high risk for an FASD outcome.
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Affiliation(s)
- Annika C Montag
- Department of Pediatrics, University of California San Diego, La Jolla, California.
| | - Andrew D Hull
- Department of Reproductive Medicine, University of California San Diego, La Jolla, California
| | - Lyubov Yevtushok
- Rivne Provincial Medical Diagnostic Center and OMNI-Net Center, Rivne, Ukraine
| | | | - Zoryana Sosyniuk
- Rivne Provincial Medical Diagnostic Center and OMNI-Net Center, Rivne, Ukraine
| | - Viktor Dolhov
- Khmelnytsky City Perinatal Center and OMNI-Net Center, Khmelnytsky, Ukraine
| | - Kenneth Lyons Jones
- Department of Pediatrics, University of California San Diego, La Jolla, California.,Rady Children's Hospital, San Diego, California
| | - Wladimir Wertelecki
- Department of Pediatrics, University of California San Diego, La Jolla, California.,Department of Medical Genetics, University of South Alabama, Mobile, Alabama
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, California.,Rady Children's Hospital, San Diego, California.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
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Niemelä O, Niemelä S, Ritvanen A, Gissler M, Bloigu A, Vääräsmäki M, Kajantie E, Werler MM, Surcel HM. Assays of Gamma-Glutamyl Transferase and Carbohydrate-Deficient Transferrin Combination from Maternal Serum Improve the Detection of Prenatal Alcohol Exposure. Alcohol Clin Exp Res 2016; 40:2385-2393. [PMID: 27650665 DOI: 10.1111/acer.13207] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/02/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Alcohol use during pregnancy leads to detrimental effects on fetal development. As self-reports by mothers are known to be unreliable for assessing prenatal alcohol exposure, there is a need for sensitive and specific biomarkers for identifying those at risk for alcohol-affected offspring. METHODS We measured serum gamma-glutamyl transferase (GGT), carbohydrate-deficient transferrin (CDT), a mathematically formulated combination of GGT and CDT (GGT-CDT), and ethylglucuronide (EtG) concentrations from 1,936 mothers with a positive (n = 480) or negative (n = 1,456) history of alcohol use at the time of pregnancy. The material included 385 alcohol-abusing mothers who subsequently gave birth to children with fetal alcohol syndrome (FAS) and 1,551 mothers without FAS children including 95 women who reported a median of 1.0 standard drinks of alcohol per day during pregnancy and 1,456 nondrinking controls. Among those without FAS outcome, there were 405 mothers with gestational diabetes mellitus (GDM) and 745 mothers representing lifelong abstainers. RESULTS Mothers of FAS children had higher mean GGT, CDT, GGT-CDT, and EtG levels than abstainers (p < 0.001 for all comparisons) or mothers reporting some alcohol consumption but whose children were not diagnosed with FAS (p < 0.001 for all comparisons). In receiver operating characteristic analyses using cutoffs based on abstainers, the area under the curves (AUCs) for GGT-CDT (0.873) were higher than those of GGT (0.824), CDT (0.776), or EtG (0.584) for differentiating the mothers of FAS children and abstainers. Unlike CDT, this combination marker also differed significantly between drinking mothers without FAS outcome and abstainers (AUC = 0.730, p < 0.001). In comparisons adjusted for GDM and body mass index, the group of mothers who had reported a median of 1.0 standard drinks of alcohol per day during pregnancy also differed from the group reporting no current alcohol intake in GGT (p < 0.02) and GGT-CDT (p < 0.01) levels. CONCLUSIONS Combination of GGT and CDT improves the identification of prenatal alcohol exposure and associated high-risk pregnancies. A more systematic use of biomarkers may help intervention efforts to prevent alcohol-induced adverse effects on fetal development.
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Affiliation(s)
- Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, University of Tampere, Seinäjoki, Finland.
| | - Solja Niemelä
- Research Unit of Clinical Neuroscience, Faculty of Medicine, University of Oulu, Oulu, Finland.,Department of Psychiatry, Lapland Hospital District, Rovaniemi, Finland
| | - Annukka Ritvanen
- Information Services Department, Finnish Register of Congenital Malformations, National Institute for Health and Welfare, Helsinki, Finland
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Aini Bloigu
- The Impact Assessment Unit, National Institute of Health and Welfare, Oulu, Finland
| | - Marja Vääräsmäki
- The Children, Adolescents and Families Unit, National Institute for Health and Welfare, Oulu, Finland.,PEDEGO Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Eero Kajantie
- PEDEGO Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.,Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki and Oulu, Finland.,Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Heljä-Marja Surcel
- The Impact Assessment Unit, National Institute of Health and Welfare, Oulu, Finland
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Garg M, Garrison L, Leeman L, Hamidovic A, Borrego M, Rayburn WF, Bakhireva L. Validity of Self-Reported Drug Use Information Among Pregnant Women. Matern Child Health J 2016; 20:41-47. [PMID: 26175273 DOI: 10.1007/s10995-015-1799-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study assesses validity of self-report for the use of major classes of illicit drugs and opioid-maintenance therapy among pregnant women at a substance abuse treatment program. METHODS Analyses used data collected from 83 pregnant women in a prospective cohort study at the University of New Mexico. Study participants with a history of substance abuse were screened and, if eligible, enrolled during an early prenatal care visit. A follow-up interview was conducted shortly after delivery. Self-reported information about drug use later in pregnancy was compared with urine drug screen (UDS) results collected during the third trimester. Simple kappa (k) and prevalence-and-bias-adjusted kappa (PABAK) coefficients were calculated as the measures of agreement. Sensitivity and specificity of self-report for each drug class were estimated using UDS as the 'gold standard'. RESULTS The sample included a large proportion of ethnic minority (80% Hispanic/Latina and 7% American Indian) and socially disadvantaged (50% less than high school education and 94% Medicaid-insured) pregnant women. On average, patients had 4.8 ± 3.0 urine drug screens during the third trimester. Sensitivity of self-report was low (<60%) for all classes of illicit drugs; however, marijuana and opioids demonstrated slightly higher sensitivity (57.9 and 58.3%, respectively) than other classes (<47%). CONCLUSIONS This study found substantial underreporting for all classes of illicit drugs among pregnant women in a substance abuse treatment program. Rates of underreporting are expected to be higher among the general population of pregnant women.
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Affiliation(s)
- Mahek Garg
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - Laura Garrison
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - Lawrence Leeman
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA.,Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Ajna Hamidovic
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - Matthew Borrego
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - William F Rayburn
- Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Ludmila Bakhireva
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA. .,Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
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45
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McQuire C, Paranjothy S, Hurt L, Mann M, Farewell D, Kemp A. Objective Measures of Prenatal Alcohol Exposure: A Systematic Review. Pediatrics 2016; 138:peds.2016-0517. [PMID: 27577579 DOI: 10.1542/peds.2016-0517] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | - Mala Mann
- Specialist Unit for Review Evidence, Cardiff University, Cardiff, United Kingdom
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Abstract
Fetal alcohol-spectrum disorders (FASDs) are a collection of physical and neurobehavioral disabilities caused by prenatal exposure to alcohol. To prevent or mitigate the costly effects of FASD, we must identify mothers at risk for having a child with FASD, so that we may reach them with interventions. Identifying mothers at risk is beneficial at all time points, whether prior to pregnancy, during pregnancy, or following the birth of the child. In this review, three approaches to identifying mothers at risk are explored: using characteristics of the mother and her pregnancy, using laboratory biomarkers, and using self-report assessment of alcohol-consumption risk. At present, all approaches have serious limitations. Research is needed to improve the sensitivity and specificity of biomarkers and screening instruments, and to link them to outcomes as opposed to exposure. Universal self-report screening of all women of childbearing potential should ideally be incorporated into routine obstetric and gynecologic care, followed by brief interventions, including education and personalized feedback for all who consume alcohol, and referral to treatment as indicated. Effective biomarkers or combinations of biomarkers may be used during pregnancy and at birth to determine maternal and fetal alcohol exposure. The combination of self-report and biomarker screening may help identify a greater proportion of women at risk for having a child with FASD, allowing them to access information and treatment, and empowering them to make decisions that benefit their children.
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Affiliation(s)
- Annika C Montag
- Department of Pediatrics, Division of Dysmorphology and Teratology, University of California San Diego, San Diego, CA, USA
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47
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Alternative sampling strategies for the assessment of alcohol intake of living persons. Clin Biochem 2016; 49:1078-91. [PMID: 27208822 DOI: 10.1016/j.clinbiochem.2016.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/28/2016] [Accepted: 05/01/2016] [Indexed: 01/16/2023]
Abstract
Monitoring of alcohol consumption by living persons takes place in various contexts, amongst which workplace drug testing, driving under the influence of alcohol, driving licence regranting programs, alcohol withdrawal treatment, diagnosis of acute intoxication or fetal alcohol ingestion. The matrices that are mostly used today include blood, breath and urine. The aim of this review is to present alternative sampling strategies that allow monitoring of the alcohol consumption in living subjects. Ethanol itself, indirect (carbohydrate deficient transferrin, CDT%) as well as direct biomarkers (ethyl glucuronide, EtG; ethyl sulphate, EtS; fatty acid ethyl esters, FAEEs and phosphatidylethanol species, PEths) of ethanol consumption will be considered. This review covers dried blood spots (CDT%, EtG/EtS, PEths), dried urine spots (EtG/EtS), sweat and skin surface lipids (ethanol, EtG, FAEEs), oral fluid (ethanol, EtG), exhaled breath (PEths), hair (EtG, FAEEs), nail (EtG), meconium (EtG/EtS, FAEEs), umbilical cord and placenta (EtG/EtS and PEth 16:0/18:1). Main results, issues and considerations specific to each matrix are reported. Details about sample preparation and analytical methods are not within the scope of this review.
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48
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Kummer N, Ingels AS, Wille SMR, Hanak C, Verbanck P, Lambert WEE, Samyn N, Stove CP. Quantification of phosphatidylethanol 16:0/18:1, 18:1/18:1, and 16:0/16:0 in venous blood and venous and capillary dried blood spots from patients in alcohol withdrawal and control volunteers. Anal Bioanal Chem 2015; 408:825-38. [PMID: 26597914 DOI: 10.1007/s00216-015-9169-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 01/30/2023]
Abstract
Phosphatidylethanol species (PEths) are promising biomarkers of alcohol consumption. Here, we report on the set-up, validation, and application of a novel UHPLC-ESI-MS/MS method for the quantification of PEth 16:0/18:1, PEth 18:1/18:1, and PEth 16:0/16:0 in whole blood (30 μL) and in venous (V, 30 μL) or capillary (C, 3 punches (3 mm)) dried blood spots (DBS). The methods were linear from 10 (LLOQ) to 2000 ng/mL for PEth 16:0/18:1, from 10 (LLOQ) to 1940 ng/mL for PEth 18:1/18:1, and from 19 (LLOQ) to 3872 ng/mL for PEth 16:0/16:0. Extraction efficiencies were higher than 55% (RSD < 18%) and matrix effects compensated for by IS were between 77 and 125% (RSD < 10%). Accuracy, repeatability, and intermediate precision fulfilled acceptance criteria (bias and RSD below 13%). Validity of the procedure for determination of PEth 16:0/18:1 in blood was demonstrated by the successful participation in a proficiency test. The quantification of PEths in C-DBS was not significantly influenced by the hematocrit, punch localization, or spot volume. The stability of PEths in V-DBS stored at room temperature was demonstrated up to 6 months. The method was applied to authentic samples (whole blood, V-DBS, and C-DBS) from 50 inpatients in alcohol withdrawal and 50 control volunteers. Applying a cut-off value to detect inpatients at 221 ng/mL for PEth 16:0/18:1 provided no false positive results and a good sensitivity (86%). Comparison of quantitative results (Bland-Altman plot, Passing-Bablok regression, and Wilcoxon signed rank test) revealed that V-DBS and C-DBS were valid alternatives to venous blood for the detection of alcohol consumption.
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Affiliation(s)
- Natalie Kummer
- Federal Public Service Justice, National Institute of Criminalistics and Criminology, Chaussée de Vilvorde 100, 1120, Brussels, Belgium
| | - Ann-Sofie Ingels
- Federal Public Service Justice, National Institute of Criminalistics and Criminology, Chaussée de Vilvorde 100, 1120, Brussels, Belgium
| | - Sarah M R Wille
- Federal Public Service Justice, National Institute of Criminalistics and Criminology, Chaussée de Vilvorde 100, 1120, Brussels, Belgium
| | - Catherine Hanak
- Laboratory of Psychological Medicine and Addictology, ULB Neuroscience Institute (UNI), Université Libre de Bruxelles (ULB), Route de Lennik 800, 1070, Brussels, Belgium
| | - Paul Verbanck
- Laboratory of Psychological Medicine and Addictology, ULB Neuroscience Institute (UNI), Université Libre de Bruxelles (ULB), Route de Lennik 800, 1070, Brussels, Belgium
| | - Willy E E Lambert
- Laboratory of Toxicology, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Nele Samyn
- Federal Public Service Justice, National Institute of Criminalistics and Criminology, Chaussée de Vilvorde 100, 1120, Brussels, Belgium
| | - Christophe P Stove
- Laboratory of Toxicology, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium.
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49
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Bakhireva LN, Shrestha S, Gutierrez HL, Berry M, Schmitt C, Sarangarm D. Stability of Phosphatidylethanol in Dry Blood Spot Cards. Alcohol Alcohol 2015; 51:275-80. [PMID: 26519350 DOI: 10.1093/alcalc/agv120] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/05/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The analysis of phosphatidylethanol, a promising direct ethanol metabolite, in dry blood spots (PEth-DBS) is advantageous due to ease of storage, transportation and minimal invasiveness of capillary blood collection. One potential application of PEth-DBS is to confirm prenatal alcohol exposure in newborns suspected of FASD; however, stability of PEth-DBS is largely unknown. METHODS Phlebotomized samples from 31 adults with a history of alcoholism, admitted to the University of New Mexico Emergency Department, were analyzed for blood alcohol content and pipetted onto DBS cards (13 spots per patient). The first spot was analyzed within 2 weeks of collection for a baseline PEth; the remaining 12 spots were allocated into three temperature conditions (room temperature, 4°C, -80°C) for the repeated measures analysis. In addition, 5 newborn DBS samples with a baseline PEth>LOD were obtained from a prospective cohort at UNM and re-analyzed at 4 months after storage at -80°C. A mixed linear model was fitted to examine the effects of temperature, time and temperature-time interaction on PEth degradation over the first 9 months. RESULTS The baseline PEth levels were 592.8 ± 86.7 ng/ml and 18.3 ± 4.8 ng/ml in adult and newborn samples, respectively. All DBS samples remained positive in successive samples in all temperature conditions. Results of mixed linear model demonstrated a significant effect of temperature (P < 0.001) on PEth degradation over 9 months. CONCLUSIONS PEth-DBS appears to be relatively stable, especially when stored at lower temperatures. These initial results are encouraging and highlight the PEth-DBS potential in retrospective assessment of alcohol exposure.
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Affiliation(s)
- Ludmila N Bakhireva
- Department of Pharmacy Practice and Administrative Sciences, UNM, Albuquerque, NM, USA Department of Family and Community Medicine, UNM, Albuquerque, NM, USA
| | - Shikhar Shrestha
- Department of Pharmacy Practice and Administrative Sciences, UNM, Albuquerque, NM, USA
| | - Hilda L Gutierrez
- Department of Pharmacy Practice and Administrative Sciences, UNM, Albuquerque, NM, USA
| | - Mike Berry
- Department of Emergency Medicine, UNM, Albuquerque, NM, USA
| | - Cheryl Schmitt
- Department of Pharmacy Practice and Administrative Sciences, UNM, Albuquerque, NM, USA
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50
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Wurst FM, Thon N, Yegles M, Schrück A, Preuss UW, Weinmann W. Ethanol Metabolites: Their Role in the Assessment of Alcohol Intake. Alcohol Clin Exp Res 2015; 39:2060-72. [DOI: 10.1111/acer.12851] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/22/2015] [Indexed: 01/12/2023]
Affiliation(s)
- Friedrich M. Wurst
- Paracelsus Medical University; Salzburg Austria
- Center for Interdisciplinary Addiction Research; University of Hamburg; Hamburg Germany
| | | | - Michel Yegles
- Service de Toxicologie; Laboratoire National de Sante; Luxembourg Luxembourg
| | - Alexandra Schrück
- Institute of Forensic Medicine; University of Bern; Bern Switzerland
| | - Ulrich W. Preuss
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine; University of Halle; Halle Germany
| | - Wolfgang Weinmann
- Institute of Forensic Medicine; University of Bern; Bern Switzerland
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