Diagnosis of fetal alcohol exposure through biomarkers in meconium

The high prevalence of alcohol consumption by women of reproductive age combined with unplanned pregnancy exposes the mother to a high risk to intoxicate at some time during pregnancy, especially in the early gestational period in which most of them have not yet became aware of the fact. Therefore, the development of methods for early detection it is extremely relevant for the prevention of fetal alcohol exposure as well for the early assessment of neonates at risk for development of problems of the fetal alcohol spectrum. The aim of this study was to develop, validate and evaluate the effectiveness of a method for quantifying fatty acid ethyl esters (FAEEs) in meconium from newborns for evaluation of fetal alcohol exposure. The evaluated FAEEs were: ethyl palmitate, ethyl stearate, ethyl oleate and linoleate etila. The method consists in preparing the samples by liquid-liquid extraction using water, acetone and hexane, followed by solid phase extraction employing aminopropyl silica cartridges. The separation and quantitation of analytes was performed by gas chromatography coupled with mass spectrometer. Limits of quantification (LOQ) ranged between 50 and 100 ng/g. The curves calibration were linear from LQ- 2000ng / g for all analytes. The recovery ranged from 69.79% to 106.57%. The analytes demonstrated stability in post-processing assay and in stability assay for standard solutions. The method was applied in meconium samples from 160 newborns recruited in a public maternity hospital of Ribeirão Preto. The maternal alcohol consumption was assessed by validated screening questionnaires (T-ACE and AUDIT) and by retrospective self-reports about the amount and frequency of alcohol consumption during pregnancy. The effectiveness of the analytical method in identifying positive cases was determined by receiver operating characteristic curve (ROC). The risk drinking was identified by the T-ACE in 31.3% of participants and 50% of them reported alcohol use during pregnancy. 51.3% of newborns tested positive for FAEEs, and 33.1% had high concentrations for sum of FAEEs (greater than 500 ng/g), compatible with alcohol abuse. The ethyl oleate was the most prevalent biomarker and ethyl linoleate was the biomarker that showed the highest concentrations. There was a variability in the distribution profile of FAEEs between individuals, and there were disagreements between the results of FAEEs and consumption reported by the mother. The cumulative sum of FAEEs was better than individual FAEEs for interpretation of positive cases. A positive cutoff of cumulative FAEE at 600 ng/g for binge drinking was stablished with 71,43% sensitivity and 84,37% specificity. This study reinforces the importance of using laboratory methods for identifying fetal alcohol exposure. (AU)