Abstract
BackgroundMaternal self-reports, used for the detection of prenatal alcohol exposure (PAE), may lack validity, necessitating the use of an objective biomarker. The detection of fatty acid ethyl esters (products of non-oxidative ethanol metabolism) in meconium has been established as a novel biomarker of PAE. The purpose of the current study was to compare the prevalence of PAE as reported via maternal self-reports with the results of meconium testing, and to quantify the disparity between these two methods.MethodsA systematic literature search for studies reporting on the prevalence of PAE, using maternal self-reports in combination with meconium testing, was conducted using multiple electronic bibliographic databases. Pooled prevalence estimates and 95% confidence intervals (CI) were calculated based on eight studies, using the Mantel-Haenszel method, assuming a random effects model. A random effects meta-regression was performed to test for a difference.ResultsThe pooled prevalence of PAE as measured by meconium testing was 4.26 (95% CI: 1.34-13.57) times the pooled prevalence of PAE as measured by maternal self-reports. Large variations across the studies in regard to the difference between estimates obtained from maternal self-reports and those obtained from meconium testing were observed.ConclusionsIf maternal self-reports are the sole information source upon which health care professionals rely, a number of infants who were prenatally exposed to alcohol are not being recognized as such. However, further research is needed in order to validate existing biomarkers, as well as discover new biomarkers, for the detection of PAE.
Highlights
Maternal self-reports, used for the detection of prenatal alcohol exposure (PAE), may lack validity, necessitating the use of an objective biomarker
Characteristics of the included studies Initially, the electronic search yielded a total of 839 publications regarding the prevalence of PAE, measured using maternal self-reports and meconium testing, when using the key words specified above
AUDIT: Alcohol Use Disorders Identification Test; FAEE: fatty acid ethyl esters; n/a: not available; SES: socio-economic status. aLevels of increased sensitivity may not total percentage figures obtained via meconium testing divided by percentage figures obtained via self-reports due to rounding errors. bPichini et al [44] reported results for two study sites (Italy and Spain). cReported “daily” consumption. dHutson et al [37] and Magri et al [38,39] were published in iteration. eDerauf et al [40,41] are dual publication. fExcludes 5 women who reported alcohol use during the first trimester only
Summary
Maternal self-reports, used for the detection of prenatal alcohol exposure (PAE), may lack validity, necessitating the use of an objective biomarker. Prenatal alcohol exposure (PAE) may cause a number of health complications for the mother and the developing fetus, including Fetal Alcohol Spectrum Disorder (FASD). Interventions have long-term benefits for a child with FASD and can potentially reduce the occurrence of secondary disabilities including poor school performance, addictions, mental health problems, sexually deviant behaviour, dependent living, legal issues, and incarceration [2]. Screening of neonates for PAE and early FASD diagnosis can prevent subsequent alcohol-exposed births by providing appropriate interventions, treatment, counselling, and support for birth mothers with unrecognized alcohol dependence and mental health problems [1,4]. Appropriate screening strategies may facilitate early recognition and intervention for affected siblings
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