Assessment of prenatal exposure to alcohol and gestational consumption by EtG testing in neonatal meconium and maternal hair and neonatal: First Italian national survey

Abstract

Use of alcohol during pregnancy and subsequent fetal exposure can cause multiple perinatal disorders (prematurity at birth, withdrawal syndromes, tremors, hyperreflexia) and impaired physical and mental development in the later stages of life, known as fetal alcohol spectrum disorders (FADS) including as major expression of impairment fetal alcohol syndrome (FAS). Gestational drinking is usually, worldwide reported by questionnaires filled during antenatal visits, but international studies demonstrated their inconsistency for under-reporting or misreporting of toxic habits. Information concerning the true prevalence of alcohol consumption during pregnancy and consequent prenatal exposure to this teratogen is essentially lacking in Italy. To assess objective gestational consumption to alcohol and fetal exposure to it, we measured one of the most specific ethyl alcohol metabolites, ethylglucuronide (EtG), in maternal hair and neonatal meconium involving delivering mothers and newborns along the whole National Italian territory. Non-paired twenty delivering women and twenty newborns per city from hospitals of the National Health system located in the North, Centre and South Italy (including islands) were enrolled in the project. Maternal hair, 8 cm as maximum length, was collected at the end of pregnancy and analyzed as entire strand and neonatal meconium was collected within the first 24 hours after birth. Ethylglucuronide was quantified in both biological matrices through a validated gas chromatography–tandem mass spectrometry methodology. Hair EtG concentrations below 5 pg/mg hair were attributed to abstinent women, those > 5 pg/mg and below 30 pg/mg were attributed to women consuming “some” alcohol during pregnancy and ≥ 30 pg/mg were attributed to excessive drinkers. Furthermore, according to previous studies from our research group, maternal hair EtG above 11 pg/mg was shown to correspond with high probability to a neonatal meconium with EtG > 30 ng/g. Hence, it was considered as a “cut-off” matching to fetal exposure to alcohol. Up to now, 781 maternal hair and 642 meconium samples have been analyzed. Only one woman out of 781(0.1%) presented chronic excessive ethanol consumption with EtG concentration > 30 pg/mg, while the 8.2% of maternal hair presented EtG concentrations > 5 pg/mg with 1.4% > 11 pg/mg. Four newborns (0.6%) resulted prenatally exposed to ethanol with meconium EtG concentration > 30 ng/g. The highest percentage of women involved in the study (mean age + SD 34 + 5.1 years) were Italian (88%) and employed (69%). With regard to educational level, 44% had a university degree and 39% high-school education level. The four exposed newborns did not present at birth any sign of evident disability or malformation. These preliminary findings, obtained in separate cohorts of pregnant and delivering mothers and newborns showed that, currently, a negligible amount of Italian women drink during pregnancy and that a minute percentage of newborns are prenatally exposed to alcohol. The policies applied by health Italian women have acquired awareness about risks associated with drinking during pregnancy.