Abstract
BackgroundAlcohol consumption during pregnancy is associated with major birth defects and developmental disabilities. Questionnaires concerning alcohol consumption during pregnancy underestimate alcohol use while the use of a reliable and objective biomarker for alcohol consumption enables more accurate screening. Phosphatidylethanol can detect low levels of alcohol consumption in the previous two weeks. In this study we aimed to biochemically assess the prevalence of alcohol consumption during early pregnancy using phosphatidylethanol in blood and compare this with self-reported alcohol consumption.MethodsTo evaluate biochemically assessed prevalence of alcohol consumption during early pregnancy using phosphatidylethanol levels, we conducted a prospective, cross-sectional, single center study in the largest tertiary hospital of the Netherlands. All adult pregnant women who were under the care of the obstetric department of the Erasmus MC and who underwent routine blood testing at a gestational age of less than 15 weeks were eligible. No specified informed consent was needed.ResultsThe study was conducted between September 2016 and October 2017. In total, we received 1,002 residual samples of 992 women. After applying in- and exclusion criteria we analyzed 684 samples. Mean gestational age of all included women was 10.3 weeks (SD 1.9). Of these women, 36 (5.3 %) tested positive for phosphatidylethanol, indicating alcohol consumption in the previous two weeks. Of women with a positive phosphatidylethanol test, 89 % (n = 32) did not express alcohol consumption to their obstetric care provider.ConclusionsOne in nineteen women consumed alcohol during early pregnancy with a high percentage not reporting this use to their obstetric care provider. Questioning alcohol consumption by an obstetric care provider did not successfully identify (hazardous) alcohol consumption. Routine screening with phosphatidylethanol in maternal blood can be of added value to identify women who consume alcohol during pregnancy.
Highlights
Alcohol consumption during pregnancy is associated with major birth defects and developmental disabilities
The aim of this study was to determine the prevalence of prenatal alcohol exposure (PAE) in early pregnancy, before fifteen weeks of gestation, in an urban university hospital in the Netherlands, by measuring PEth in maternal blood
Setting and participants The study was conducted between September 2016 and October 2017 at the Erasmus MC, a tertiary hospital in an urban area in the Netherlands
Summary
Alcohol consumption during pregnancy is associated with major birth defects and developmental disabilities. Phosphatidylethanol can detect low levels of alcohol consumption in the previous two weeks. In this study we aimed to biochemically assess the prevalence of alcohol consumption during early pregnancy using phosphatidylethanol in blood and compare this with self-reported alcohol consumption. Heavy alcohol drinking is considered most harmful to the developing fetus and the first trimester seems to be the most vulnerable period [3,4,5]. Is was shown that even low levels of maternal alcohol consumption are associated with changes in offspring brain development [7]. The American Academy of Pediatrics emphasizes that there is no pregnancy trimester or amount of alcohol consumption that can be considered safe during pregnancy, and the British Medical Association advises complete abstinence during pregnancy [11, 12]. The same advice applies in the Netherlands, [13] 4 % of Dutch pregnant women reported consuming alcohol while knowing to be pregnant in 2018, 82 % of these women reported only a few sips [14]
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