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The Detection of Fetal Alcohol Exposure by FAEEs Meconium Analysis

  • Fetal Alcohol Syndrome (EF Furtado, Section Editor)
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Abstract

Fetal alcohol exposure can be assessed either retrospectively by directly asking mothers or reliable informants through structured interviews and screening questionnaires or actually by measuring biomarkers of alcohol consumption in pregnancy or in the perinatal phase. For research purposes and even in some clinical cases with a need for objective corroboration of the information given by the mother or when this information is missing, there is the possibility of laboratory assessment of alcohol biomarkers. This review will present the current state of the art of FAEE (fatty acid ethyl esters) meconium analysis. An electronic search of computerized databases was carried out on an English language database (PubMed). The searched keywords in PubMed were “fatty acid ethyl ester AND meconium”. The search was limited to the English language. The PubMed search resulted in 67 articles of which 23 were excluded by the analysis of titles and abstracts. The most frequently employed assay methods were: GC-MS (40.9 %), followed by LC-MS/MS (36.4 %), GC-FID (9.1 %), and GC-FID confirmed by GC-MS (13.6 %).

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References

  1. Hoyme HE, Kalberg WO, Elliott AJ, Blankenship J, Buckley D, Marais AS, et al. Updated clinical guidelines for diagnosing fetal alcohol spectrum disorders. Pediatrics. 2016;138(2).

  2. Organization WH. Guidelines for the identification and management of substance use and substance use disorders in pregnancy. Geneva: World Health Organization; 2014. 224 p.

    Google Scholar 

  3. Sulik KK. Fetal alcohol spectrum disorder: pathogenesis and mechanisms. Handb Clin Neurol. 2014;125:463–75.

    Article  PubMed  Google Scholar 

  4. Sokol RJ, Martier SS, Ager JW. The T-ACE questions: practical prenatal detection of risk-drinking. Am J Obstet Gynecol. 1989;160(4):863–70.

    Article  CAS  PubMed  Google Scholar 

  5. Babor T, World Health Organization. Department of Mental Health and Substance Dependence. AUDIT, the alcohol use disorders identification test : guidelines for use in primary care. 2nd ed. Geneva, Switzerland: World Health Organization, Dept. of Mental Health and Substance Dependence; 2001. 39 p.

  6. Sobell LC, Sobell MB, Leo GI, Cancilla A. Reliability of a timeline method: assessing normal drinkers' reports of recent drinking and a comparative evaluation across several populations. Br J Addict. 1988;83(4):393–402.

    Article  CAS  PubMed  Google Scholar 

  7. Joya X, Friguls B, Ortigosa S, Papaseit E, Martínez SE, Manich A, et al. Determination of maternal-fetal biomarkers of prenatal exposure to ethanol: a review. J Pharm Biomed Anal. 2012;69:209–22.

    Article  CAS  PubMed  Google Scholar 

  8. Gareri J, Klein J, Koren G. Drugs of abuse testing in meconium. Clin Chim Acta. 2006;366(1-2):101–11.

    Article  CAS  PubMed  Google Scholar 

  9. Klein J, Karaskov T, Korent G. Fatty acid ethyl esters: a novel biologic marker for heavy in utero ethanol exposure: a case report. Ther Drug Monit. 1999;21(6):644–6.

    Article  CAS  PubMed  Google Scholar 

  10. Gareri J, Lynn H, Handley M, Rao C, Koren G. Prevalence of fetal ethanol exposure in a regional population-based sample by meconium analysis of fatty acid ethyl esters. Ther Drug Monit. 2008;30(2):239–45.

    Article  CAS  PubMed  Google Scholar 

  11. Manich A, Velasco M, Joya X, García-Lara NR, Pichini S, Vall O, et al. Validity of a maternal alcohol consumption questionnaire in detecting prenatal exposure. An Pediatr (Barc). 2012;76(6):324–8.

    Article  CAS  Google Scholar 

  12. Zelner I, Shor S, Lynn H, Roukema H, Lum L, Eisinga K, et al. Clinical use of meconium fatty acid ethyl esters for identifying children at risk for alcohol-related disabilities: the first reported case. J Popul Ther Clin Pharmacol. 2012;19(1):e26–31.

    PubMed  Google Scholar 

  13. Peterson J, Kirchner HL, Xue W, Minnes S, Singer LT, Bearer CF. Fatty acid ethyl esters in meconium are associated with poorer neurodevelopmental outcomes to two years of age. J Pediatr. 2008;152(6):788–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Min MO, Singer LT, Minnes S, Wu M, Bearer CF. Association of fatty acid ethyl esters in meconium and cognitive development during childhood and adolescence. J Pediatr. 2015;166(4):1042–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Yang JY, Kwak HS, Han JY, Choi JS, Ahn HK, Oh YJ, et al. Linear versus non-linear dose-response relationship between prenatal alcohol exposure and meconium concentration of nine different fatty acid ethyl esters. Dose Response. 2015;13(1).

  16. Joya X, Marchei E, Salat-Batlle J, García-Algar O, Calvaresi V, Pacifici R, et al. Fetal exposure to ethanol: relationship between ethyl glucuronide in maternal hair during pregnancy and ethyl glucuronide in neonatal meconium. Clin Chem Lab Med. 2016;54(3):427–35.

    Article  CAS  PubMed  Google Scholar 

  17. Himes SK, Dukes KA, Tripp T, Petersen JM, Raffo C, Burd L, et al. Clinical sensitivity and specificity of meconium fatty acid ethyl ester, ethyl glucuronide, and ethyl sulfate for detecting maternal drinking during pregnancy. Clin Chem. 2015;61(3):523–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Cabarcos P, Tabernero MJ, Otero JL, Míguez M, Bermejo AM, Martello S, et al. Quantification of fatty acid ethyl esters (FAEE) and ethyl glucuronide (EtG) in meconium for detection of alcohol abuse during pregnancy: correlation study between both biomarkers. J Pharm Biomed Anal. 2014;100:74–8.

    Article  CAS  PubMed  Google Scholar 

  19. Bryanton J, Gareri J, Boswall D, McCarthy MJ, Fraser B, Walsh D, et al. Incidence of prenatal alcohol exposure in Prince Edward Island: a population-based descriptive study. CMAJ Open. 2014;2(2):E121–6.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Goecke TW, Burger P, Fasching PA, Bakdash A, Engel A, Häberle L, et al. Meconium indicators of maternal alcohol abuse during pregnancy and association with patient characteristics. Biomed Res Int. 2014;2014:702848.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kwak HS, Han JY, Choi JS, Ahn HK, Kwak DW, Lee YK, et al. Dose-response and time-response analysis of total fatty acid ethyl esters in meconium as a biomarker of prenatal alcohol exposure. Prenat Diagn. 2014;34(9):831–8.

    Article  CAS  PubMed  Google Scholar 

  22. Pichini S, Morini L, Pacifici R, Tuyay J, Rodrigues W, Solimini R, et al. Development of a new immunoassay for the detection of ethyl glucuronide (EtG) in meconium: validation with authentic specimens analyzed using LC-MS/MS. Preliminary results. Clin Chem Lab Med. 2014;52(8):1179–85.

    Article  CAS  PubMed  Google Scholar 

  23. Himes SK, Concheiro M, Scheidweiler KB, Huestis MA. Validation of a novel method to identify in utero ethanol exposure: simultaneous meconium extraction of fatty acid ethyl esters, ethyl glucuronide, and ethyl sulfate followed by LC-MS/MS quantification. Anal Bioanal Chem. 2014;406(7):1945–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. McGlone L, Mactier H, Hassan H, Cooper G. In utero drug and alcohol exposure in infants born to mothers prescribed maintenance methadone. Arch Dis Child Fetal Neonatal Ed. 2013;98(6):F542–4.

    Article  PubMed  Google Scholar 

  25. Morini L, Marchei E, Tarani L, Trivelli M, Rapisardi G, Elicio MR, et al. Testing ethylglucuronide in maternal hair and nails for the assessment of fetal exposure to alcohol: comparison with meconium testing. Ther Drug Monit. 2013;35(3):402–7.

    Article  CAS  PubMed  Google Scholar 

  26. Hastedt M, Krumbiegel F, Gapert R, Tsokos M, Hartwig S. Fatty acid ethyl esters (FAEEs) as markers for alcohol in meconium: method validation and implementation of a screening program for prenatal drug exposure. Forensic Sci Med Pathol. 2013;9(3):287–95.

    Article  CAS  PubMed  Google Scholar 

  27. Cabarcos P, Tabernero MJ, Alvarez I, Miguez M, Fernández P, Bermejo AM. A new method for quantifying prenatal exposure to ethanol by microwave-assisted extraction (MAE) of meconium followed by gas chromatography-mass spectrometry (GC-MS). Anal Bioanal Chem. 2012;404(1):147–55.

    Article  CAS  PubMed  Google Scholar 

  28. Zelner I, Hutson JR, Kapur BM, Feig DS, Koren G. False-positive meconium test results for fatty acid ethyl esters secondary to delayed sample collection. Alcohol Clin Exp Res. 2012;36(9):1497–506.

    Article  CAS  PubMed  Google Scholar 

  29. Zelner I, Shor S, Lynn H, Roukema H, Lum L, Eisinga K, et al. Neonatal screening for prenatal alcohol exposure: assessment of voluntary maternal participation in an open meconium screening program. Alcohol. 2012;46(3):269–76.

    Article  CAS  PubMed  Google Scholar 

  30. Pichini S, Marchei E, Vagnarelli F, Tarani L, Raimondi F, Maffucci R, et al. Assessment of prenatal exposure to ethanol by meconium analysis: results of an Italian multicenter study. Alcohol Clin Exp Res. 2012;36(3):417–24.

    Article  CAS  PubMed  Google Scholar 

  31. Hutson JR, Rao C, Fulga N, Aleksa K, Koren G. An improved method for rapidly quantifying fatty acid ethyl esters in meconium suitable for prenatal alcohol screening. Alcohol. 2011;45(2):193–9.

    Article  CAS  PubMed  Google Scholar 

  32. Kwak HS, Kang YS, Han KO, Moon JT, Chung YC, Choi JS, et al. Quantitation of fatty acid ethyl esters in human meconium by an improved liquid chromatography/tandem mass spectrometry. J Chromatogr B Anal Technol Biomed Life Sci. 2010;878(21):1871–4.

    Article  CAS  Google Scholar 

  33. Goh YI, Hutson JR, Lum L, Roukema H, Gareri J, Lynn H, et al. Rates of fetal alcohol exposure among newborns in a high-risk obstetric unit. Alcohol. 2010;44(7-8):629–34.

    Article  PubMed  Google Scholar 

  34. Roehsig M, de Paula DM, Moura S, Diniz EM, Yonamine M. Determination of eight fatty acid ethyl esters in meconium samples by headspace solid-phase microextraction and gas chromatography-mass spectrometry. J Sep Sci. 2010;33(14):2115–22.

    Article  CAS  PubMed  Google Scholar 

  35. Zelner I, Shor S, Gareri J, Lynn H, Roukema H, Lum L, et al. Universal screening for prenatal alcohol exposure: a progress report of a pilot study in the region of Grey Bruce, Ontario. Ther Drug Monit. 2010;32(3):305–10.

    Article  CAS  PubMed  Google Scholar 

  36. Hutson JR, Magri R, Gareri JN, Koren G. The incidence of prenatal alcohol exposure in Montevideo Uruguay as determined by meconium analysis. Ther Drug Monit. 2010;32(3):311–7.

    Article  CAS  PubMed  Google Scholar 

  37. Moller M, Karaskov T, Koren G. Opioid detection in maternal and neonatal hair and meconium: characterization of an at-risk population and implications to fetal toxicology. Ther Drug Monit. 2010;32(3):318–23.

    Article  CAS  PubMed  Google Scholar 

  38. Morini L, Marchei E, Vagnarelli F, Garcia Algar O, Groppi A, Mastrobattista L, et al. Ethyl glucuronide and ethyl sulfate in meconium and hair-potential biomarkers of intrauterine exposure to ethanol. Forensic Sci Int. 2010;196(1-3):74–7.

    Article  CAS  PubMed  Google Scholar 

  39. Bakdash A, Burger P, Goecke TW, Fasching PA, Reulbach U, Bleich S, et al. Quantification of fatty acid ethyl esters (FAEE) and ethyl glucuronide (EtG) in meconium from newborns for detection of alcohol abuse in a maternal health evaluation study. Anal Bioanal Chem. 2010;396(7):2469–77.

    Article  CAS  PubMed  Google Scholar 

  40. Morini L, Groppi A, Marchei E, Vagnarelli F, Algar OG, Zuccari P, et al. Population baseline of meconium ethyl glucuronide and ethyl sulfate concentrations in newborns of nondrinking women in 2 Mediterranean cohorts. Ther Drug Monit. 2010;32(3):359–63.

    Article  CAS  PubMed  Google Scholar 

  41. Pichini S, Morini L, Marchei E, Palmi I, Rotolo MC, Vagnarelli F, et al. Ethylglucuronide and ethylsulfate in meconium to assess gestational ethanol exposure: preliminary results in two Mediterranean cohorts. Can J Clin Pharmacol. 2009;16(2):e370–5.

    PubMed  Google Scholar 

  42. Hutson JR, Aleksa K, Pragst F, Koren G. Detection and quantification of fatty acid ethyl esters in meconium by headspace-solid-phase microextraction and gas chromatography-mass spectrometry. J Chromatogr B Anal Technol Biomed Life Sci. 2009;877(1-2):8–12.

    Article  CAS  Google Scholar 

  43. Pichini S, Pellegrini M, Gareri J, Koren G, Garcia-Algar O, Vall O, et al. Liquid chromatography-tandem mass spectrometry for fatty acid ethyl esters in meconium: assessment of prenatal exposure to alcohol in two European cohorts. J Pharm Biomed Anal. 2008;48(3):927–33.

    Article  CAS  PubMed  Google Scholar 

  44. Garcia-Algar O, Kulaga V, Gareri J, Koren G, Vall O, Zuccaro P, et al. Alarming prevalence of fetal alcohol exposure in a Mediterranean city. Ther Drug Monit. 2008;30(2):249–54.

    Article  CAS  PubMed  Google Scholar 

  45. Ostrea EM, Hernandez JD, Bielawski DM, Kan JM, Leonardo GM, Abela MB, et al. Fatty acid ethyl esters in meconium: are they biomarkers of fetal alcohol exposure and effect? Alcohol Clin Exp Res. 2006;30(7):1152–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Bearer CF, Santiago LM, O'Riordan MA, Buck K, Lee SC, Singer LT. Fatty acid ethyl esters: quantitative biomarkers for maternal alcohol consumption. J Pediatr. 2005;146(6):824–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Chan D, Caprara D, Blanchette P, Klein J, Koren G. Recent developments in meconium and hair testing methods for the confirmation of gestational exposures to alcohol and tobacco smoke. Clin Biochem. 2004;37(6):429–38.

    Article  CAS  PubMed  Google Scholar 

  48. Bearer CF, Jacobson JL, Jacobson SW, Barr D, Croxford J, Molteno CD, et al. Validation of a new biomarker of fetal exposure to alcohol. J Pediatr. 2003;143(4):463–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Derauf C, Katz AR, Easa D. Agreement between maternal self-reported ethanol intake and tobacco use during pregnancy and meconium assays for fatty acid ethyl esters and cotinine. Am J Epidemiol. 2003;158(7):705–9.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Chan D, Bar-Oz B, Pellerin B, Paciorek C, Klein J, Kapur B, et al. Population baseline of meconium fatty acid ethyl esters among infants of nondrinking women in Jerusalem and Toronto. Ther Drug Monit. 2003;25(3):271–8.

    Article  CAS  PubMed  Google Scholar 

  51. Moore C, Jones J, Lewis D, Buchi K. Prevalence of fatty acid ethyl esters in meconium specimens. Clin Chem. 2003;49(1):133–6.

    Article  CAS  PubMed  Google Scholar 

  52. Bearer CF, Lee S, Salvator AE, Minnes S, Swick A, Yamashita T, et al. Ethyl linoleate in meconium: a biomarker for prenatal ethanol exposure. Alcohol Clin Exp Res. 1999;23(3):487–93.

    CAS  PubMed  Google Scholar 

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Correspondence to Erikson Felipe Furtado.

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Conflict of Interest

Fabiana Spineti dos Santos reports a grant from FAPESP - São Paulo Research Foundation.

Bruno Spinosa de Martinis and Erikson Felipe Furtado declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Fetal Alcohol Syndrome

Glossary

E12:0

Ethyl laurate

E14:0

Ethyl myristate

E17:0

Ethyl heptadecanoate

E16:0

Ethyl palmitate

E16:1

Ethyl palmitoleate

E18:0

Ethyl stearate

E18:1

Ethyl oleate

E18:2

Ethyl linoleate

E18:3

Ethyl linolenate

E20:4

Ethyl arachidonate

FAEEs

Fatty acid ethyl esters

GC-FID

Gas Chromatography - Flame Ionization Detector

GC-MS

Gas Chromatography - Mass Spectrometry

HS-SPME

Headspace – Solid Phase Microextraction

LC-MS

Liquid Chromatography - Mass Spectrometry

LLE

Liquid-Liquid Extraction

MAE

Microwave Assisted Extraction

SPE

Solid Phase Extraction

SPME

Solid Phase Microextraction

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dos Santos, F.S., de Martinis, B.S. & Furtado, E.F. The Detection of Fetal Alcohol Exposure by FAEEs Meconium Analysis. Curr Dev Disord Rep 3, 235–241 (2016). https://doi.org/10.1007/s40474-016-0102-x

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