The Global Issue of FASD: Results of Characterizing Alcohol

Consumption in Pregnancy in Montevideo, Uruguay

Janine Hutson, MScFaculty of Medicine, University of Toronto

Motherisk Laboratory, Hospital for Sick Children

                    

Publications From Around the World

Latin America• Cantabria, Spain

– 22.7% of women reported alcohol consumption during pregnancy (n=1510) (Palma et al., 2006)

• São Paulo, Brazil– 17/16440 babies referred to genetics

clinic diagnosed with FAS and likely underdiagnosed in the city (Grinfeld et al., 1999)

Latin America

• Santiago, Chile – 57.4% lower middle class women

reported alcohol consumption during pregnancy in a prenatal clinic (n=9628)

– 101/887 with home visits reported an average of 4 drinks/day

(Aros et al., 2006)

Latin America• Tapachula, Chiapas, Mexico

– 46% women receiving prenatal care reported alcohol consumption and alcohol dependence (n=132)

– rate of consumption was higher than reported in non-pregnant women(Montesinos et al., 2004)

• Solís Valley, Mexico– 73% reported consuming an alcoholic

beverage, ‘pulque’ and 29% consumed >150g ethanol/week (n=70) (Backstrand et al., 2001)

Uruguay

• Low birth weight – 10.1% LBW in public

sector

• 80% prevalence of drinking in women of childbearing age

Pan American Health Organization; 2002, Magri R, 2002

Koren et al. CMAJ 2003;169:1181-5.

Fatty Acid Ethyl Esters (FAEE)

•Ethyl Palmitate

•Ethyl Palmitoleate

•Ethyl Stearate

•Ethyl Oleate

•Ethyl Linolate

•Ethyl Linolenate

•Ethyl Arachidonate

• 2 nmol/gram is a positive test

• 100% sensitivity

• 98% specificity

Chan et al., 2003

Hypotheses

A. There will be a significant incidence of prenatal alcohol exposure in Montevideo, Uruguay that is higher than in North America.

B. Prenatal alcohol and tobacco exposure will be significant predictors of birth weight in Montevideo, Uruguay

Methods - Uruguay• Collected meconium samples from all

births from April 4, 2005 – June 18, 2005 at Pereyra Rossell & Clinicas Hospital

• Mothers in good health & give consent• Questionnaire completed

Methods - Toronto

• FAEE extracted from meconium and analyzed by GC-FID

• Cocaine, benzoylecgonine (BE), amphetamine, THC, and cotinine by enzyme-linked immunosorbent assay (ELISA)

• Statistical Analysis

Completed Maternal Questionnaires n=900

Total Births n=1115

Meconium Samples for FAEE Analysis n=905

Analysis for Cotinine & 5 Illicit Drugs n=195

Matched questionnaire & FAEE results n=681

Questionnaires w/o FAEE results n=219

Unable to Analyze for FAEE n=81

Successful Analysis for FAEE n=824

Multiple Births Excluded n=2

Maternal Characteristics

• Average Age = 25

• 11% employed

• 95% did not complete secondary education

• 9% no prenatal care, 30% < 4 visits

GC-FID Chromatograms

Ethyl Oleate

Ethyl Linolate

Ethyl Linolenate

Internal Standard

Internal Standard

Inte

nsi

ty (

mV

olt

s)

Time (min)

0

5

10

15

20

25

30

35

40

45

50%

Pos

itiv

e

FAEE Cotinine Amph. Cocaine THC

44%42%

8%2% 2%

2% Fetal Alcohol Syndrome*

*Abel. Neurotoxicol Teratol 1995;17:437-43.

20% Fetal Alcohol Spectrum Disorder*

0

5

10

15

20

25

30

35

40

45

50%

Pos

itiv

e

FAEE Cotinine Amph. Cocaine THC

44%42%

8%2% 2%

Alcohol Tobacco Stimulants Cocaine THC

37% 42% 1% 0.4% 1.5% Self-Report

Comparison to Other Regions

Grey-Bruce, Ontario (Gareri, 2006)

• Fetal alcohol exposure: 2.5%– Uruguayan study population has 18 the

exposure

Comparison to Other Regions

Grey-Bruce, Ontario (Gareri, 2006)

• Fetal alcohol exposure: 2.5%– Uruguayan study population has 18 the

exposure

Honolulu, Hawaii (Derauf et al, 2003)

•Fetal alcohol exposure: 17.1%–Uruguayan study population has 3 the exposure

Multiple Linear Regression(n=681)

– Maternal self-report of tobacco use• β = -0.149, p = 0.001

– Ethyl Linolate• β = -0.108, p = 0.022

– Infant Gender• β = 0.102, p = 0.030

– Maternal BMI • β = 0.100, p = 0.033

p < 0.001 R2 = 0.057

Birth weight can be predicted by

Conclusions

1. This urban Uruguayan population characterized by low socioeconomic status is at very high risk for prenatal alcohol exposure.

Low Socioeconomic Status

Heavy Prenatal Alcohol Exposure

Life Chances

Conclusions (cont.)

2. Prenatal alcohol and tobacco exposure are significant predictors of decreased birth weight in this population.

Acknowledgements

• Dr. Gideon Koren• Dr. Raquel Magri• Dr. Jacob Wolpin• Dr. Bhushan Kapur• Dr. Cindy Woodland• Dr. Tatiana Karaskov• Dr. Hector Suarez