Agreement Between Maternal Self-Reported Ethanol Intake and Tobacco Use During Pregnancy and Meconium Assays for Fatty Acid Ethyl Esters and Cotinine

Chris Derauf, Alan R. Katz, David Easa

First Published: 01 October 2003   DIO: 10.1093/aje/kwg215

Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, HI. Department of Public Health Sciences and Epidemiology, University of Hawaii John A. Burns School of Medicine, Honolulu, HI.

Abstract

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Summary

Reliance on maternal self-reporting of ethanol intake and tobacco use during pregnancy is associated with a high probability of error. Numerous studies have documented substantial underreporting. Early identification of gestational exposure to illicit drugs, alcohol, and tobacco is important so that appropriate diagnostic and therapeutic interventions may be offered. In addition, mothers who continue to use these substances put their children at high risk for adverse health outcomes, including abusive and neglectful parenting, and should be targeted for postnatal support services.

The use of biological markers, or biomarkers, to identify drug exposure during pregnancy has been demonstrated for illicit and licit drugs such as cocaine, amphetamines, marijuana, opiates, and tobacco. Toxicologic assay of neonatal urine at the time of birth has been the most commonly used methodology. However, because of the relatively short window of opportunity for detection, urine testing frequently gives false-negative results and underestimates drug exposure. Recent reports have shown the superiority of meconium assays for detecting in-utero drug exposure.

Cotinine, a nicotine metabolite, has been measured in both neonatal urine and meconium. It is relatively stable, with a urinary half-life of approximately 24 hours, and is an established biomarker for both active and passive tobacco exposure. Unlike the situation for nicotine, there is presently no conventionally accepted biomarker for diagnosing long-term in utero ethanol exposure. Because the half-life of ingested ethanol is less than 1 hour, even mothers who drink daily during pregnancy may have negative ethanol toxicology screens if a drink has not been consumed within a few hours prior to presentation. Recent reports have identified fatty acid ethyl esters (FAEE), nonoxidative metabolites of ethanol that result from the transesterification of ethanol with fatty acids, as sensitive and stable biomarkers for ethanol exposure. FAEE have a prolonged half-life compared with ethanol and its oxidative metabolites, and serum levels in adults have correlated well with ethanol ingestion. Several authors have reported that both the placenta and meconium itself appear to have the necessary enzymes to produce these ethanol metabolites. In addition, a number of recent studies have reported increased levels of FAEE in the meconium of neonates exposed to ethanol in utero.

The purpose of this study was to assess the concordance between maternal self-reported tobacco use and ethanol intake during pregnancy and detection in neonatal meconium of the tobacco and ethanol metabolites, cotinine and FAEE, in a cohort of women giving birth at a large urban regional perinatal center.