Alcohol consumption among pregnant women in Barcelona (Spain)

1
Alcohol consumption among pregnant women in
Barcelona (Spain)
Oriol Vall Paediatrics Unit, URIE,
Neuropsychopharmacology ProgramIMIM-Hospital del
MarBarcelona

• Alcohol and Pregnancy ConferenceBrussels, 9
  September 2009

2
Migrants Addicts Middle social class
Gipsies
H
3
Our reality Hospital del Mar

• 1.700 deliveries /yr
• 2.000 total paediatric admitions/yr
• 10.000 outpatients /yr
• 15.000 paediatric emergencies/yr

• It is high the addiction among the mothers of
  maternity ward

4
Analyzed substances

• Tobacco
• Opioids and opiates (heroin, methadone)
• Cannabis
• Cocaine
• MDMA (Extasis)
• Alcohol
• Areca nut
• Mate

5
Plan Nacional de Drogas (2006) (Drugs Abuse
National Plan)
General population between 15 and 64 years (by
questionnaire)

• 35.1 tobacco
• 15.3 alcohol
• 6.5 cannabis
• 1.4 cocaine
• 0.6 amphetamines

6
Questionnaire and biomarkers
7
Drugs of abuse
Biological matrices for evaluation of prenatal
exposure to drugs of abuse

• Meconium
• Hair
• Teeth
• Placenta
• Cord blood
• Human milk

Ther Drug Monit 2007 Dec29(6)711-34.
8
Advantagesalternative bilogical matrices

• Non invasive collection
• Easy sample collection
• Wider time window for substance detection
• No degradation

9
Some results published in medical journals
10
(No Transcript)
11
Prenatal exposure to drugs of abuse using
meconium analysis in a low socioeconomic
population in Barcelona Article in Spanish
12
In 353 meconium samples analyzed for detection of
FAEEs, 159 (45) showed results ? 2 nmol/g
meconium 2 nmol/g meconium reference value
internationally considered for distinguishing
during the pergnancy an alcohol important
maternal consumption, from not consumption at all
13

• Prevalence of pregnant chronical consumers y
  gestantes with meconio as biomarcaker
• Women Hawai 16 ()
• Women Canadá 22 ()
• Women Hosp. del Mar 45
• () Moore C,Jones J, Lewis D, Buchi K. Prevalence
  of fatty acid ethyl esters in meconium specimens.
  Clin Chem. 200349133-136.
• () Chan D, Klein J, Karaskov T, Koren G. Fetal
  exposure to alcohol as evidenced by fatty acid
  athyl esters in meconium in absence of maternal
  drinking history in pregnancy. Ther Drug Monit
  2004 26474-481.

14
Is the positive FAEEs more feasible on
polyconsumers pregnant women or addicted only to
alcohol?

• Positive Drug abuse and Positive FAAEs (45.7)
• Negative Drug abuse and Positive FAAEs (44.7)

15
Technicaly, How do we get the biomarkers ?

• FAEEs Liquid chromatography tandem mass
  spectrometry (LC/MS/MS)
• Ethyl Glucoronide (EtG) Immuno assay or GC/MS or
  LC/MS
• Ethyl Sulphate (EtS) Immuno assay or GC/MS or
  LC/MS
• But!! FAEEs versus EtG/EtS NO correlation

FAEEs Faty Acid Esters
16
(No Transcript)
17
In summary

• FAEEs in meconium are the best markers in fetal
  ethanol exposure diagnosis so far
• FAEEs in hair could be useful as well, but
  further studies are needed
• EtG and EtS have been recently detected and
  quantified in meconium. Evaluation of a possible
  cutoff is the next step
• The sensitivity and specificity of EtG in hair is
  well-known and the determination of this
  metabolite in pregnant womens hair could be very
  useful in the diagnosis of gestational ethanol
  exposure

18
Remember FASD is 100 preventable
Neonatal screening for prenatal alcohol exposure
Lead to
An alternative Harm Reduction approach to treat
the mother, her child, and her future pregnancies
Fetal Alcohol Spectrum Disorder
19
Alcohol newborns

• FASD FAS, Partial FAS (PFAS), Alcohol-Related
  birth defects (ARBD), Alcohol-Related
  Neurodevelopment Disorder (ARND)
• Facial dysmorphology
• Growth retardation
• CNS development abnormalities
• FASD is very infrequent as a diagnostic in our
  hospitals despite of the high prenatal alcohol
  exposure
• Why? Maybe
• Health care workers not trained.
• Adverse effects not identified or recognized
  (ADHD, school failure, etc.)
• Depend of differents habits of consumption?

Fetal Alcohol Spectrum Disorders
20
Alcohol newborns

• Ethanol is the main known teratogen
• Specially affects the neurodevelopment and has
  negative cognitive effects
• Brain damage can not be repared...
• But an adequate follow up can achieve the best
  possible neurodevelopment

21
Toronto (Canada) MOTHERISK

• Detection
• Follow up
• Intervention

22
Main objectives
To design and to implement a prenatal diagnosis
and a neonatal screening protocols of prenatal
ethanol exposure
To design an intervention program -
Consumption prevention (clinical guidelines)
- Diagnosis (biomarkers) -
Intervention (structured counseling) -
Follow up (clinical protocol) Pregnancy Without
Alcohol
To check the effectiveness of the intervention
To follow up of children prenatally exposed to
ethanol
23
Translational research and Integrate several areas
Health Education
Clinical Atenttion
Social problems Addiction
Public Health Resources
24
The Proposal

• Is to work in conection with other clinicicians
  and researchers groups in order to improve
• Coordination
• Exchenge information and
• Implementation

25
Towards decreased risks for the fetus and the
mother...
26
Also decreased the risks for the adolescents
Botellones!!
27
And by the timea person reaches adult life
28
RR and 95 CI associated with alcohol
intake lower than 25g/day
Corrao G, Bagnardi V, Zambon A, la Vecchia C. A
meta-analysis of alcohol consumption and the risk
of 15 diseases. Prev Med 2004,38613-9.