The Global Issue of FASD: Results of Characterizing Alcohol Consumption in Pregnancy in Montevideo, Uruguay

1
The Global Issue of FASD Results of
Characterizing Alcohol Consumption in Pregnancy
in Montevideo, Uruguay

• Janine Hutson, MSc
• Faculty of Medicine, University of Toronto
• Motherisk Laboratory, Hospital for Sick Children

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Publications From Around the World
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Latin America

• Cantabria, Spain
• 22.7 of women reported alcohol consumption
  during pregnancy (n1510)
• (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)

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Latin America

• Santiago, Chile 
• 57.4 lower middle class women reported alcohol
  consumption during pregnancy in a prenatal clinic
  (n9628)
• 101/887 with home visits reported an average of
  ?4 drinks/day
• (Aros et al., 2006)

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Latin America

• Tapachula, Chiapas, Mexico
• 46 women receiving prenatal care reported
  alcohol consumption and alcohol dependence
  (n132)
• 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 gt150g ethanol/week
  (n70)
• (Backstrand et al., 2001)

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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
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Koren et al. CMAJ 20031691181-5.
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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
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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

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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

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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

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Total Births n1115
Completed Maternal Questionnaires n900
Meconium Samples for FAEE Analysis n905
Questionnaires w/o FAEE results n219
Unable to Analyze for FAEE n81
Successful Analysis for FAEE n824
Multiple Births Excluded n2
Matched questionnaire FAEE results n681
Analysis for Cotinine 5 Illicit Drugs n195
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Maternal Characteristics

• Average Age 25
• 11 employed
• 95 did not complete secondary education
• 9 no prenatal care, 30 lt 4 visits

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GC-FID Chromatograms
Internal Standard
Internal Standard
Intensity (mVolts)
Ethyl Oleate Ethyl Linolate Ethyl Linolenate
Time (min)
15
44
42
2 Fetal Alcohol Syndrome
Positive
20 Fetal Alcohol Spectrum Disorder
8
2
2
FAEE Cotinine Amph.
Cocaine THC
Abel. Neurotoxicol Teratol 199517437-43.
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44
42
Positive
8
2
2
FAEE Cotinine Amph.
Cocaine THC
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Comparison to Other Regions

• Grey-Bruce, Ontario (Gareri, 2006)
• Fetal alcohol exposure 2.5
• Uruguayan study population has 18 ? the exposure

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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

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Multiple Linear Regression(n681)
Birth weight can be predicted by

• Maternal self-report of tobacco use
• ß -0.149, p 0.001
• Ethyl Linolate
• ß -0.108, p 0.022
• Infant Gender
• ß 0.102, p 0.030
• Maternal BMI
• ß 0.100, p 0.033
• p lt 0.001
• R2 0.057

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Conclusions

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

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Conclusions (cont.)

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

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Acknowledgements

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