The Global Issue of FASD: Results of Characterizing Alcohol Consumption in Pregnancy in Montevideo, Uruguay - PowerPoint PPT Presentation

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

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Title: Fatty Acid Ethyl Esters as a Biomarker of in utero Alcohol Exposure Author: Janine Hutson Last modified by: Janine Created Date: 11/8/2005 11:40:57 PM – PowerPoint PPT presentation

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Title: 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

2
Publications From Around the World
3
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)

4
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)

5
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)

6
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
7
Koren et al. CMAJ 20031691181-5.
8
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
9
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

10
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

11
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

12
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
13
Maternal Characteristics
  • Average Age 25
  • 11 employed
  • 95 did not complete secondary education
  • 9 no prenatal care, 30 lt 4 visits

14
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.
16
44
42
Positive
8
2
2
FAEE Cotinine Amph.
Cocaine THC
17
Comparison to Other Regions
  • Grey-Bruce, Ontario (Gareri, 2006)
  • Fetal alcohol exposure 2.5
  • Uruguayan study population has 18 ? the exposure

18
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

19
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

20
Conclusions
  1. This urban Uruguayan population characterized by
    low socioeconomic status is at very high risk for
    prenatal alcohol exposure.

21
Conclusions (cont.)
  • Prenatal alcohol and tobacco exposure are
    significant predictors of decreased birth weight
    in this population.

22
Acknowledgements
  • Dr. Gideon Koren
  • Dr. Raquel Magri
  • Dr. Jacob Wolpin
  • Dr. Bhushan Kapur
  • Dr. Cindy Woodland
  • Dr. Tatiana Karaskov
  • Dr. Hector Suarez
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