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Alcohol consumption among pregnant women in Barcelona (Spain). Alcohol and Pregnancy Conference Brussels, 9 September 2009. Oriol Vall Paediatrics Unit, URIE, Neuropsychopharmacology Program IMIM-Hospital del Mar Barcelona. Vila Olimpica. Ciutat Vella. Barceloneta. La Mina. - PowerPoint PPT Presentation
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Alcohol consumption among pregnant women in Barcelona
(Spain)
Alcohol and Pregnancy ConferenceBrussels, 9 September 2009
Oriol Vall
Paediatrics Unit, URIE, Neuropsychopharmacology ProgramIMIM-Hospital del Mar
Barcelona
Migrants Addicts Middle social class Gipsies
Ciutat Vella Barceloneta Vila Olimpica La Mina
H
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
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Tobacco
Opioids and opiates (heroin, methadone)
Cannabis
Cocaine
MDMA (Extasis)
Alcohol
Areca nut
Mate
Analyzed substances
Plan Nacional de Drogas (2006) *(Drugs Abuse National Plan)
35.1 % tobacco
15.3 % alcohol
6.5 % cannabis
1.4 % cocaine
0.6 % amphetamines
General population between 15 and 64 years (by questionnaire):
Questionnaire and biomarkers
Drugs of abuse:
Meconium Hair Teeth Placenta Cord blood Human milk
Biological matrices for evaluation of prenatal exposure to drugs of abuse
Ther Drug Monit 2007 Dec;29(6):711-34.
Advantages:alternative bilogical matrices
Non invasive collection
Easy sample collection
Wider time window for substance detection
No degradation
Some results published in medical journals
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[Prenatal exposure to drugs of abuse using meconium analysis in a low socioeconomic population in Barcelona]
[Article in Spanish]
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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
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. 2003;49:133-136.
(**) 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; 26:474-481.
- Positive Drug abuse and Positive FAAEs (45.7%)
- Negative Drug abuse and Positive FAAEs (44.7%)
Is the positive FAEEs more feasible on polyconsumers pregnant women or addicted only to alcohol?
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
Technicaly, ¿ How do we get the biomarkers ?
*FAEEs: Faty Acid Esters
PapaseitPapaseit E* , E* , J oyaJ oya X* , Pichini S* * , X* , Pichini S* * , GarcGarcííaa AlgarAlgar O* , O* , MoriniMorini L* * * ,L* * * , VagnarelliVagnarelli F* * * * , F* * * * , Vall O* and Vall O* and de la Torre R* .de la Torre R* .(* ) (* ) I nstitutI nstitut Municipal Municipal dd’’I nvestigaciI nvestigacióó MMèèdicadica-- NeuropsychopharmacologyNeuropsychopharmacology ProgrammeProgramme, Barcelona, Spain., Barcelona, Spain.(* * ) (* * ) I stitutoI stituto SuperioreSuperiore didi SanitSanitàà, Rome, I taly., Rome, I taly.(* * * ) (* * * ) DepartmentDepartment of of LegalLegal Medicine and Public Medicine and Public HealthHealth, University of Pavia, , University of Pavia, I talyI taly..(* * * * ) (* * * * ) ArcispedaleArcispedale Santa Maria Santa Maria NuovaNuova, Reggio Emilia, I taly., Reggio Emilia, I taly.
The preliminary results of our study evidence for first time the presence of EtG and EtS in meconium. Further investigations are ongoing to verify the use of these two ethanol metabolites
as alternative biomarkers of chronic in utero exposure to alcohol.
ETHYLGLUCURONIDE AND ETHYLSULFATE IN MECONIUM: ETHYLGLUCURONIDE AND ETHYLSULFATE IN MECONIUM: NEW BIOMARKERS OF GESTATIONAL ETHANOL EXPOSURE?NEW BIOMARKERS OF GESTATIONAL ETHANOL EXPOSURE?
Results and Discussion
Objectives: To investigate: (1) the presence and the concentration of EtG and EtS in meconium from two
different European newborn cohorts and (2) the eventual correlation between these two biomarkers and FAEEs
from the same meconium samples.
Material and methods: Liquid chromatography tandem mass spectrometry was applied to measure EtG, EtS and FAEE in meconium samples obtained from Reggio
Emilia, I taly (n=60) and from Barcelona, Spain (n=50).
LOQ for EtS in meconium samples:1 ng/ g
LOQ for EtG in meconium samples:5 ng/ g
MECONI UM ANALYSI S in 60 samples of Reggio EmiliaMeconium analysis revealed:59 FAEE<2nmol/ g of 60 total samples.
MECONI UM ANALYSI S in 50 samples of BarcelonaMeconium analysis disclosed:24 samples FAEE>2nmol/ g sample and 26 FAEE<2nmol/ g.
[email protected]@iss.it
FAEE MENOR 2 FAEE MAYOR 2
0,00
1,00
2,00
3,00
4,00
5,00
6,00
FAEE MENOR 2 FAEE MAYOR 2
0,00
200,00
400,00
600,00
800,00
1.000,00
FAEE>2
EtGmean
EtSmean
Fatty acid ethylesters (nmol/g)
EtG and EtS values did not correlate with total amount of the seven FAEEs in both Reggio Emilia and Barcelona meconium samples. This could be due
to the different mechanism of formation of these metabolites.
The preliminary results showed values of EtGin meconium samples from Reggio Emilia were statistically lower than those from Barcelona specimens, similarly to what
happen with FAEEs.
Prevalence of fetal alcohol exposure
45% 45% ethanolethanol consumptionconsumption duringduring pregnancypregnancy
in in accordanceaccordance withwith previousprevious studiesstudies* .* .*Garcia-Algar O, Kulaga V, Gareri J, Koren G, Vall O, Zuccaro P, Pacifici R, Pichini S. Alarming prevalence of fetal alcohol exposure in a Mediterranean city. Ther DrugMonit. 2008 Apr;30(2):249-54.
0 100 200 300 400 500 600
0 0,5 1 1,5 2 2,5 3 3,5 4
Barras 2Barras 1
EtG ng/ g
FAEE>2 FAEE<2FAEE<2
BarcelonaBarcelona
ReggioReggio EmiliaEmilia
Similar sociodemographic
and ethnic
characteristics
EtS ng/ g
When considering only Barcelona samples with FAEEsbelow 2 nmol/g, values of EtG that were still different in
the two cohorts. Conversely, EtS values were similar when comparing the whole samples from the two city cohorts and also RE samples with those from BCN with FAEEs
below 2 nmol/g.
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 women’s hair could be very useful in the diagnosis of gestational ethanol exposure
An alternative: Harm Reduction approach to treat the mother, her child, and her future pregnancies
Neonatal screening for prenatal alcohol exposure
Remember……
FASD* is 100% preventable
Lead to
* Fetal Alcohol Spectrum Disorder
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
• 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
Alcohol: newborns
Toronto (Canada): MOTHERISK
Detection
Follow up
Intervention
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
Translational research and Integrate several areas
Social problemsAddiction
Clinical AtenttionHealth Education
Public HealthResources
Is to work in conection with other clinicicians and researchers groups in order to improve:
Coordination
Exchenge information and
Implementation
The Proposal
Towards decreased risks for
the fetus and the mother...
Also decreased the risks for the adolescents…
¡¡Botellones!!
And… by the timea person reaches adult life
Corrao G, Bagnardi V, Zambon A, la Vecchia C. A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med 2004,38:613-9.
RR and 95% CI associated with alcohol intakelower than 25g/day