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The Global Issue of FASD: Results of Characterizing Alcohol
Consumption in Pregnancy in Montevideo, Uruguay
Janine Hutson, MScFaculty of Medicine, University of Toronto
Motherisk Laboratory, Hospital for Sick Children
Latin America• Cantabria, Spain
– 22.7% of women reported alcohol consumption during pregnancy (n=1510) (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)
Latin America
• Santiago, Chile – 57.4% lower middle class women
reported alcohol consumption during pregnancy in a prenatal clinic (n=9628)
– 101/887 with home visits reported an average of 4 drinks/day
(Aros et al., 2006)
Latin America• Tapachula, Chiapas, Mexico
– 46% women receiving prenatal care reported alcohol consumption and alcohol dependence (n=132)
– 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 >150g ethanol/week (n=70) (Backstrand et al., 2001)
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
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
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
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
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
Completed Maternal Questionnaires n=900
Total Births n=1115
Meconium Samples for FAEE Analysis n=905
Analysis for Cotinine & 5 Illicit Drugs n=195
Matched questionnaire & FAEE results n=681
Questionnaires w/o FAEE results n=219
Unable to Analyze for FAEE n=81
Successful Analysis for FAEE n=824
Multiple Births Excluded n=2
Maternal Characteristics
• Average Age = 25
• 11% employed
• 95% did not complete secondary education
• 9% no prenatal care, 30% < 4 visits
GC-FID Chromatograms
Ethyl Oleate
Ethyl Linolate
Ethyl Linolenate
Internal Standard
Internal Standard
Inte
nsi
ty (
mV
olt
s)
Time (min)
0
5
10
15
20
25
30
35
40
45
50%
Pos
itiv
e
FAEE Cotinine Amph. Cocaine THC
44%42%
8%2% 2%
2% Fetal Alcohol Syndrome*
*Abel. Neurotoxicol Teratol 1995;17:437-43.
20% Fetal Alcohol Spectrum Disorder*
0
5
10
15
20
25
30
35
40
45
50%
Pos
itiv
e
FAEE Cotinine Amph. Cocaine THC
44%42%
8%2% 2%
Alcohol Tobacco Stimulants Cocaine THC
37% 42% 1% 0.4% 1.5% Self-Report
Comparison to Other Regions
Grey-Bruce, Ontario (Gareri, 2006)
• Fetal alcohol exposure: 2.5%– Uruguayan study population has 18 the
exposure
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
Multiple Linear Regression(n=681)
– Maternal self-report of tobacco use• β = -0.149, p = 0.001
– Ethyl Linolate• β = -0.108, p = 0.022
– Infant Gender• β = 0.102, p = 0.030
– Maternal BMI • β = 0.100, p = 0.033
p < 0.001 R2 = 0.057
Birth weight can be predicted by
Conclusions
1. This urban Uruguayan population characterized by low socioeconomic status is at very high risk for prenatal alcohol exposure.
Low Socioeconomic Status
Heavy Prenatal Alcohol Exposure
Life Chances
Conclusions (cont.)
2. Prenatal alcohol and tobacco exposure are significant predictors of decreased birth weight in this population.