Association of fatty acid ethyl esters in meconium and cognitive development during childhood and adolescence.

OBJECTIVE: To examine associations between amounts of fatty acid ethyl esters (FAEEs) in meconium and cognitive development in school-aged children exposed to alcohol and drugs in utero. STUDY DESIGN: A secondary analysis of a prospective cohort of children, primarily African American and of low socioeconomic status, that was recruited at birth. FAEEs were quantified with gas chromatography via a flame ionization detector. Meconium was analyzed for FAEEs in 216 newborns; 191 of these infants were assessed for IQ at ages 9, 11, and 15 years with the Wechsler Intelligence Scales for Children-Fourth Edition. RESULTS: Longitudinal mixed model analyses indicated that, after we controlled for maternal and child covariates, greater concentrations of FAEEs (ethyl myristate, ethyl oleate, ethyl linoleate, and ethyl linolenate) were associated with lower Wechsler Intelligence Scales for Children-Fourth Edition Verbal Comprehension Index, Working Memory Index, and Full-Scale IQ scores. Associations of FAEEs with Verbal Comprehension Index, Working Memory Index, and Full-Scale IQ did not vary over time. No associations of FAEEs with Perceptual Reasoning and Processing Speed Indices were found. CONCLUSION: Elevated levels of FAEEs in meconium are potential markers for identifying newborns at risk for poor cognitive development related to prenatal alcohol exposure.

Fatty acid ethyl esters in meconium are associated with poorer neurodevelopmental outcomes to two years of age.

OBJECTIVE: To determine the relationship between fatty acid ethyl esters (FAEE) in meconium and neurodevelopment in infants exposed to alcohol in utero at 6.5 months, 1 year, and 2 years of age. STUDY DESIGN: A secondary analysis of a prospective cohort of mothers at high risk and their infants recruited after admission to a labor and delivery unit. Mothers were screened for drug and alcohol use during pregnancy by clinical interview and urine screening. Meconium was analyzed for FAEE in 216 newborn infants. Outcome measures included the Bayley Scales of Infant Development Mental (MDI) and Psychomotor (PDI) Developmental Index scores in infants at 6.5 months, 1 year, and 2 years of age. RESULTS: After controlling for prenatal visits and maternal factors, increasing concentrations of FAEE were significantly associated with poorer mental and psychomotor development (beta +/- standard error) at all follow-up visits: ethyl myristate (MDI -2.46 +/- 1.24, P = .05; PDI -3.88 +/- 1.67, P = .02), ethyl oleate (MDI -1.94 +/- 0.65, P < .01; PDI -2.60 +/- 0.93, P < .01), ethyl linoleate (MDI -1.92 +/- 0.60, P < .01; PDI -2.28 +/- 0.84, P < .01), ethyl linolenate (MDI -1.99 +/- 0.74, P < .01; PDI -2.98 +/- 1.04, P < .01), and ethyl arachidonate (MDI -2.40 +/- 1.11, P = .03; PDI -3.32 +/- 1.51, P = .03). CONCLUSION: FAEE in meconium may be a marker for identifying newborns at risk for neurodevelopmental delay from alcohol exposure in utero.

Fatty Acid ethyl esters: quantitative biomarkers for maternal alcohol consumption.

OBJECTIVE: To develop a laboratory marker to identify newborns exposed to alcohol. STUDY DESIGN: Meconium was collected from 30 infants from Jordan who were unexposed and from 248 Cleveland study infants of varying exposure status. Retrospective maternal alcohol histories were obtained. Fatty acid ethyl esters (FAEEs) were quantified with gas chromatography/flame ionization and compared between abstainers and non-abstainers to identify FAEEs of interest. The area under the receiver operating characteristic curve, sensitivity, specificity, and positive and negative predictive values were calculated by using definitions of drinking obtained from a graphical representation. RESULTS: Six of 7 FAEEs were significantly different between the non-abstainers and at least 1 of 2 of the abstaining groups. FAEEs best predicted drinks per drinking day, and ethyl linoleate had the greatest area under the curve (76%), with a sensitivity rate of 88%, a specificity rate of 64%, a positive predictive value of 9%, and a negative predictive value of 99%. No combination of FAEEs was better than a single ester for identifying drinkers. CONCLUSION: Ethyl linoleate in meconium is a useful biological marker for identifying infants not exposed in utero to high levels of alcohol in a high-risk, substance-abusing, clinic-based sample.

Validation of a new biomarker of fetal exposure to alcohol.

OBJECTIVE: To test the sensitivity and specificity of fatty acid ethyl esters (FAEEs) extracted from meconium to identify alcohol-using pregnant women with a sensitive and specific methodology, gas chromatography-tandem mass spectroscopy (GC/MS/MS). Study design Twenty-seven samples of meconium were obtained from infants from the mixed race community in Cape Town, South Africa, who were enrolled in a longitudinal neurobehavioral study. Maternal alcohol use was reported prospectively during pregnancy. FAEEs were isolated from meconium and quantitated by GC/MS/MS. RESULTS: Ethyl oleate was the FAEE that correlated most strongly with maternal self-reported drinking, especially with the average ounces of absolute alcohol ingested per drinking day. Ethyl oleate was most strongly related to drinking in the second and third trimesters (Pearson r=.55 and.40, respectively). At a threshold of 1.5 average ounces of absolute alcohol ingested per drinking day, the area under the receiving operator characteristic curve was.92 (95% confidence interval, 0.74-0.97). Using a cut-off value of 32 ng/g, sensitivity was 84.2% and specificity was 83.3%. CONCLUSIONS: Ethyl oleate concentration in meconium assayed by GC/MS/MS provides a highly sensitive and specific indicator of maternal alcohol use during pregnancy.