Ethyl Linolenate is Elevated in Meconium of Very Low Birthweight Neonates Exposed to Alcohol in Utero Público
Gross, Teresa Shireen (2016)
Published
Abstract
Objectives: In an effort to improve research on the specific health complications of alcohol exposure during development, this study is to evaluates fatty acid ethyl esters (FAEEs) in meconium as potential biomarkers of in utero alcohol exposure in very low birth weight (VLBW) neonates. Meconium FAEEs have been studied in full term neonates with alcohol exposure in high quantities late in pregnancy. To study meconium FAEEs in VLBW neonates, first it needs to be determined if FAEEs are present in quantifiable amounts in VLBW neonates. Then an association between alcohol exposure in utero and meconium FAEE concentration needs to be established. Finally, a model will be developed to identify which VLBW neonates were exposed to alcohol in utero.
Methods: This retrospective cohort study included 70 neonates weighing less than 1500 grams who were admitted to the NICUs at Grady Memorial Hospital and Emory University Hospital Midtown. Meconium samples from each neonate were processed with gas chromatography mass spectrometry to quantify the concentration of FAEEs. Mothers underwent an in depth structure interview to determine the timing and quantity of alcohol consumption during pregnancy. Alcohol consumers were classified as those drinking at least one alcoholic beverage during the first trimester, and alcohol abstainers as those who drank zero. FAEE concentrations were compared between alcohol consumers and alcohol abstainers.
Results: Thirty percent of women reported drinking alcohol during the first trimester of pregnancy. FAEE concentrations were measurable in the meconium of 69 out of 70 neonates. The FAEE ethyl linolenate was significantly elevated when mothers reported alcohol consumption during trimester one (p=0.02). A simple logistic regression model including meconium ethyl linolenate concentration, birth weight, and maternal drinking status before pregnancy differentiated the alcohol abstainers from the alcohol consumers with 89% sensitivity and 87% specificity.
Conclusions: Meconium FAEEs were measurable in over 98% of VLBW neonates, with ethyl linolenate showing a significant positive association with alcohol consumption during pregnancy. A model based on this FAEE could accurately differentiate alcohol abstainers from consumers with 89% sensitivity and 87% specificity. In future, this biomarker may help in risk management of neonates exposed to alcohol in utero.
Table of Contents
Introduction. 1
Background. 3
Methods. 11
Results. 17
Discussion. 21
References. 25
Tables and Figures. 28
Figure 1. Retrospective cohort study design of 70 women recruited at Emory Midtown Hospital NICU and Grady Memorial Hospital NICU who were divided into alcohol abstainer and alcohol consumer groups. 28
Figure 2. Causal diagram depicting relationship of alcohol consumption, maternal alcohol consumption reported in interviews, and meconium FAEEs. 29
Table 1A. Maternal Characteristics for 64 very low birth weight neonates from the NICUs of Grady Memorial Hospital and Emory Midtown Hospital. 30
Table 1B. Characteristics of 64 very low birth weight neonates from the NICUs of Grady Memorial Hospital and Emory Midtown Hospital. 31
Figure 3. Fatty acid ethyl ester (FAEE) concentration, by type, in meconium of 69 very low birth weight neonates from the NICUs of Grady Memorial Hospital and Emory Midtown Hospital, as determined by Gas Chromatography Mass Spectrometry. 32
Table 2A. Characteristics of 64 mothers who had just given birth to very low birth weight neonates in the NICUs at Grady Memorial Hospital and Emory Midtown Hospital. 33
Table 2B. Characteristics of 64 very low birth weight neonates in the NICUs at Grady Memorial Hospital and Emory Midtown Hospital. 34
Table 3. Fatty acid ethyl ester (FAEE) concentration, by type, in meconium of 64 very low birth weight neonates comparing those had not been exposed to alcohol in utero compared to those who had been exposed to alcohol in utero. 35
Figure 4. Ethyl linolenate concentration in meconium of 64 very low birth weight neonates comparing those had not been exposed to alcohol in utero compared to those who had been exposed to alcohol in utero. 36
Figure 5. Receiver Operating Curve of logistic regression model characterizing 64 very low birth weight neonates as alcohol exposed or unexposed based on Ethyl Linolenate only. 37
Figure 6. Receiver Operating Curve of multivariate logistic regression model characterizing 64 very low birth weight neonates as alcohol exposed or unexposed based on Ethyl Linolenate with adjustments for demographic variables. 38
Table 4. Odds Ratios of variables in final fully adjusted logistic regression model used to characterize 64 very low birth weight neonates as part of the alcohol abstainer group or the alcohol consumer group. 39
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