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

This study analyzes the prevalence of prenatal alcohol consumption in Montevideo, Uruguay and its impact on birth weight. The findings highlight the high risk of alcohol exposure and demonstrate its significant negative effect on birth weight.

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

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  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 (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)

  4. 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)

  5. 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)

  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 2003;169:1181-5.

  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 n=1115 Completed Maternal Questionnaires n=900 Meconium Samples for FAEE Analysis n=905 Unable to Analyze for FAEE n=81 Successful Analysis for FAEE n=824 Questionnaires w/o FAEE results n=219 Multiple Births Excluded n=2 Matched questionnaire & FAEE results n=681 Analysis for Cotinine & 5 Illicit Drugs n=195

  13. Maternal Characteristics • Average Age = 25 • 11% employed • 95% did not complete secondary education • 9% no prenatal care, 30% < 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 1995;17:437-43.

  16. Alcohol Tobacco Stimulants Cocaine THC 37% 42% 1% 0.4% 1.5% Self-Report 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(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

  20. Low Socioeconomic Status Heavy Prenatal Alcohol Exposure  Life Chances Conclusions • 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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