Identifying Alcohol-Exposed Newborns

By Charles Plate, PhD, Laboratory Director, USDTL

Alcohol is a teratogen (causes birth defects) and acts principally by inducing a variety of neurological defects in the developing infant brain. Consumption of alcohol by a pregnant woman results in a spectrum of fetal development disorders that is now referred to as Fetal Alcohol Spectrum Disorder (FASD) which includes physical, clinical and behavioral effects.1 In a recent study to determine the prevalence, patterns, and predictors of alcohol consumption prior to and during various intervals of pregnancy in the United States, it was found that 30.3% of women reported drinking alcohol at some time during the pregnancy. The most common pattern reported was to drink during the first month of pregnancy and then abstain for the remainder of the pregnancy (13.9%). The second most common pattern was to drink through all the trimesters of the pregnancy (2.7%), and the third most common pattern was to abstain until the third trimester and then resume drinking (2.5%).2

An unfortunate fact about FASD is that it is not diagnosed until several years after birth, when the alcohol damage has become irreversible and permanent.1 Diagnosis of FASD shortly after birth would allow societal and clinical treatments to be applied and, while these treatments cannot reverse FASD, they can benefit the child by limiting mental impairments, improving health care, and enriching the learning environment.1

For over 20 years United States Drug Testing Laboratories, Inc. (USDTL) has been offering fatty acid ethyl ester (FAEE) testing of a newborn’s meconium that, when positive, is an indicator that the newborn has been exposed to alcohol in utero.3,4 FAEEs are formed only in the presence of ethanol. However, meconium is not always available for testing, or there is an insufficient amount, and this happens with anywhere from 9 to 27% of newborns.

In 2008 USDTL introduced umbilical cord testing to determine exposure of the fetus to drugs of abuse in utero. In 2010 USDTL introduced CordStat® EtOH which measured the direct alcohol biomarker phosphatidylethanol (PEth) in umbilical cord tissue. PEth is a biomarker of dangerous (binge3) drinking in the last two to four weeks of pregnancy. We have determined the frequency of PEth in umbilical cord tissue to be less than 1%, which is consistent with 0.5% of women who binge drink in the third trimester. 2 Recent research at USDTL has revealed the presence of ethyl glucuronide (EtG), another direct alcohol biomarker, in some umbilical cord tissues. To determine the frequency of EtG in umbilical cord tissue, we have examined over one thousand umbilical cords and have found EtG present in approximately 2% of them. These findings indicate that EtG is detecting newborns that have been exposed to alcohol levels lower than what result from binge drinking in the third trimester. It is possible that EtG is detecting either those mothers who drink during all the trimesters of their pregnancy (2.7%), or those mothers who abstain until the third trimester, and then drink (2.5%). In either case EtG appears to be superior to PEth in detecting a broader spectrum of drinking habits and, thereby, the number of infants exposed to alcohol that it detects.

1. Pass K. A., Mizejewski G. J. 2009. Is it time for newborn screening for fetal alcohol spectrum disorders: A commentary. J. Pediatr Sci 1: e5.
2. Ethen M. K. et al. 2009. Alcohol consumption by women before and during pregnancy. Matern Child Health J 13: 274-285.
3. What is binge drinking? According to the National Institute on Alcohol Abuse and Alcoholism binge drinking is defined as a pattern of alcohol consumption that brings the blood alcohol concentration (BAC) level to 0.08% or more. This pattern of drinking usually corresponds to 5 or more drinks on a single occasion for men or 4 or more drinks on a single occasion for women http://www.cdc.gov/alcohol/faqs.htm#bingeDrinking

Charles Plate received his doctorate in biochemistry from Duke University Medical Center, and spent two years as an American Cancer Society postdoctoral fellow and six years as a research associate with Nobel Laureate Salvador Luria at the Massachusetts Institute of Technology. In 2004, Plate assumed the position of laboratory director at USDTL, where he also supervises research and development.