title: Neonatal screening for prenatal alcohol exposure: assessment of voluntary maternal participation in an open meconium screening program.
abstract: Meconium fatty acid ethyl esters (FAEEs) are validated biomarkers of fetal alcohol exposure. Meconium FAEE testing can potentially be used as a screen by health-care professionals to identify neonates at-risk for Fetal Alcohol Spectrum Disorder, thereby permitting diagnostic follow-up of these children and early intervention in those who develop disabilities. The purpose of this study was to assess whether women would willingly partake in a screening program of this nature. This was determined by launching a pilot screening program for prenatal alcohol exposure in a high-risk obstetric unit previously shown to have a high prevalence of FAEE-positive meconium via anonymous meconium testing. The program involved voluntary testing of meconium for FAEEs and long-term developmental follow-up of positive cases through an existing public health program. The participation rate in the screening program was significantly lower than when testing was conducted anonymously (78% vs. 95%, respectively; p < 0.05), and the positivity rate was 3% in contrast to 30% observed under anonymous conditions (p < 0.001). These low rates suggest that the majority of mothers who consumed alcohol in pregnancy refused to participate. We conclude that despite the potential benefits of such screening programs, maternal unwillingness to consent, likely due to fear, embarrassment, and guilt, may limit the effectiveness of meconium testing for population-based open screening, highlighting the need for public education and social marketing efforts for such programs to be of benefit.
authors.affiliation: Division of Clinical Pharmacology & Toxicology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Irene
authors.initials: I
authors.lastname: Zelner
authors.forename: Sarit
authors.initials: S
authors.lastname: Shor
authors.forename: Hazel
authors.initials: H
authors.lastname: Lynn
authors.forename: Henry
authors.initials: H
authors.lastname: Roukema
authors.forename: Lisa
authors.initials: L
authors.lastname: Lum
authors.forename: Kirsten
authors.initials: K
authors.lastname: Eisinga
authors.forename: Gideon
authors.initials: G
authors.lastname: Koren
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D015415:Biomarkers / Q000032:analysis; D002657:Child Development / Q000502:physiology; D002675:Child, Preschool; D061345:Early Medical Intervention; D004952:Esters / Q000032:analysis; D005227:Fatty Acids / Q000032:analysis; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007258:Informed Consent; D008470:Meconium / Q000737:chemistry*; D015997:Neonatal Screening / Q000191:economics / Q000379:methods*; D009864:Ontario / Q000453:epidemiology; D010865:Pilot Projects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D014836:Volition
chemical_list: D015415:Biomarkers; D004952:Esters; D005227:Fatty Acids