title: Advanced gestational age increases serum carbohydrate-deficient transferrin levels in abstinent pregnant women.
abstract: OBJECTIVE
  Carbohydrate-deficient transferrin (%CDT) is a well-established and highly specific biomarker for sustained heavy consumption of alcohol. However, in pregnant women, the specificity of this biomarker might be affected by advanced gestational age, even after accounting for increased transferrin concentrations in pregnancy. The goal of this prospective study was to assess the variability in %CDT during pregnancy among alcohol-abstaining patients.
  
  
  METHODS
  Patients were recruited during one of the first prenatal care visits and followed-up to term. Abstinence was confirmed by maternal self-report and by alcohol biomarkers. Biomarkers assessed in the mother included serum gamma-glutamyltranspeptidase, urine ethyl glucuronide and ethyl sulfate, and whole blood phosphatidylethanol (PEth). In addition, PEth was measured in a dry blood spot card obtained from a newborn. For %CDT analysis, serum samples were collected at baseline and at term and analyzed by an internationally validated high-performance liquid chromatography and spectrophotometric detection method.
  
  
  RESULTS
  At recruitment (mean gestational age 22.6 ± 7.3 weeks), the mean %CDT concentration was 1.49 ± 0.30%, while at term, it increased to 1.67 ± 0.28% (P = 0.001). Using a conventional cutoff concentration %CDT >1.7%, 22.9 and 45.7% of the sample would be classified as 'positive' for this biomarker at recruitment and at term, respectively (P = 0.011 ).
  
  
  CONCLUSIONS
  These results suggest that a conventional cutoff of 1.7% might be too low for pregnant women and would generate false-positive results. We propose that %CDT >2.0% be used as a cutoff concentration indicative of alcohol exposure in pregnant women. The sensitivity of %CDT at this cutoff for heavy drinking during pregnancy needs to be assessed further.
authors.affiliation: Department of Pharmacy Practice and Administrative Sciences, University of New Mexico Health Sciences Center, MSC09 5360, Albuquerque, NM 87131, USA. lbakhireva@salud.unm.edu
authors.forename: Ludmila N
authors.initials: LN
authors.lastname: Bakhireva
authors.forename: Sandra
authors.initials: S
authors.lastname: Cano
authors.forename: William F
authors.initials: WF
authors.lastname: Rayburn
authors.forename: Renate D
authors.initials: RD
authors.lastname: Savich
authors.forename: Lawrence
authors.initials: L
authors.lastname: Leeman
authors.forename: Raymond F
authors.initials: RF
authors.lastname: Anton
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Savage
mesh_terms: D000367:Age Factors; D000428:Alcohol Drinking / Q000097:blood* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013695:Temperance; D014168:Transferrin / Q000031:analogs & derivatives* / Q000378:metabolism; D055815:Young Adult
chemical_list: D015415:Biomarkers; D014168:Transferrin; C056759:carbohydrate-deficient transferrin