title: Clinical sensitivity and specificity of meconium fatty acid ethyl ester, ethyl glucuronide, and ethyl sulfate for detecting maternal drinking during pregnancy.
abstract: BACKGROUND
  We investigated agreement between self-reported prenatal alcohol exposure (PAE) and objective meconium alcohol markers to determine the optimal meconium marker and threshold for identifying PAE.
  
  
  METHODS
  Meconium fatty acid ethyl esters (FAEE), ethyl glucuronide (EtG), and ethyl sulfate (EtS) were quantified by LC-MS/MS in 0.1 g meconium from infants of Safe Passage Study participants. Detailed PAE information was collected from women with a validated timeline follow-back interview. Because meconium formation begins during weeks 12-20, maternal self-reported drinking at or beyond 19 weeks was our exposure variable.
  
  
  RESULTS
  Of 107 women, 33 reported no alcohol consumption in pregnancy, 16 stopped drinking by week 19, and 58 drank beyond 19 weeks (including 45 third-trimester drinkers). There was moderate to substantial agreement between self-reported PAE at ≥19 weeks and meconium EtG ≥30 ng/g (κ = 0.57, 95% CI 0.41-0.73). This biomarker and associated cutoff was superior to a 7 FAEE sum ≥2 nmol/g and all other individual and combination marker cutoffs. With meconium EtG ≥30 ng/g as the gold standard condition and maternal self-report at ≥19 weeks' gestation as the test condition, 82% clinical sensitivity (95% CI 71.6-92.0) and 75% specificity (95% CI 63.2-86.8) were observed. A significant dose-concentration relationship between self-reported drinks per drinking day and meconium EtG ≥30 ng/g also was observed (all P < 0.01).
  
  
  CONCLUSIONS
  Maternal alcohol consumption at ≥19 weeks was better represented by meconium EtG ≥30 ng/g than currently used FAEE cutoffs.
authors.affiliation: Chemistry and Drug Metabolism Section, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD;
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Himes
authors.affiliation: DM-STAT Inc., Malden, MA;
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Dukes
authors.affiliation: DM-STAT Inc., Malden, MA;
authors.forename: Tara
authors.initials: T
authors.lastname: Tripp
authors.affiliation: DM-STAT Inc., Malden, MA;
authors.forename: Julie M
authors.initials: JM
authors.lastname: Petersen
authors.affiliation: DM-STAT Inc., Malden, MA;
authors.forename: Cheri
authors.initials: C
authors.lastname: Raffo
authors.affiliation: Department of Pediatrics, University of North Dakota School of Medicine, Grand Forks, ND;
authors.forename: Larry
authors.initials: L
authors.lastname: Burd
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Tygerberg, South Africa;
authors.forename: Hein
authors.initials: H
authors.lastname: Odendaal
authors.affiliation: Center for Health Outcomes and Prevention Research, Sanford Research, Sioux Falls, SD;
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Elliott
authors.affiliation: Division of Metabolism and Health Effects, National Institute on Alcohol Abuse and Alcoholism, NIH, Rockville, MD;
authors.forename: Dale
authors.initials: D
authors.lastname: Hereld
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD.
authors.forename: Caroline
authors.initials: C
authors.lastname: Signore
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD.
authors.forename: Marian
authors.initials: M
authors.lastname: Willinger
authors.affiliation: Chemistry and Drug Metabolism Section, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD; mhuestis@intra.nida.nih.gov.
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Huestis
mesh_terms: D000428:Alcohol Drinking; D015415:Biomarkers / Q000097:blood*; D002853:Chromatography, Liquid; D004952:Esters / Q000737:chemistry; D005227:Fatty Acids / Q000097:blood* / Q000737:chemistry; D005260:Female; D005965:Glucuronates / Q000097:blood*; D006801:Humans; D057230:Limit of Detection; D008470:Meconium / Q000737:chemistry*; D011247:Pregnancy; D012680:Sensitivity and Specificity; D013463:Sulfuric Acid Esters / Q000097:blood*; D053719:Tandem Mass Spectrometry
chemical_list: D015415:Biomarkers; D004952:Esters; D005227:Fatty Acids; D005965:Glucuronates; D013463:Sulfuric Acid Esters; C093924:ethyl glucuronide; C011612:diethyl sulfate