title: Ethylglucuronide in maternal hair as a biomarker of prenatal alcohol exposure.
abstract: While direct ethanol metabolites, including ethylglucuronide (EtG), play an important role for the confirmation of prenatal alcohol exposure (PAE), their utility is often limited by their short half-lives in blood and urine. Maternal hair allows for a retrospective measure of PAE for up to several months. This study examined the validity of hair EtG (hEtG) relative to self-reporting and five other biomarkers in 85 pregnant women. Patients were recruited from a UNM prenatal clinic, which provides care to women with substance abuse and addiction disorders. The composite index, which was based on self-reported measures of alcohol use and allowed us to classify subjects into PAE (n = 42) and control (n = 43) groups, was the criterion measure used to estimate the sensitivity and specificity of hEtG. Proximal segments of hair were collected at enrollment (average 22.0 gestational weeks) and analyzed by LC-MS/MS. At the same visit, maternal blood and urine specimens were collected for analysis of GGT, %dCDT, PEth, uEtG, and uEtS. The study population included mostly opioid-dependent (80%) patients, a large proportion of ethnic minorities (75.3% Hispanic/Latina, 8.2% American Indian, 4.7% African-American), and patients with low education (48.2% < high school). The mean maternal age at enrollment was 26.7 ± 4.8 years. Hair EtG demonstrated 19% sensitivity and 86% specificity. The sensitivities of other biomarkers were comparable (5-20%) to hEtG but specificities were higher (98-100%). Hair EtG sensitivity improved when combined with other biomarkers, especially with GGT (32.5%) and PEth (27.5%). In addition, validity of hEtG improved in patients with less frequent shampooing and those who did not use hair dyes/chemical treatments. These data suggest that hEtG alone is not a sufficiently sensitive or specific biomarker to be used separately for the identification of PAE, but might be useful in a battery along with other maternal biomarkers.
authors.affiliation: Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Hilda L
authors.initials: HL
authors.lastname: Gutierrez
authors.affiliation: Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Hund
authors.affiliation: Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Shikhar
authors.initials: S
authors.lastname: Shrestha
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA.
authors.forename: William F
authors.initials: WF
authors.lastname: Rayburn
authors.affiliation: Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA; Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Leeman
authors.affiliation: Department of Neurosciences, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Savage
authors.affiliation: Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, Albuquerque, NM, USA; Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA. Electronic address: lbakhireva@salud.unm.edu.
authors.forename: Ludmila N
authors.initials: LN
authors.lastname: Bakhireva
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000378:metabolism*; D015415:Biomarkers / Q000032:analysis / Q000737:chemistry / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005965:Glucuronates / Q000032:analysis* / Q000378:metabolism*; D006197:Hair / Q000737:chemistry* / Q000378:metabolism*; D006801:Humans; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005965:Glucuronates; C093924:ethyl glucuronide
keywords: Alcohol; Biomarkers; Ethylglucuronide; Hair; Pregnancy; Prenatal alcohol exposure