title: Prevalence of Prenatal Alcohol Exposure in the State of Texas as Assessed by Phosphatidylethanol in Newborn Dried Blood Spot Specimens.
abstract: BACKGROUND
  While 2 to 5% of school-aged children in the United States are estimated to be affected by fetal alcohol spectrum disorders (FASD), the prevalence of prenatal alcohol exposure (PAE) might be substantially underreported. Our objective was to systematically estimate the prevalence of PAE in Texas by measuring a direct ethanol metabolite, phosphatidylethanol (PEth), in 1,000 infant residual dried blood spots (irDBSs) in the Texas Newborn Screening Repository.
  
  
  METHODS
  All public health regions (PHRs) were represented proportional to their 2014 birth rate (~0.25% of total births). A cross-sectional study design (unit of observation: individual irDBS cards/infants) with additional ecologic subanalysis (unit of observation: aggregate measures for each Texas PHR) was utilized. The study used PEth-irDBS to estimate the prevalence of PAE within 1 month before delivery for the state of Texas and each Texas PHR. The ecologic subanalysis compared different geographical regions' aggregate prevalence of PAE with (i) retail liquor licenses, (ii) median household income by PHR, and (iii) prevalence of birth outcomes commonly associated with FASD.
  
  
  RESULTS
  The sample included an equal number of males and females; 47.8% non-Hispanic White, 40.8% Hispanic, 6.6% African American, and 4.8% Asian infants. In the entire sample, 8.4% of irDBSs were positive for PEth (>20 ng/ml) indicative of PAE within approximately 1 month before delivery. Large regional differences were observed with mostly urban, high median-income regions demonstrating the highest prevalence.
  
  
  CONCLUSIONS
  Results of this first systematic statewide PAE prevalence study demonstrate that PAE might be more prevalent than previously thought. Active case ascertainment efforts for FASD coupled with systematic objective assessment of PAE should expand to the national level to better estimate public health needs required to provide adequate services for children affected by PAE.
authors.affiliation: Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, New Mexico.|Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico.
authors.forename: Ludmila N
authors.identifier: http://orcid.org/0000-0001-9877-0211
authors.initials: LN
authors.lastname: Bakhireva
authors.affiliation: Texas Office for Prevention of Developmental Disabilities , Austin, Texas.
authors.forename: Janet
authors.initials: J
authors.lastname: Sharkis
authors.affiliation: Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, New Mexico.
authors.forename: Shikhar
authors.initials: S
authors.lastname: Shrestha
authors.affiliation: Texas Office for Prevention of Developmental Disabilities , Austin, Texas.
authors.forename: Tristan J
authors.initials: TJ
authors.lastname: Miranda-Sohrabji
authors.affiliation: Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, New Mexico.
authors.forename: Sonnie
authors.initials: S
authors.lastname: Williams
authors.affiliation: Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center, College of Medicine, Bryan, Texas.
authors.forename: Rajesh C
authors.initials: RC
authors.lastname: Miranda
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000097:blood* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D059788:Dried Blood Spot Testing / Q000379:methods; D005260:Female; D020404:Glycerophospholipids / Q000097:blood*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000379:methods; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D013781:Texas / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D020404:Glycerophospholipids; C051521:phosphatidylethanol
keywords: Alcohol; Biomarkers; Dried Blood Spots; Infants; Phosphatidylethanol; Prevalence; Surveillance