Academic journal article Alcohol Research

Biomarkers of Alcohol Use in Pregnancy

Academic journal article Alcohol Research

Biomarkers of Alcohol Use in Pregnancy

Article excerpt

Alcohol use during pregnancy is a significant public health problem. Although most women who drink before pregnancy substantially reduce their consumption or completely stop drinking once they become pregnant, approximately 14 to 22.5 percent of women report drinking some alcohol during pregnancy (Bearer 2001).

The costs of prenatal alcohol use are high. Risky drinking (defined as more than seven standard drinks (1) per week or five or more standard drinks on a drinking day [CDC 2002]) during pregnancy is a primary risk factor for fetal alcohol syndrome (FAS), the most common preventable cause of mental retardation. (2) Prenatal alcohol exposure also can result in fetal alcohol spectrum disorders (FASD), in which the affected children do not show the classical FAS pattern but nonetheless exhibit mental, developmental, behavioral, and social deficits as well as other birth defects. Some evidence indicates that even low-risk drinking (defined as fewer than seven standard drinks per week or three or fewer standard drinks per drinking day [NIAAA 1995]) during pregnancy can cause adverse fetal effects, but how this damage occurs is not fully understood (Bearer 2001). An estimated 1 percent of all live-born infants show some prenatal alcohol-related damage, contributing to societal costs estimated at between $75 million and $9.7 billion per year (May and Gossage 2001).

Because of alcohol's adverse effects on the fetus, all women should be counseled to refrain from drinking during pregnancy. Tests that could identify women who continue to drink while pregnant--and could detect the effects of alcohol exposure on the developing fetus or newborn--would be invaluable for several reasons. Identifying these women would facilitate interventions that could help them stop using alcohol during pregnancy, thereby minimizing alcohol's effects on fetal brain development. Even discovering prenatal alcohol use later in pregnancy or soon after birth would be important because it would identify infants who are at risk for alcohol-associated birth defects and could make it possible to monitor them for potential problems, facilitate a more stable living environment, and provide special services if needed (Bearer et al. 1999; Stoler and Holmes 1999, 2004). In particular, identifying at-risk children before age 6 reduces the likelihood of secondary problems associated with FAS and FASD, such as mental health problems, school failure, delinquency, inappropriate sexual behavior, and alcohol and other drug problems (Streissguth et al. 1996). In addition, interventions that help new mothers reduce problem drinking could enhance their ability to care for their children and reduce the risk of alcohol problems during their subsequent pregnancies (Russell et al. 1996).

Developing effective biomarkers of prenatal alcohol use also may promote better scientific understanding of alcohol effects that occur with different patterns of maternal alcohol use during pregnancy.

Maternal Self-Report

Currently no laboratory test can identify and quantify prenatal alcohol use that takes place over a protracted period. Because alcohol itself and the main product of its metabolism, acetaldehyde, break down rapidly in the blood, they cannot be used to distinguish between a single drinking episode and chronic, intermittent alcohol use. Testing blood, breath, or urine is useful only for assessing very recent alcohol exposure. Because biological markers currently in use may not be effective in screening for risky alcohol use occurring over the longer term, such as during pregnancy, clinicians most commonly use brief screening measures that rely on maternal self-reports to assess drinking patterns (Chang 2001; Russell et al. 1994, 1996; Savage et al. 2002).

Major disadvantages of such screening measures are that it often is difficult for people to recall the amount and frequency of their alcohol intake, and the stigma and fear of punishment (e. …

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