First comprehensive study of prenatal fetal alcohol exposure in PEI newborns
A multidisciplinary team of researchers on PEI recently completed an anonymous, provincial, population-based study to determine the incidence of prenatal fetal alcohol exposure in PEI newborns. The team consisted of researchers and clinicians from the University of Prince Edward Island, the Queen Elizabeth and Prince County hospitals, the PEI Reproductive Care Program, and the Motherisk Laboratory at Toronto's Hospital for Sick Children.
The PEI Meconium Study, facilitated by the Canadian Association of Paediatric Health Centres (CAPHC) with funding from the Public Health Agency of Canada, was led by Dr. Janet Bryanton, associate professor, UPEI School of Nursing and Dr. Kathy Bigsby, pediatrician, QEH.
Prior to this study, PEI had no reliable data about the incidence of alcohol use during pregnancy. It is well-known that alcohol use in pregnancy can cause a range of disabilities; however, it is highly challenging to accurately determine the incidence of prenatal alcohol use in a population. The heavy stigma associated with drinking in pregnancy results in both under-reporting by pregnant women and reluctance on the part of their health-care providers to ask about prenatal alcohol use.
Meconium samples (i.e. a baby's first bowel movements) were anonymously collected from the diapers of all babies born to PEI mothers over a one-year period, including those born at IWK in Halifax. Samples were tested for biomarkers of prenatal alcohol exposure (FAEE), a unique laboratory test developed at the Motherisk Laboratory in Toronto. Close to 1,300 samples were collected and tested; the study results show that at least 3.1% of PEI babies were exposed to frequent prenatal alcohol consumption after the first trimester of pregnancy, placing these children at risk for Fetal Alcohol Spectrum Disorder (FASD). It is expected that approximately 40% of exposed babies (1.3% of babies born in this population or at least 16 babies) will have FASD.
This is the first province-wide study in Canada to comprehensively evaluate the incidence of prenatal alcohol exposure. Regional studies conducted in other areas of Canada show similar rates of prenatal alcohol exposure, demonstrating that Islanders are dealing with a similar public-health impact of prenatal alcohol exposure as the rest of the country.
Whereas not drinking is the best choice for a woman who is or might become pregnant, there are many complex factors that may influence why a pregnant woman may use alcohol. The results of this study provide a basis upon which to begin discussion about a multifaceted approach to addressing prevention, early identification, and intervention for FASD.
ALCOHOL USE IN PREGNANCY:
The Society of Obstetricians and Gynaecologists of Canada advises that abstinence is the prudent choice for a woman who is or might become pregnant.
The impact of alcohol on the fetus can range in severity and depends on factors such as how much, when, and how often the mother drinks, and the mother's and baby's genetic makeup and health.
Alcohol use and misuse spans all segments of society. Lack of information or advice about the potential harm is rarely the main issue. Some women who have a difficult time stopping drinking during pregnancy may have a history of complex issues including trauma, abuse, mental illness, and poverty.
FETAL ALCOHOL SPECTRUM DISORDER:
Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term that includes a wide range of physical, cognitive, and behavioural disabilities resulting from alcohol consumption by pregnant women. It is one of the leading preventable causes of developmental disability and birth defects in Canada. Several studies, including the current PEI study, estimate that 1% of the North American population is affected by FASD.
FASD is a significant public-health concern, as it has a profound impact on individuals, families, and society in general. The estimated cost of FASD in Canada each year is about $5.3 billion and in the Atlantic region about $57 million. A medical diagnosis is needed and includes a comprehensive history and physical and neurobehavioural assessment with a multidisciplinary approach.
The effects that a child is born with are permanent and are known as the primary disabilities, such as: the presence of an inability to comprehend non-verbal social cues, attention deficits, sensory issues, and emotional dysregulation. Secondary disabilities are problems that individuals may develop as a result of their primary brain dysfunction, such as high risk of early school drop-out, incarceration, dependent living, and mental health problems (e.g. depression, addiction). Secondary disabilities are preventable with early identification and intervention.
MECONIUM-TESTING FOR PRENATAL ALCOHOL EXPOSURE
Meconium is the first bowel movements of a newborn. It is formed by the fetus after about 13 weeks of pregnancy, when swallowing of amniotic fluid begins. When a mother drinks during pregnancy, alcohol metabolites (fatty acid ethyl esters or FAEEs) are formed by the baby and are deposited in the meconium. Small amounts of FAEE naturally occur in meconium; levels above 2.0 nanomoles per gram (nmol/g) reflect frequent or binge alcohol consumption during the last six months of pregnancy. 'Positive' results reported for this study are those with FAEE concentrations above 2.0 nmol/g.
FAEE-positive meconium results do not constitute a diagnosis of FASD. Positive results indicate a risk for FASD; prenatally alcohol-exposed children should have their development monitored closely (i.e. milestones, etc.) and be referred for a full diagnostic assessment at between five and six years of age. The meconium-screening process employed by the Motherisk Program at Toronto's Hospital for Sick Children, is part of the FASD Tool Kit compiled by the National FASD Screening Tool Development Project which is available on CAPHC's Knowledge Exchange Network (KEN) at www.ken.caphc.org.
ADDITIONAL STUDY DETAILS:
From November 2010 to November 2011, a meconium sample was collected from the diapers of 1,307 live PEI newborns, including those born at the IWK in Halifax. To maintain anonymity of samples, no identifying information was collected. To our knowledge, this is the first province-wide study in Canada to involve meconium sampling from all live newborns for a full year. 1,271 meconium samples were successfully tested for FAEE, with 39 samples (3.1%) returning positive results. It is expected that approximately 40% of babies with documented heavy prenatal alcohol exposure will likely exhibit FASD. This means that at least 16 PEI babies born during the one-year study period will likely have FASD.
