New test can determine newborn's alcohol exposure: CrossCurrents Spring 2003

CrossCurrents

A new test for newborns that reveals whether a mother drank alcohol during pregnancy promises earlier diagnosis and intervention for alcohol-related problems in children. The procedure, developed at the Motherisk fetal toxicology lab at the Hospital for Sick Children in Toronto, involves testing meconium, the newborn's first bowel movement. Toxicologists measure the levels of fatty acid ethyl esther (FAEE), a chemical compound that appears at the start of the second trimester and accumulates in the meconium as the fetus is exposed to alcohol.

According to Dr. Julia Klein, director of Motherisk, alcohol is extremely dangerous to a developing fetus because it is a potent teratogen, an element that passes undiluted to the fetus through the placenta. "Alcohol is the most common non-genetic cause of mental retardation," she says. "It is by far more potent and more prevalent than street drugs."

Since information on drinking during pregnancy relies heavily on self-reporting, accurate statistics are difficult to calculate. According to recent data, the number of pregnant women who drink is falling, but drinking among women of childbearing age has risen. Klein says that alcohol consumption is common among young women of reproductive age and that approximately 20 per cent of pregnant women who drink continue drinking even after they realize they are pregnant, four per cent at heavy levels. Recent years have shown a 2.2 per cent increase in binge drinking during pregnancy, according to Klein.

The FAEE, in and of itself, does not diagnose Fetal Alcohol Spectrum Disorder (FASD), which includes fetal alcohol syndrome and possible fetal alcohol effects (pFAE), and which is estimated to occur in one of 500 children in Canada. Rather, the test will be a useful tool in determining whether a child may be at risk for problems caused by maternal alcohol use that may not be diagnosed until years later, particularly in the case of pFAE, where symptoms like impulsivity and learning difficulties may not surface until the child is in school.

 The test may be helpful for pediatricians or child protection agencies that suspect alcohol use during pregnancy. It may also be useful for a mother who wants to prove she did not drink during her pregnancy; and for prospective adoptive parents involved prior to the infant's birth. As Klein says, "Due to fear, guilt or embarrassment, maternal history may not be a reliable source of information about what the baby was exposed to during the gestational period. Our test is an objective biomarker that has the ability to point to a potential problem in a newborn, enabling the family, pediatrician and social worker to mobilize the help needed."

An early diagnosis of FASD will benefit children. Dr. Peter Selby, an assistant professor at the University of Toronto's Department of Family and Community Medicine and Department of Psychiatry and head of the Centre for Addiction and Mental Health's Nicotine Dependence Clinic in Toronto, says: "Early diagnosis has been associated with fewer secondary disabilities such as depression and low self-esteem because the child gets access to specialized services faster."

Patsy Hamilton, a manager at the Toronto Children's Aid Society (CAS), adds: "These children need nurturing home environments. They need professional supports, stability, consistency, patience." Hamilton explains that many parents of children with undiagnosed alcohol-related birth defects become frustrated with their child's behaviours: "They use child management techniques that cannot be successful with these children. As a result, they feel unsuccessful as parents. Early diagnosis of such issues could mean early education for caregivers and the early introduction of services for children."

Potential adoptive parents can also benefit from the early diagnosis. According to Nancy Dale, director of the Toronto CAS Adoption Centre, 40 per cent of children placed for adoption by the agency in 2001 had significant prenatal exposure to alcohol or illicit drugs.

Caregivers, be they parents, foster parents or teachers, stand to gain a greater understanding of the child's difficulties. They can explore alternative child management and educational techniques, and quite simply have an explanation for hard to explain behaviours. As a result, caregivers may be less likely to blame themselves for the child's problems and feel less powerless to help. Ultimately, Hamilton believes that the chances of positive outcomes for these children will be increased with the test.

Help is also available for mothers or pregnant women with substance use issues. The Ontario Drug and Alcohol Registry of Treatment (DART) provides referrals for addiction treatment services in Ontario, toll-free at 1 800 565-8603. Motherisk in Toronto also offers an alcohol and substance use helpline at toll-free 1 877 327-4636.

Shannon Maunder

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