Prevalence of Prenatal Alcohol Exposure in the State of Texas as Assessed by Phosphatidylethanol in Newborn Dried Blood Spot Specimens

• Published in: Alcoholism, clinical and experimental research Vol. 41; no. 5; pp. 1004 - 1011
• Main Authors: Bakhireva, Ludmila N., Sharkis, Janet, Shrestha, Shikhar, Miranda‐Sohrabji, Tristan J., Williams, Sonnie, Miranda, Rajesh C.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2017
• Subjects: Adult; Alcohol; Alcohol Drinking - adverse effects; Alcohol Drinking - blood; Alcohol Drinking - epidemiology; Biomarkers; Biomarkers - blood; Cross-Sectional Studies; Dried Blood Spot Testing - methods; Dried Blood Spots; Female; Glycerophospholipids - blood; Humans; Infant, Newborn; Infants; Male; Neonatal Screening - methods; Phosphatidylethanol; Pregnancy; Prenatal Exposure Delayed Effects - blood; Prenatal Exposure Delayed Effects - diagnosis; Prenatal Exposure Delayed Effects - epidemiology; Prevalence; Surveillance; Texas - epidemiology; Dried Blood Spots; Prevalence; Surveillance; Biomarkers; Alcohol; Infants; Phosphatidylethanol
• ISSN: 0145-6008; 1530-0277
• DOI: 10.1111/acer.13375

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. This is the first study to objectively assess prenatal alcohol exposure (PAE) across a large, multi‐ethnic, high birth‐rate state, with proportional representation by region, using a direct ethanol metabolite PEth. PEth was measured in infant residual dried blood spots (irDBS) from the Texas Newborn Screening Repository. Results demonstrate that 8.4% of irDBS were positive for PEth, indicative of PAE within approximately one month before delivery. Large regional differences were observed with mostly urban, high median‐income regions demonstrating the highest prevalence.