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Alarming Prevalence of Fetal Alcohol Exposure in a Mediterranean City

Garcia-Algar, Oscar MD, PhD*; Kulaga, Vivan BSc; Gareri, Joey BSc; Koren, Gideon MD, PhD; Vall, Oriol PhD*; Zuccaro, Piergiorgio PhD; Pacifici, Roberta PhD; Pichini, Simona PhD

doi: 10.1097/FTD.0b013e31816a8657
Proceedings Paper

The prevalence of gestational ethanol exposure and subsequent fetal exposure has been assessed in a cohort of mother-infant dyads in a Mediterranean city (Barcelona, Spain) by meconium analysis of fatty acid ethyl esters (FAEEs) after showing in this population a high prevalence of meconium opiates (8.7%), cocaine (4.4%), and cannabis (5.3%). Of the 353 meconium samples analyzed for FAEEs, 159 (45%) contained a total amount of seven FAEEs equal or above 2 nmol/g meconium, the cutoff internationally accepted to differentiate heavy maternal alcohol consumption during pregnancy from occasional use or no use at all. No parental sociodemographic differences or maternal features differentiated exposed from unexposed newborns. The prevalence of gestational consumption of ethanol was similar between women using and not using drugs of abuse during pregnancy (45.7% and 44.7% of samples with total FAEEs equal or higher than 2 nmol/g meconium, respectively).

Meconium samples from newborns exposed in utero to ethanol, and positive for at least one illicit drug (cocaine, opiates, or cannabis), had total FAEEs and five of nine individual FAEEs statistically higher than the meconium samples that were negative for the most frequently used illicit drugs of abuse. Among the most prevalent FAEEs, oleic acid ethyl ester showed the best correlation to total FAEE concentration followed by palmitoleic acid ethyl ester.

This study, which highlights a 45% ethanol consumption during pregnancy in a low socioeconomic status cohort, may serve as an eye opener for Europeans that gestational alcohol exposure is not endemic only in areas outside of Europe.

From the *Unitat de Recerca Infància i Entorn (URIE), Paediatric Service, Hospital del Mar, and Departament de Pediatria, Ginecologia i Obstetricia, i Medicina Preventiva, Universitat Autònoma Barcelona, Spain; the †Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Canada; and ‡Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy.

Received for publication October 5, 2007; accepted January 25, 2007.

Supported in part by the Canadian Institutes for Health Research.

Reprints: Dr. Simona Pichini, PhD, Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, V.le Regina Elena 299, 00161, Rome, Italy (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.