# Estimation of Prenatal Alcohol Exposure: Comparison of Retrospective Survey and Measurement of Fatty Acid Ethyl Esters, Ethyl Sulfate, and Ethyl Glucuronide Concentrations in Neonatal Meconium

## TL;DR

This study compares self-reported alcohol use during pregnancy with chemical tests on newborn meconium to better estimate prenatal alcohol exposure.

## Contribution

The study introduces combined EtG and EtS measurements in meconium as a more reliable method for detecting prenatal alcohol exposure.

## Key findings

- Only 4% of mothers reported alcohol use, but biomarkers suggested higher prenatal exposure.
- Combined EtG and EtS measurements were found to be the most reliable diagnostic method.
- Self-reported data significantly underestimates the true scale of prenatal alcohol exposure.

## Abstract

Determining the concentration of fatty acid ethyl esters (FAEEs), ethyl sulfate (EtS), and ethyl glucuronide (EtG) is crucial for establishing the true scale of prenatal alcohol exposure (PAE) and enabling early diagnosis of fetal alcohol spectrum disorders. This study primarily aimed to compare two detection methods: retrospective maternal alcohol consumption surveys and chromatographic analysis of newborn meconium. Among 478 mothers, parallel survey data and meconium samples were collected. Nine FAEEs were measured by gas chromatography–mass spectrometry, and EtG and EtS by liquid chromatography–tandem mass spectrometry. The study also aimed to establish marker cut-offs and evaluate their clinical utility. While only 4% (approximately) of mothers reported alcohol consumption during pregnancy, the biomarker analysis suggested a significant underestimation of the actual PAE scale, highlighting the limitations of self-reported data. Analysis using the cumulative biomarker index for two biomarkers with a threshold of ≥5 indicated that alcohol consumption affected approximately 3% of the studied population, further demonstrating the low reliability of maternal self-reports. Ultimately, this study confirms that the combined EtG and EtS measurements provide the most reliable diagnostic information for PAE and underscores the necessity of objective meconium screening in clinical practice.