STAMPA ANN.06-06 - Caprara

INTRODUCTION Prenatal alcohol exposure is associated with a wide spectrum of adverse effects known as fetal alcohol spectrum disorder (FASD). Diagnosing an infant who has been exposed to alcohol in utero can be an extremely difficult task since often, the effects of gestational drinking on the fetus may not be clinically evident at birth or shortly thereafter. In less apparent cases of FASD where no physical signs have manifested, (e.g., the alcohol related neurodevelopmental disorder, ARND), children exposed to ethanol during pregnancy may go undetected until the adverse effects of impaired brain growth become evident [1]. Diagnosis of FASD is difficult since this requires in most cases positive confirmation of heavy maternal drinking. According to current diagnostic guidelines [2], without the distinctive pathognomonic facial features seen in fetal alcohol syndrome (FAS), confirmation of in utero alcohol exposure is required. Admission to gestational drinking, especially of addictive patterns, may not be the most accurate information source for in utero ethanol exposure [3]. Maternal self-reporting is often unreliable because of the countless stigmas associated with a pregnant mother’s admission to risky behaviours [3]. Questionnaires, such as the TWEAK and T-ACE, have been developed to facilitate a physician’s ability to screen their pregnant patients for problem drinking. Unfortunately, the effectiveness of these tests is dependent on frank maternal reports [3]. In attempting to find an accurate method to detect problem drinking in pregnancy, laboratory biochemical blood markers have often attempted alone or in combination to identify alcohol consumption. Immediately following ingestion, ethanol can be measured in blood, breath or urine. However, using ethanol itself or its aldehyde can only indicate recent exposure due to their relatively rapid metabolism and lack of appreciable accumulation for long periods of time. The association between gestational alcohol consumption and maternal biochemical markers such as gamma-glutamyl transferase (GGT), mean corpuscular volume (MCV), haemoglobin-associated acetylaldehyde (HAA) and carbohydrate deficient transferrin (CDT) have some potential, but many of these tests are unavailable in Diagnosis of fetal alcohol spectrum disorder (FASD): fatty acid ethyl esters and neonatal hair analysis