Gauthier Theresa W, Mohan Sowmya S, Gross Teresa S, Harris Frank L, Guidot David M, Brown Lou Ann S
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America.
Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America.
PLoS One. 2015 May 15;10(5):e0126552. doi: 10.1371/journal.pone.0126552. eCollection 2015.
The accumulation of fatty acid ethyl esters (FAEEs) in meconium of term newborns has been described as one potential biomarker of maternal alcohol use during pregnancy. FAEEs accumulate in multiple alcohol-exposed fetal tissues and in the placenta. Limited research has focused on the identification of the premature newborn exposed to alcohol in utero. We hypothesized that maternal alcohol use occurs in a significant proportion of premature deliveries and that this exposure can be detected as elevated placental FAEEs. The goals of this study were to 1) determine the prevalence of maternal alcohol use in the premature newborn and 2) investigate whether placental FAEEs could identify those newborns with fetal alcohol exposure. This prospective observational study evaluated 80 placentas from 80 women after premature delivery. Subjects were interviewed for alcohol intake and placental FAEEs were quantified via GC/MS. Receiver Operator Characteristic (ROC) Curves were generated to evaluate the ability of placental FAEEs to predict maternal drinking during pregnancy. Adjusted ROC curves were generated to adjust for gestational age, maternal smoking, and illicit drug use. 30% of the subjects admitted to drinking alcohol during pregnancy and approximately 14% answered questions indicative of problem drinking (designated AUDIT+). The specific FAEEs ethyl stearate and linoleate, as well as combinations of oleate + linoleate + linolenate (OLL) and of OLL + stearate, were significantly (p<0.05) elevated in placentas from AUDIT+ pregnancies. Adjusted ROC Curves generated areas under the curve ranging from 88-93% with negative predictive values of 97% for AUDIT+ pregnancies. We conclude that nearly one third of premature pregnancies were alcohol-exposed, and that elevated placental FAEEs hold great promise to accurately determine maternal alcohol use, particularly heavy use, in pregnancies complicated by premature delivery.
足月新生儿胎粪中脂肪酸乙酯（FAEEs）的积累已被描述为孕期母亲饮酒的一种潜在生物标志物。FAEEs在多个受酒精影响的胎儿组织和胎盘中积累。有限的研究集中在识别子宫内暴露于酒精的早产新生儿。我们假设，相当比例的早产产妇存在饮酒情况，并且这种暴露可以通过胎盘FAEEs升高来检测。本研究的目的是：1）确定早产新生儿母亲饮酒的患病率；2）调查胎盘FAEEs是否能够识别那些有胎儿酒精暴露的新生儿。这项前瞻性观察性研究评估了80例早产妇女的80份胎盘。对受试者进行了酒精摄入量访谈，并通过气相色谱/质谱法对胎盘FAEEs进行了定量。生成了受试者工作特征（ROC）曲线，以评估胎盘FAEEs预测孕期母亲饮酒的能力。生成了校正后的ROC曲线，以校正胎龄、母亲吸烟和非法药物使用情况。30%的受试者承认在孕期饮酒，约14%的受试者回答的问题表明存在问题饮酒（定义为AUDIT+）。在AUDIT+妊娠的胎盘中，硬脂酸乙酯和亚油酸乙酯这两种特定的FAEEs，以及油酸+亚油酸+亚麻酸（OLL）和OLL+硬脂酸的组合，均显著升高（p<0.05）。校正后的ROC曲线下面积在88%-93%之间，AUDIT+妊娠的阴性预测值为97%。我们得出结论，近三分之一的早产妊娠存在酒精暴露，胎盘FAEEs升高有望准确确定早产合并妊娠中母亲的饮酒情况，尤其是重度饮酒情况。
