Improving Screening for At Risk Alcohol Use during PregnancyAfua Nyanin, MD1, Luis A. Bracero, MD1, Stefan Maxwell, MD2, Mike Broce, BA3, Dara J. Seybold, MAA3

1 Department of Obstetrics and Gynecology, West Virginia University-Charleston Division, Charleston Area Medical Center, 2 Department of Pediatrics, Neonatal Intensive Care Unit Charleston Area Medical Center, 3 Center for Health Services and Outcomes Research, Charleston Area Medical Center Health Education and Research Institute

INTRODUCTION

METHODS

OBJECTIVE

RESULTS

CONCLUSION

Urine alcohol testing measures ethanol levels, with a typical window of detection up to 12 hours after alcohol consumption. False positive results can occur due to fermentation in urine samples containing glucose and yeast. In contrast, phosphatidylethanol (PEth) is a metabolite only produced in the presence of ethanol and is considered a biomarker of alcohol consumption. It can be measured in dried blood spot samples up to three weeks after alcohol consumption. The specificity of this biomarker is believed to approach 100%.

To compare the alcohol use detection rate of dried blood spot PEth testing with the current practice of urine ethanol testing, during prenatal care.

This was a retrospective review of a prospective data registry study of women seeking prenatal care who were screened for alcohol use. The study was conducted at Women’s and Children’s Women’s Medicine Center (Charleston, WV). Patients with both urine ethanol and dried blood spot PEth test results were included in the analysis. PEth testing was conducted using dried blood spots from finger-sticks collected on Whatman 903 filter paper.

A total of 173 pregnant patients were included in analysis. The average (Mean+/-SEM) age was 24.5+/-0.5 years with a BMI of 29.3+/-0.7, presenting to the clinic at 11.8+/-0.6 weeks gestational age.

We compared the positive detection rate of urine ethanol testing with PEth testing. Self-reported alcohol use recorded in the ACOG medical history was also included in both groups. A sample size calculation was conducted based on a past urine alcohol use detection rate of 1.1%, a new PEth dried blood spot testing detection rate of 6.0%, and an alpha level of 0.05 with a power of 80. It was estimated that approximately 223 patients would be needed.

The agreement between the two screening methods was tested by Kappa coefficient and the difference measured by McNemar’s Test. Practitioners and patients were not informed of the PEth results. Patients who tested positive with the urine ethanol test or self-reported use had a brief intervention and were referred for addiction counseling.

• PEth testing in dried blood spots identified significantly more women at risk for alcohol use duringpregnancy than urine ethanol testing.

• The findings suggest that PEth testing may be a more reliable alternative to urine ethanol testing foridentifying alcohol use during pregnancy.

• Urine ethanol testing identified 2 patients with alcohol use while dried blood spot PEth testing identified10. One patient had both a positive urine ethanol and blood PEth. Three women self-reported alcohol use,and all three had negative urine ethanol and blood PEth results.

• We had good agreement between the two methods (159 both negative and 4 both positive; (159+4)/173 =94.2%; Kappa, p<0.001).

• * PEth testing identified significantly more women with alcohol use (McNemar, p=0.021) with a detection rate of 1.2% for urine ethanol and 5.8% for PEth in dried blood spots.

PEthin Dried Blood Spots

Ethanolin Urine

Number of Positives for Alcohol Consumption (n = 173) 10 2

Rate of Detection 5.8 %* 1.2 %*

Table 1. Differences in Testing Methods

United States Drug Testing Laboratories, Inc.

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