Fatty Acid Ethyl Esters: Quantitative Biomarkers for Maternal Alcohol Consumption

Objective

To develop a laboratory marker to identify newborns exposed to alcohol.

Study design

Meconium was collected from 30 infants from Jordan who were unexposed and from 248 Cleveland study infants of varying exposure status. Retrospective maternal alcohol histories were obtained. Fatty acid ethyl esters (FAEEs) were quantified with gas chromatography/flame ionization and compared between abstainers and non-abstainers to identify FAEEs of interest. The area under the receiver operating characteristic curve, sensitivity, specificity, and positive and negative predictive values were calculated by using definitions of drinking obtained from a graphical representation.

Results

Six of 7 FAEEs were significantly different between the non-abstainers and at least 1 of 2 of the abstaining groups. FAEEs best predicted drinks per drinking day, and ethyl linoleate had the greatest area under the curve (76%), with a sensitivity rate of 88%, a specificity rate of 64%, a positive predictive value of 9%, and a negative predictive value of 99%. No combination of FAEEs was better than a single ester for identifying drinkers.

Conclusion

Ethyl linoleate in meconium is a useful biological marker for identifying infants not exposed in utero to high levels of alcohol in a high-risk, substance-abusing, clinic-based sample.

AUC, Area under the receiver operating characteristics curve, DRDD, Drinks per drinking day, DRWK, Drinks per week, DYWK, Drinking days per week, FAS, Fetal alcohol syndrome, FAEE, Fatty acid ethyl ester, GC/FID, Gas chromatography with flame ionization detection, GC/MS, Gas chromatography with mass spectroscopy detection, NPV, Negative predictive value, PPV, Positive predictive value, ROC, Receiver operating characteristics