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Alcohol consumption among pregnant women in Barcelona (Spain)

Alcohol consumption among pregnant women in Barcelona (Spain). Alcohol and Pregnancy Conference Brussels, 9 September 2009. Oriol Vall Paediatrics Unit, URIE, Neuropsychopharmacology Program IMIM-Hospital del Mar Barcelona. Vila Olimpica. Ciutat Vella. Barceloneta. La Mina.

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Alcohol consumption among pregnant women in Barcelona (Spain)

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  1. Alcohol consumption among pregnant women in Barcelona (Spain) Alcohol and Pregnancy ConferenceBrussels, 9 September 2009 Oriol VallPaediatrics Unit, URIE, Neuropsychopharmacology ProgramIMIM-Hospital del MarBarcelona

  2. Vila Olimpica Ciutat Vella Barceloneta La Mina MigrantsAddictsMiddle social classGipsies H

  3. Our reality: Hospital del Mar • 1.700 deliveries /yr • 2.000 total paediatric admitions/yr • 10.000 outpatients /yr • 15.000 paediatric emergencies/yr • It is high the addiction among the mothers of maternity ward

  4. Tobacco Opioids and opiates (heroin, methadone) Cannabis Cocaine MDMA (Extasis) Alcohol Areca nut Mate Analyzed substances Here comes your footer  Page 4

  5. Plan Nacional de Drogas (2006) *(Drugs Abuse National Plan) General population between 15 and 64 years (by questionnaire): 35.1 % tobacco 15.3 % alcohol 6.5 % cannabis 1.4 % cocaine 0.6 % amphetamines

  6. Questionnaire and biomarkers

  7. Drugs of abuse: Biological matrices for evaluation of prenatal exposure to drugs of abuse • Meconium • Hair • Teeth • Placenta • Cord blood • Human milk Ther Drug Monit 2007 Dec;29(6):711-34.

  8. Advantages:alternative bilogical matrices • Non invasive collection • Easy sample collection • Wider time window for substance detection • No degradation

  9. Some results published in medical journals

  10. Here comes your footer  Page 10

  11. [Prenatal exposure to drugs of abuse using meconium analysis in a low socioeconomic population in Barcelona] [Article in Spanish] Here comes your footer  Page 11

  12. In 353 meconium samples analyzed for detection of FAEEs, 159 (45%) showed results  2 nmol/g meconium 2 nmol/g meconium: reference value internationally considered for distinguishing during the pergnancy an alcohol important maternal consumption, from not consumption at all Here comes your footer  Page 12

  13. Prevalence of pregnant chronical consumers y gestantes with meconio as biomarcaker: Women Hawai: 16% (*) Women Canadá: 22% (**) Women Hosp. del Mar: 45% (*) Moore C,Jones J, Lewis D, Buchi K. Prevalence of fatty acid ethyl esters in meconium specimens. Clin Chem. 2003;49:133-136. (**) Chan D, Klein J, Karaskov T, Koren G. Fetal exposure to alcohol as evidenced by fatty acid athyl esters in meconium in absence of maternal drinking history in pregnancy. Ther Drug Monit 2004; 26:474-481.

  14. Is the positive FAEEs more feasible on polyconsumers pregnant women or addicted only to alcohol? • Positive Drug abuse and Positive FAAEs (45.7%) • Negative Drug abuse and Positive FAAEs (44.7%)

  15. Technicaly, ¿ How do we get the biomarkers ? • FAEEs*: Liquid chromatography tandem mass spectrometry (LC/MS/MS) • Ethyl Glucoronide (EtG): Immuno assay or GC/MS or LC/MS • Ethyl Sulphate (EtS): Immuno assay or GC/MS or LC/MS • But!! FAEEs versus EtG/EtS: NO correlation *FAEEs: Faty Acid Esters

  16. In summary • FAEEs in meconium are the best markers in fetal ethanol exposure diagnosis so far • FAEEs in hair could be useful as well, but further studies are needed • EtG and EtS have been recently detected and quantified in meconium. Evaluation of a possible cutoff is the next step • The sensitivity and specificity of EtG in hair is well-known and the determination of this metabolite in pregnant women’s hair could be very useful in the diagnosis of gestational ethanol exposure

  17. Remember…… FASD* is 100% preventable Neonatal screening for prenatal alcohol exposure Lead to An alternative: Harm Reduction approach to treat the mother, her child, and her future pregnancies * Fetal Alcohol Spectrum Disorder

  18. Alcohol: newborns • FASD*: FAS, Partial FAS (PFAS), Alcohol-Related birth defects (ARBD), Alcohol-Related Neurodevelopment Disorder (ARND) • Facial dysmorphology • Growth retardation • CNS development abnormalities • FASD is very infrequent as a diagnostic in our hospitals despite of the high prenatal alcohol exposure • Why? Maybe: • Health care workers not trained. • Adverse effects not identified or recognized (ADHD, school failure, etc.) • Depend of differents habits of consumption? * Fetal Alcohol Spectrum Disorders

  19. Alcohol: newborns • Ethanol is the main known teratogen • Specially affects the neurodevelopment and has negative cognitive effects • Brain damage can not be repared... • But an adequate follow up can achieve the best possible neurodevelopment

  20. Toronto (Canada): MOTHERISK • Detection • Follow up • Intervention

  21. Main objectives To design and to implement a prenatal diagnosis and a neonatal screening protocols of prenatal ethanol exposure To design an intervention program: - Consumption prevention (clinical guidelines) - Diagnosis (biomarkers) - Intervention (structured counseling) - Follow up (clinical protocol): “Pregnancy Without Alcohol” To check the effectiveness of the intervention To follow up of children prenatally exposed to ethanol

  22. Translational research and Integrate several areas Health Education Clinical Atenttion Public Health Resources Social problems Addiction

  23. The Proposal • Is to work in conection with other clinicicians and researchers groups in order to improve: • Coordination • Exchenge information and • Implementation

  24. Towards decreased risks for the fetus and the mother...

  25. Also decreased the risks for the adolescents… ¡¡Botellones!!

  26. And… by the timea person reaches adult life

  27. RR and 95% CI associated with alcohol intake lower than 25g/day Corrao G, Bagnardi V, Zambon A, la Vecchia C. A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med 2004,38:613-9.

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