1. The Global Issue of FASD: Results of Characterizing Alcohol Consumption in Pregnancy in Montevideo, Uruguay Janine Hutson, MSc Faculty of Medicine, University of Toronto Motherisk Laboratory, Hospital for Sick Children

2. Publications From Around the World

3. Latin America Cantabria, Spain –22.7% of women reported alcohol consumption during pregnancy (n=1510) (Palma et al., 2006) São Paulo, Brazil –17/16440 babies referred to genetics clinic diagnosed with FAS and likely underdiagnosed in the city (Grinfeld et al., 1999)

4. Latin America Santiago, Chile –57.4% lower middle class women reported alcohol consumption during pregnancy in a prenatal clinic (n=9628) –101/887 with home visits reported an average of  4 drinks/day (Aros et al., 2006)

5. Latin America Tapachula, Chiapas, Mexico –46% women receiving prenatal care reported alcohol consumption and alcohol dependence (n=132) –rate of consumption was higher than reported in non-pregnant women (Montesinos et al., 2004) Solís Valley, Mexico –73% reported consuming an alcoholic beverage, ‘pulque’ and 29% consumed >150g ethanol/week (n=70) (Backstrand et al., 2001)

6. Uruguay Low birth weight –10.1% LBW in public sector 80% prevalence of drinking in women of childbearing age Pan American Health Organization; 2002, Magri R, 2002

7. Koren et al. CMAJ 2003;169:1181-5.

8. Fatty Acid Ethyl Esters (FAEE) Ethyl Palmitate Ethyl Palmitoleate Ethyl Stearate Ethyl Oleate Ethyl Linolate Ethyl Linolenate Ethyl Arachidonate 2 nmol/gram is a positive test 100% sensitivity 98% specificity Chan et al., 2003

9. Hypotheses A.There will be a significant incidence of prenatal alcohol exposure in Montevideo, Uruguay that is higher than in North America. B.Prenatal alcohol and tobacco exposure will be significant predictors of birth weight in Montevideo, Uruguay

10. Methods - Uruguay Collected meconium samples from all births from April 4, 2005 – June 18, 2005 at Pereyra Rossell & Clinicas Hospital Mothers in good health & give consent Questionnaire completed

11. Methods - Toronto FAEE extracted from meconium and analyzed by GC-FID Cocaine, benzoylecgonine (BE), amphetamine, THC, and cotinine by enzyme-linked immunosorbent assay (ELISA) Statistical Analysis

12. Completed Maternal Questionnaires n=900 Total Births n=1115 Meconium Samples for FAEE Analysis n=905 Analysis for Cotinine & 5 Illicit Drugs n=195 Matched questionnaire & FAEE results n=681 Questionnaires w/o FAEE results n=219 Unable to Analyze for FAEE n=81 Successful Analysis for FAEE n=824 Multiple Births Excluded n=2

13. Maternal Characteristics Average Age = 25 11% employed 95% did not complete secondary education 9% no prenatal care, 30% < 4 visits

14. GC-FID Chromatograms Ethyl Oleate Ethyl Linolate Ethyl Linolenate Internal Standard Intensity (mVolts) Time (min)

15. % Positive FAEE Cotinine Amph. Cocaine THC 44% 42% 8% 2% 2% Fetal Alcohol Syndrome* *Abel. Neurotoxicol Teratol 1995;17:437-43. 20% Fetal Alcohol Spectrum Disorder*

16. % Positive FAEE Cotinine Amph. Cocaine THC 44% 42% 8% 2% Alcohol Tobacco Stimulants Cocaine THC 37% 42% 1% 0.4% 1.5% Self-Report

17. Comparison to Other Regions Grey-Bruce, Ontario (Gareri, 2006) Fetal alcohol exposure: 2.5% –Uruguayan study population has 18  the exposure

18. Comparison to Other Regions Grey-Bruce, Ontario (Gareri, 2006) Fetal alcohol exposure: 2.5% –Uruguayan study population has 18  the exposure Honolulu, Hawaii (Derauf et al, 2003) Fetal alcohol exposure: 17.1% –Uruguayan study population has 3  the exposure

19. Multiple Linear Regression (n=681) –Maternal self-report of tobacco use β = -0.149, p = 0.001 –Ethyl Linolate β = -0.108, p = 0.022 –Infant Gender β = 0.102, p = 0.030 –Maternal BMI β = 0.100, p = 0.033 p < 0.001 R 2 = 0.057 Birth weight can be predicted by

20. Conclusions 1.This urban Uruguayan population characterized by low socioeconomic status is at very high risk for prenatal alcohol exposure. Low Socioeconomic Status Heavy Prenatal Alcohol Exposure  Life Chances

21. Conclusions (cont.) 2.Prenatal alcohol and tobacco exposure are significant predictors of decreased birth weight in this population.

22. Acknowledgements Dr. Gideon Koren Dr. Raquel Magri Dr. Jacob Wolpin Dr. Bhushan Kapur Dr. Cindy Woodland Dr. Tatiana Karaskov Dr. Hector Suarez