Prevalence of alcohol use in late pregnancy.

BACKGROUND: Prenatal alcohol exposure (PAE) can result in detrimental developmental complications. The objective of this study was to estimate the most recent PAE prevalence data for the state of West Virginia (WV) and associated factors. METHOD: In all, 1830 newborn residual dried blood spots (DBS) in the WV Newborn Screening Repository were analyzed for phosphatidylethanol (PETH). Data were matched with Project WATCH data (94% match, N = 1729). RESULTS: The prevalence of late pregnancy PAE was 8.10% (95%CI: 6.81, 9.38) for all births, 7.61% (95%CI: 6.26, 8.97) for WV residents only, and ranged from 2.27 to 17.11% by region. The significant factors associated with PAE included smoking (OR: 2.03, 95% CI: 1.40, 2.94), preterm births (OR: 1.88; 95% CI: 1.23, 2.89), birth weight of ≤2000 g vs. >3000 g (OR: 2.62, 95%CI: 1.19, 5.79), no exclusive breastfeeding intention (OR: 1.45, 95% CI: 1.02, 2.04), and not exclusively breastfeeding before discharge (OR: 1.61; 95% CI: 1.09, 2.38). CONCLUSION: The prevalence of PAE is higher than previously shown for the state. Accurate and timely estimates are vital to inform public health workers, policymakers, researchers, and clinicians to develop and promote effective prevention strategies to lower PAE prevalence and provide targeted interventions and treatment services for infants affected by PAE.

Screening for prenatal alcohol exposure and corresponding short-term neonatal outcomes.

Detection of prenatal alcohol exposure (PAE) is important for early intervention and treatment. The main purpose of this study was to compare 1.) PAE rates using the biomarker, phosphatidylethanol (PEth), in umbilical cord (UC) blood vs. ethyl glucuronide (EtG) in UC tissue, the standard of care, and 2.) Pregnancy characteristics and neonatal outcomes in newborns positive vs. negative for PAE biomarkers. We examined records of neonates born over a two-year span receiving UC-PEth dried blood spots testing at the time of delivery in addition to standard of care PAE screening (n = 146). UC-PEth testing had a higher PAE detection rate (26%) vs. UC tissue EtG (0%, p < 0.01). PAE was not associated with any neonatal dysmorphic features or short-term adverse outcomes. The absence of significant clinical findings for identifying PAE in neonates reinforces alcohol biomarker necessity. We conclude that UC-PEth may be a valuable test for assessing PAE at birth and in identifying infants at risk for developing fetal alcohol spectrum disorder.

Capturing the statewide incidence of neonatal abstinence syndrome in real time: the West Virginia experience.

BACKGROUND: Neonatal abstinence syndrome (NAS) is one of the consequences at birth affecting the newborn after discontinuation of prenatal drug exposure to mainly opioids. The objective of this study was to determine the extent of the problem in the state of West Virginia (WV) using a real-time statewide surveillance system. METHODS: Project WATCH is a surveillance tool that since 1998 collects data on all infants born in the state of WV. NAS surveillance item was added to the tool in October 2016. This study examined all births (N = 23,667) in WV from October to December 2017. The data from six WV birthing facilities were audited for 1 month to evaluate how well this tool was capturing NAS data using κ-statistics. RESULTS: The 2017 annual incidence rate of NAS was 51.3 per 1000 live births per year for all births and 50.6 per 1000 live births per year for WV residents only. The κ-coefficient between the hospital medical records and Project WATCH data was 0.74 (95% confidence interval: 0.66-0.82) for NAS. CONCLUSION: The study provides justification to develop effective systems of care for the mother-infant dyad affected by substance use, especially targeting pregnant women in rural communities.

Improving screening for alcohol consumption during pregnancy with phosphatidylethanol.

OBJECTIVE: The study objective was to compare rates of alcohol use between urine ethanol testing and self- reporting (Method: 1) and Phosphatidylethanol (PEth) dried blood spot testing and self-reporting (Method: 2). METHODS: This was a prospective observational study in an obstetric clinic with universal alcohol screening. RESULTS: Method: 1 identified 11 patients with alcohol use (5 urine and 6 self-reported); Method: 2 identified 28 (22 PEth and 6 self-reported) out of 315 patients (one patient positive for both urine and PEth). The six patients with self-reported use had negative urine and PEth testing. We had fair agreement between the two methods (282 negative and 7 positive; 289/314=92.0%; Kappa 0.32, p<0.001); method 2 identified significantly more women (McNemar, p<0.001). Combining methods: resulted in an alcohol detection rate of 10.2% (32/314). CONCLUSION: Method: 2 identified more alcohol users than Method: 1. Combining both methods: identified the most alcohol consumption.

Prevalence of drug use in pregnant West Virginia patients.

INTRODUCTION: Substance abuse in pregnancy is of serious concern to society as well as health care providers caring for pregnant women and their infants. Various studies have suggested a prevalence of 10 -20%. This study used anonymous sampling of umbilical cord tissue to estimate the prevalence of substance abuse in West Virginia. METHODS: For the period of August 2009, as many umbilical cord samples as possible were collected at 8 regionally diverse hospitals in West Virginia. The cord tissue samples were then assayed for amphetamines, cocaine, opiates, marijuana, benzodiazapines, methadone, buprenorphine and alcohol. RESULTS: 146 of 759 collected (19.2%) were positive for drugs or alcohol. The regional diversity in drug and alcohol consumption was striking, as was the absence of cocaine, methamphetamine and buprenorphine. Voluntary reporting on birth certificates and other maternal questionnaires underestimated the prevalence by 2-3 fold. CONCLUSION: One in five infants born in West Virginia has a significant drug exposure that is not captured by conventional reporting instruments. It is hard to estimate the societal and financial cost since so many infants are exposed.