Early identification/brief intervention of alcohol related problems during pregnancy:
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Simona Pichini Board Member of European Alliance on Fetal Alcohol Spectrum Disorders
National Counterpart on alcohol policies at WHO
Early identification/brief intervention of alcohol related problems during pregnancy:
the Mediterranean Experience
Protecting the unborn baby from alcohol, EUROPARLAMENT, Brussels, September 2013
The adverse effects of prenatal exposure to maternal alcohol comprise a spectrum of structural anomalies and behavioral and neurocognitive disabilities, most accurately termed fetal alcohol spectrum disorders (FASD) including the full blown
fetal alcohol syndrome (FAS)
At present, there are no systematic data on ethanol consumption during pregnancy and consequent
fetal exposure to this toxin in any European country.
Most of the research on the prevalence of FAS and FASD comes from North America and South Africa
Prevalence estimates of FAS and FASD in Canada range from 1-3 to 9 cases per 1,000 live-born infants. State-based estimates of the
prevalence of FAS in the United States vary from 0.3 to 1.5 per
1,000 live-born infants, whereas the highest prevalence of FAS
worldwide was reported in a wine-growing region in the Western
Cape province of South Africa with a FAS prevalence of 40.5
to 46.4 per 1,000 children aged 5–9 years in one community in
Western Cape.
The only Italian experience of a field study, aimed to assess the prevalence of FAS and FASD by retrospective cohort study, was carried out in a restricted area of Rome wine-
producing province and reported a striking FAS and FADS prevalence of 0.37 and 2.3% examined children, respectively
The most recent Italian National Surveys on use and abuse of alcohol show that the percentage of women of childbearing age who declare daily intake of any
alcoholic drink is around 5-6% between 18 and 44 years of age, while that of
risky consumers, those who declare to exceed the daily ethanol dose of 12-24 g is 9.5 at 18–24 and 5.0% at 25–44 years of age
It is thus conceivable that a significant number of women who are not only problem drinkers but also social drinkers and are of child bearing age will not refrain from
ethanol drinking during pregnancy and may givebirth to an infant in utero exposed to this toxin.
“The Meconium Project”: An Italian-Spanish Joint Study to Assess Exposure to Illicit Drugs
During Pregnancy and Birth Outcomes in a mediterranean city (2004-2008)
Istituto Superiore di Sanità, Roma, Italy IMIM- Hospital del Mar, Barcelona, Spain
We found in 1209 meconium samples of mother-infant dyads attending the Hospital during 2002-2004 a prevalence of prenatal exposure to 2.6%
Cocaine, 4.7% heroin and 5.3% cannabis and….
45% daily maternal ethanol measured by FAEEs in meconium
ITALIAN MULTICENTRE STUDYITALIAN MULTICENTRE STUDY20102010
Meconium samples of newborns of
Neonatology Units from:
Reggio Emilia- 160
Roma- 51
Napoli- 61
San Daniele del Friuli- 50
Crotone- 96
Firenze- 99
Verona- 90
All the neonates born in the Unit in a
certain period of time (e.g.1 month)
excluding the ones with severe
pathologies (e.g. prematures, N=8)
requesting intensive care
% newborns prenatally exposed to maternal
ethanol in different Italian Cities:
Roma- 29.4%
Reggio Emilia- 10.6%
Crotone- 6.2%
Firenze- 5.0%
Napoli- 4.9%
San Daniele del Friuli- 4.0%
Verona- 0%
Overall: 7.9% newborns
prenatally exposed to
maternal ethanol
Neurodevelopmental characteristics of newborns exposed to maternal alcohol as
proved by meconium screening: preliminary data
G. Coriale, L. Tarani, S. Pichini, R. Pacifici, D. Fiorentino, M. Fiore, F. Di Lauro, R. Marchitelli,
G. Parlapiano, B. Scalese, M. Ceccanti
n=8 children (mean age 16 months; s.d. 2.3) positive for FAEEs and EtG in meconium and n=8 children (mean age 17 months; s.d. 1.4) negative for the biomarkers in meconium were enrolled in the study.
Physical growth and dysmorphological data collected by pediatrician,
Cognitive motor development and the adaptive abilities assessed using the Griffiths Mental Development Scales (GMDS ) and Vineland Adaptive Behaviour Scale (VABS).
Results30,0
69,5
50,843,5
50,9
60,9 71,6
52,5 51,3 52,5
01020304050607080
Locomotor
Personal-Social
Hearing-Speech
Eye-Hand
Performance
Positive Meconium
Negative Meconium
Fig.1 The developmental profiles of the positiveand negative meconium sample on GMDS(Percentile)
**
*significant comparison (p < 0.05)30.0
69.5
50.843.5
50.9
60.9 71.6
52.5 51.3 52.5
01020304050607080
Locomotor
Personal-Social
Hearing-Speech
Eye-Hand
Performance
Positive Meconium
Negative Meconium
Fig.1 The developmental profiles of the positiveand negative meconium sample on GMDS(Percentile)
**
*significant comparison (p < 0.05)
Fig.1 The developmental profiles of the positiveand negative meconium sample on GMDS(Percentile)
**
*significant comparison (p < 0.05)
54,355,249,947,9
68,465,062,760,4
01020304050607080
Comm
unicat
ion
Daily
Liv
ing
Social
izatio
n
Moto
r
Positive Meconium
Negative Meconium
Figure 2 The developmental profiles of the positive and negativemeconium sample on VABS (raw scores )
**significant comparison (p < 0.05)
*
54.355.249.947.9
68.465.062.760.4
01020304050607080
Comm
unicat
ion
Daily
Liv
ing
Social
izatio
n
Moto
r
Positive Meconium
Negative Meconium
Figure 2 The developmental profiles of the positive and negativemeconium sample on VABS (raw scores )
**significant comparison (p < 0.05)
*
The FRAMES methodology
In order to
The 5 A’s counseling
Released in 3000 copies the last September 9, 2011 during a press release with representatives of
pediatricians, neonatologists and gynecologists. Available also on line at http://www.iss.it/ofad.
Distributed to the principal hospitals, neonatology wards, regional departments of health along the
peninsula
ReceiverNumber of
copies
General Practitioners and health
professionals
Hospital neonatologistsFamily Consellings ASL/AUSLHealth Regional Directorates ASLPediatriciansAlcohol detox Centres ASL
1350
Congresses
SIN – Italian Society of NeonatologistsSIGO – Italian Society of gynecologists and obstetriciansForum Public AdministrationForum Risk Management in Health
600
Scientific SocietiesSIP – Italian Society of PediatriciansSIGO -Italian Society of gynecologists and obstetriciansSIN - Italian Society of Neonatologists
50
Regional Health Dept. 21
Varia
Centres for drug addiction detoxAdoption centresJournalistsOther
700
on-line on the web site of the Italian Observatory on Tobacco, Alcohol, drugs of abuse and doping (ISS)
www.iss.it/ofad
Guideline To diagnose FAS and FASDGuideline To diagnose FAS and FASD
3000 printed copies
Lazio Region Alcohologic Centre
• Italian Society on FASD/
Since 2012 early diagnosis /brief intervention has been performed on 1500 pregnant women attending Umberto I Hospital in Rome
Suggested strategy to detect drinking during pregnancy:Questionnaire and EtG in urine at first antenatal visit; if positive- EtG in hair; if
positive brief intervention or detoxification centre.
If suspicion, EtG in urine at each visit, standard biomarkers
Suggested strategy to detect fetal exposure to maternal drinking:EtG in meconium for all newborns; for newborns from risky environments; for
newborns of mothers suspected of drinking during pregnancy
Thanks
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