Early identification/brief intervention of alcohol related problems during pregnancy:

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