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Assessment of Prenatal Exposure to Ethanol by Meconium Analysis: Results of an Italian Multicenter Study

Authors

  • Simona Pichini,

    1. From the Istituto Superiore di Sanitá (SP, EM, PZ, RP), Roma, Italy; Arcispedale Santa Maria Nuova (FV), Reggio Emilia, Italy; Policlinico Umberto I (LT), Roma, Italy; Policlinico Universitario Federico II (FR, RM), Napoli, Italy; Ospedale Sant’Antonio (BS), San Daniele del Friuli, Italy; Ospedale San Giovanni di Dio (MB), Crotone, Italy; Ospedale Santa Maria Annunziata (GR, MRE), Bagno a Ripoli, Italy; Ospedale Civile Maggiore (PB), Verona, Italy; ARS Toscana (AP), Osservatorio Qualità, Firenze, Italy; and Department of Legal Medicine and Public Health (LM), Pavia, Italy.
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  • Emilia Marchei,

    1. From the Istituto Superiore di Sanitá (SP, EM, PZ, RP), Roma, Italy; Arcispedale Santa Maria Nuova (FV), Reggio Emilia, Italy; Policlinico Umberto I (LT), Roma, Italy; Policlinico Universitario Federico II (FR, RM), Napoli, Italy; Ospedale Sant’Antonio (BS), San Daniele del Friuli, Italy; Ospedale San Giovanni di Dio (MB), Crotone, Italy; Ospedale Santa Maria Annunziata (GR, MRE), Bagno a Ripoli, Italy; Ospedale Civile Maggiore (PB), Verona, Italy; ARS Toscana (AP), Osservatorio Qualità, Firenze, Italy; and Department of Legal Medicine and Public Health (LM), Pavia, Italy.
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  • Federica Vagnarelli,

    1. From the Istituto Superiore di Sanitá (SP, EM, PZ, RP), Roma, Italy; Arcispedale Santa Maria Nuova (FV), Reggio Emilia, Italy; Policlinico Umberto I (LT), Roma, Italy; Policlinico Universitario Federico II (FR, RM), Napoli, Italy; Ospedale Sant’Antonio (BS), San Daniele del Friuli, Italy; Ospedale San Giovanni di Dio (MB), Crotone, Italy; Ospedale Santa Maria Annunziata (GR, MRE), Bagno a Ripoli, Italy; Ospedale Civile Maggiore (PB), Verona, Italy; ARS Toscana (AP), Osservatorio Qualità, Firenze, Italy; and Department of Legal Medicine and Public Health (LM), Pavia, Italy.
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  • Luigi Tarani,

    1. From the Istituto Superiore di Sanitá (SP, EM, PZ, RP), Roma, Italy; Arcispedale Santa Maria Nuova (FV), Reggio Emilia, Italy; Policlinico Umberto I (LT), Roma, Italy; Policlinico Universitario Federico II (FR, RM), Napoli, Italy; Ospedale Sant’Antonio (BS), San Daniele del Friuli, Italy; Ospedale San Giovanni di Dio (MB), Crotone, Italy; Ospedale Santa Maria Annunziata (GR, MRE), Bagno a Ripoli, Italy; Ospedale Civile Maggiore (PB), Verona, Italy; ARS Toscana (AP), Osservatorio Qualità, Firenze, Italy; and Department of Legal Medicine and Public Health (LM), Pavia, Italy.
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  • Francesco Raimondi,

    1. From the Istituto Superiore di Sanitá (SP, EM, PZ, RP), Roma, Italy; Arcispedale Santa Maria Nuova (FV), Reggio Emilia, Italy; Policlinico Umberto I (LT), Roma, Italy; Policlinico Universitario Federico II (FR, RM), Napoli, Italy; Ospedale Sant’Antonio (BS), San Daniele del Friuli, Italy; Ospedale San Giovanni di Dio (MB), Crotone, Italy; Ospedale Santa Maria Annunziata (GR, MRE), Bagno a Ripoli, Italy; Ospedale Civile Maggiore (PB), Verona, Italy; ARS Toscana (AP), Osservatorio Qualità, Firenze, Italy; and Department of Legal Medicine and Public Health (LM), Pavia, Italy.
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  • Rosalba Maffucci,

    1. From the Istituto Superiore di Sanitá (SP, EM, PZ, RP), Roma, Italy; Arcispedale Santa Maria Nuova (FV), Reggio Emilia, Italy; Policlinico Umberto I (LT), Roma, Italy; Policlinico Universitario Federico II (FR, RM), Napoli, Italy; Ospedale Sant’Antonio (BS), San Daniele del Friuli, Italy; Ospedale San Giovanni di Dio (MB), Crotone, Italy; Ospedale Santa Maria Annunziata (GR, MRE), Bagno a Ripoli, Italy; Ospedale Civile Maggiore (PB), Verona, Italy; ARS Toscana (AP), Osservatorio Qualità, Firenze, Italy; and Department of Legal Medicine and Public Health (LM), Pavia, Italy.
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  • Bruno Sacher,

    1. From the Istituto Superiore di Sanitá (SP, EM, PZ, RP), Roma, Italy; Arcispedale Santa Maria Nuova (FV), Reggio Emilia, Italy; Policlinico Umberto I (LT), Roma, Italy; Policlinico Universitario Federico II (FR, RM), Napoli, Italy; Ospedale Sant’Antonio (BS), San Daniele del Friuli, Italy; Ospedale San Giovanni di Dio (MB), Crotone, Italy; Ospedale Santa Maria Annunziata (GR, MRE), Bagno a Ripoli, Italy; Ospedale Civile Maggiore (PB), Verona, Italy; ARS Toscana (AP), Osservatorio Qualità, Firenze, Italy; and Department of Legal Medicine and Public Health (LM), Pavia, Italy.
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  • Massimo Bisceglia,

    1. From the Istituto Superiore di Sanitá (SP, EM, PZ, RP), Roma, Italy; Arcispedale Santa Maria Nuova (FV), Reggio Emilia, Italy; Policlinico Umberto I (LT), Roma, Italy; Policlinico Universitario Federico II (FR, RM), Napoli, Italy; Ospedale Sant’Antonio (BS), San Daniele del Friuli, Italy; Ospedale San Giovanni di Dio (MB), Crotone, Italy; Ospedale Santa Maria Annunziata (GR, MRE), Bagno a Ripoli, Italy; Ospedale Civile Maggiore (PB), Verona, Italy; ARS Toscana (AP), Osservatorio Qualità, Firenze, Italy; and Department of Legal Medicine and Public Health (LM), Pavia, Italy.
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  • Gherardo Rapisardi,

    1. From the Istituto Superiore di Sanitá (SP, EM, PZ, RP), Roma, Italy; Arcispedale Santa Maria Nuova (FV), Reggio Emilia, Italy; Policlinico Umberto I (LT), Roma, Italy; Policlinico Universitario Federico II (FR, RM), Napoli, Italy; Ospedale Sant’Antonio (BS), San Daniele del Friuli, Italy; Ospedale San Giovanni di Dio (MB), Crotone, Italy; Ospedale Santa Maria Annunziata (GR, MRE), Bagno a Ripoli, Italy; Ospedale Civile Maggiore (PB), Verona, Italy; ARS Toscana (AP), Osservatorio Qualità, Firenze, Italy; and Department of Legal Medicine and Public Health (LM), Pavia, Italy.
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  • Maria Rosaria Elicio,

    1. From the Istituto Superiore di Sanitá (SP, EM, PZ, RP), Roma, Italy; Arcispedale Santa Maria Nuova (FV), Reggio Emilia, Italy; Policlinico Umberto I (LT), Roma, Italy; Policlinico Universitario Federico II (FR, RM), Napoli, Italy; Ospedale Sant’Antonio (BS), San Daniele del Friuli, Italy; Ospedale San Giovanni di Dio (MB), Crotone, Italy; Ospedale Santa Maria Annunziata (GR, MRE), Bagno a Ripoli, Italy; Ospedale Civile Maggiore (PB), Verona, Italy; ARS Toscana (AP), Osservatorio Qualità, Firenze, Italy; and Department of Legal Medicine and Public Health (LM), Pavia, Italy.
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  • Paolo Biban,

    1. From the Istituto Superiore di Sanitá (SP, EM, PZ, RP), Roma, Italy; Arcispedale Santa Maria Nuova (FV), Reggio Emilia, Italy; Policlinico Umberto I (LT), Roma, Italy; Policlinico Universitario Federico II (FR, RM), Napoli, Italy; Ospedale Sant’Antonio (BS), San Daniele del Friuli, Italy; Ospedale San Giovanni di Dio (MB), Crotone, Italy; Ospedale Santa Maria Annunziata (GR, MRE), Bagno a Ripoli, Italy; Ospedale Civile Maggiore (PB), Verona, Italy; ARS Toscana (AP), Osservatorio Qualità, Firenze, Italy; and Department of Legal Medicine and Public Health (LM), Pavia, Italy.
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  • Piergiorgio Zuccaro,

    1. From the Istituto Superiore di Sanitá (SP, EM, PZ, RP), Roma, Italy; Arcispedale Santa Maria Nuova (FV), Reggio Emilia, Italy; Policlinico Umberto I (LT), Roma, Italy; Policlinico Universitario Federico II (FR, RM), Napoli, Italy; Ospedale Sant’Antonio (BS), San Daniele del Friuli, Italy; Ospedale San Giovanni di Dio (MB), Crotone, Italy; Ospedale Santa Maria Annunziata (GR, MRE), Bagno a Ripoli, Italy; Ospedale Civile Maggiore (PB), Verona, Italy; ARS Toscana (AP), Osservatorio Qualità, Firenze, Italy; and Department of Legal Medicine and Public Health (LM), Pavia, Italy.
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  • Roberta Pacifici,

    1. From the Istituto Superiore di Sanitá (SP, EM, PZ, RP), Roma, Italy; Arcispedale Santa Maria Nuova (FV), Reggio Emilia, Italy; Policlinico Umberto I (LT), Roma, Italy; Policlinico Universitario Federico II (FR, RM), Napoli, Italy; Ospedale Sant’Antonio (BS), San Daniele del Friuli, Italy; Ospedale San Giovanni di Dio (MB), Crotone, Italy; Ospedale Santa Maria Annunziata (GR, MRE), Bagno a Ripoli, Italy; Ospedale Civile Maggiore (PB), Verona, Italy; ARS Toscana (AP), Osservatorio Qualità, Firenze, Italy; and Department of Legal Medicine and Public Health (LM), Pavia, Italy.
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  • Andrea Pierantozzi,

    1. From the Istituto Superiore di Sanitá (SP, EM, PZ, RP), Roma, Italy; Arcispedale Santa Maria Nuova (FV), Reggio Emilia, Italy; Policlinico Umberto I (LT), Roma, Italy; Policlinico Universitario Federico II (FR, RM), Napoli, Italy; Ospedale Sant’Antonio (BS), San Daniele del Friuli, Italy; Ospedale San Giovanni di Dio (MB), Crotone, Italy; Ospedale Santa Maria Annunziata (GR, MRE), Bagno a Ripoli, Italy; Ospedale Civile Maggiore (PB), Verona, Italy; ARS Toscana (AP), Osservatorio Qualità, Firenze, Italy; and Department of Legal Medicine and Public Health (LM), Pavia, Italy.
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  • Luca Morini

    1. From the Istituto Superiore di Sanitá (SP, EM, PZ, RP), Roma, Italy; Arcispedale Santa Maria Nuova (FV), Reggio Emilia, Italy; Policlinico Umberto I (LT), Roma, Italy; Policlinico Universitario Federico II (FR, RM), Napoli, Italy; Ospedale Sant’Antonio (BS), San Daniele del Friuli, Italy; Ospedale San Giovanni di Dio (MB), Crotone, Italy; Ospedale Santa Maria Annunziata (GR, MRE), Bagno a Ripoli, Italy; Ospedale Civile Maggiore (PB), Verona, Italy; ARS Toscana (AP), Osservatorio Qualità, Firenze, Italy; and Department of Legal Medicine and Public Health (LM), Pavia, Italy.
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Reprint requests: Simona Pichini, Istituto Superiore di Sanità, V.le Regina Elena 299, 00161 Rome, Italy; Tel.: +39-06-4990-6545; Fax: +39-06-4990-2016; E-mail: simona.pichini@iss.it

Abstract

Background:  This study estimated in 7 Italian cities the prevalence of prenatal exposure to ethanol by determining fatty acid ethyl esters (FAEEs; palmitic, palmitoleic, stearic, oleic, linoleic, linolenic, and arachidonic esters) and ethyl glucuronide (EtG) in neonatal meconium samples.

Methods:  A total of 607 meconium samples were obtained from neonatal wards of 7 public hospitals: Verona and San Daniele del Friuli in the northeast of the country, Reggio Emilia in the middle east, Florence and Rome in the center, and Naples and Crotone in the southwest of the peninsula. Meconium biomarkers were assessed by a validated methodology using liquid chromatography–tandem mass spectrometry and the results categorized using the accepted cutoff of 2 nmol/g total amount of 7 FAEEs and 2 nmol/g EtG, to differentiate between heavy maternal ethanol use during pregnancy and occasional or no use at all.

Results:  On the basis of the above-reported cutoffs, the overall prevalence of newborns prenatally exposed to maternal ethanol was 7.9%: 0% in Verona, 4.0% in San Daniele del Friuli, 4.9% in Naples, 5.0% in Florence, 6.2% in Crotone, up to 10.6% in Reggio Emilia, and 29.4% in Rome. Low maternal education level and younger maternal age were associated with biomarker scores over the cutoff. There was also a significant correlation between the highest percentage of prenatal exposure in the capital and certain maternal sociodemographic characteristics.

Conclusions:  These results indicate considerable variability in the prevalence of fetal exposure to ethanol in different Italian cities, as determined by the objective measurement of biomarkers in meconium. These data, together with previous ones obtained in Barcelona, Spain, indicate that gestational ethanol exposure is widespread, at least in parts of Europe.

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