Ethyl Glucuronide, Umbilical Cord Tissue, Qualitative

Ethyl Glucuronide, Umbilical Cord Tissue, Qualitative 3000443
Method: Qualitative Liquid Chromatography-Tandem Mass Spectrometry

Detect and document maternal alcohol use during the last trimester of pregnancy

Detect of ethyl glucuronide, a metabolite of alcohol/ethanol

Confirmation testing usually not required due to analytical specificity of mass spectrometry

Order as an alternative to meconium screening or when meconium is not available

For other tests that detect alcohol use or drug exposure in newborns, see Related Tests

Ethyl glucuronide testing can be used to detect prenatal exposure to alcohol for infants born to mothers with risk factors (eg, history of alcohol/drug use, mental health issues, and injuries), little or no prenatal care, or previous children with fetal alcohol spectrum disorder (FASD).   Evaluation for prenatal alcohol exposure is indicated if an infant presents with characteristic facial anomalies, prenatal growth deficiency, and/or abnormal neurophysiology.  Testing for ethyl glucuronide in umbilical cord tissue may be used as an alternative to urine ethyl glucuronide screening for a newborn.

Disease Overview

Screening/Detection

Identification of in utero alcohol exposure may aid in early diagnosis of adverse outcomes known as fetal alcohol spectrum disorders (FASD), and can help facilitate timely follow-up and effective management of long-term social and medical needs for the exposed newborns. 

Acute ethanol exposure is not predicted by testing umbilical cord tissue but detects ethyl glucuronide, which 

  • Has a longer window of detection than ethanol
  • Is a good biomarker of alcohol use in pregnancy

Umbilical cord tissue testing may be preferable to meconium due to 

  • Ease of collection of a larger specimen
  • Reduced turnaround time (if specimen is sent to the laboratory on the day of birth)

Test Interpretation

Sensitivity/Specificity

  • Clinical sensitivity: consistent with detection of ethanol metabolite(s) observed in meconium testing 
  • Clinical specificity: high; mass spectrometric method reduces false positive and the need for confirmatory testing

Results

Results Result Description Interpretive Data

Detected

Ethanol metabolite detected in umbilical cord tissue

Does not insinuate impairment and may not affect outcomes for the infant

Not detected

Ethanol metabolite absent in umbilical cord tissue

Does not exclude the possibility that the mother used alcohol during pregnancy

Limitations

  • Detection of ethyl glucuronide in umbilical cord tissue is intended to reflect maternal alcohol use during pregnancy
    • Pattern and frequency of alcohol used by the mother cannot be determined by this test
    • False positive results may be caused by postcollection production/synthesis of ethyl glucuronide
  • A negative result does not exclude the possibility the mother used alcohol during pregnancy
  • Detection of ethyl glucuronide in umbilical cord tissue depends on extent of maternal alcohol use, as well as ethyl glucuronide stability during sample storage and/or transport, variability in ethyl glucuronide formation, and placental transfer of ethanol and metabolites, and analytical performance
  • Incidental exposure from ethanol-containing products (ie, hand sanitizers and wipes, mouthwash) may be detected when used directly on the specimen or used nearby during sample collection
References 
  1. Joya X, Friguls B, Ortigosa S, Papaseit E, Martínez SE, Manich A, Garcia-Algar O, Pacifici R, Vall O, Pichini S. Determination of maternal-fetal biomarkers of prenatal exposure to ethanol: a review. J Pharm Biomed Anal. 2012; 69: 209-22. PubMed
  2. Kvigne VL, Leonardson GR, Borzelleca J, Brock E, Neff-Smith M, Welty TK. Characteristics of mothers who have children with fetal alcohol syndrome or some characteristics of fetal alcohol syndrome. J Am Board Fam Pract. 2003; 16(4): 296-303. PubMed
  3. Hoyme E, Kalberg WO, Elliott AJ, Blankenship J, Buckley D, Marais A, Manning MA, Robinson LK, Adam MP, Abdul-Rahman O, Jewett T, Coles CD, Chambers C, Jones KL, Adnams CM, Shah PE, Riley EP, Charness ME, Warren KR, May PA. Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders. Pediatrics. 2016; 138(2): PubMed
  4. Maxwell S, Thompson S, Zakko F, Bracero LA. Screening for prenatal alcohol exposure and corresponding short-term neonatal outcomes. Reprod Toxicol. 2019; 85: 6-11. PubMed
  5. Montgomery D, Plate C, Alder SC, Jones M, Jones J, Christensen RD. Testing for fetal exposure to illicit drugs using umbilical cord tissue vs meconium. J Perinatol. 2006; 26(1): 11-4. PubMed

Last Update: August 2019