Disclosing alcohol abuse during gestation by urine ethyl glucuronide

Fetal Alcohol Spectrum Disorders (FASD) are a group of pathological conditions typical of babies exposed to alcohol during gestation. For this reason, it is important to disclose any form of use and abuse of alcohol during pregnancy. One approach to overcome this issue is to use screening questionnaires such as AUDIT-C, T-ACE/TACER-3, and TWEAK. As a direct metabolite of ethanol, ethyl glucuronide (EtG) is used as a marker of alcohol consumption and is measured in the urine. The aims and novelties of this study were to compare EtG urinary value with the questionnaires score and of a food diary. Furthermore, for the first time, we defined a normalized cut-off for EtG at 103 ng/g of urinary creatinine using the 90th right-sided percentile of the population of pregnant women (n=129). Women who did not complete one of the questionnaires, or that refused to handle urine samples were excluded. In the end, 309 pregnant women were enrolled in our study. Our data show that 20% of the pregnant women were over the established normalized cut-off value. Considering the cut-off proposed by the test manufacturer (100 ng/mL), a moderate concordance was found with the normalized cut-off. Instead, poor concordance was found between the EtG data and the screening interviews, as the latter indicate lower levels of alcohol consumption. In conclusion, this study proposes a new normalized urine EtG cut-off and provides evidence that the assessment of maternal alcohol consumption during preg-nancy, only with questionnaires and food diary, can lead to incorrect assessment