Thinking About Meconium Screening

Two weeks ago at the Fetal Alcohol Canadian Expertise (FACE) Roundtable in Vancouver, there were a couple of presentations on the use of infant meconium, the black, tar-like substance that comprises the first stools from newborns and what it can tell us about prenatal exposure to various substances, including alcohol.

Due to the difficulties with diagnosing FASD in infancy and early childhood, especially when there is no evidence or denial of maternal alcohol consumption, researchers have been looking for alternate strategies for identifying newborns who may have been exposed to alcohol so that appropriate assistance and follow-up can be offered to families.

Studies are showing that elevated levels of fatty acid ethyl esters in meconium can be a biomarker for prenatal alcohol exposure. If this is true, then perhaps universal screening could be a good thing as it would assist in the diagnosis of FASD?

Well, no. It’s doesn’t appear to be quite that easy. One of the presentations at the FACE Roundtable  discussed the differences between offering anonymous versus open meconium testing. Anonymous screening resulted in 94% of mothers consenting to meconium testing and found a positivity rate of 30% for fetal alcohol exposure. Open screening resulted in a participation rate of  78% and a positivity rate of 3%.

What’s going on here? Marcellus (2007) comments:

Screening for prenatal substance use is unique from all other types of newborn screening in that there is a greater element of social risk for parents, particularly mothers. Because of the punitive and judgmental social and legal positions that society generally takes toward women using substances when pregnant, a positive test often results in child welfare involvement and apprehension of the infant.

It’s clear from the difference in numbers between anonymous and open screening that social factors are at play in terms of mothers’ decisions to participate. Until these issues are addressed, it’s quite likely that universal screening will not deliver on its promise and that sticky ethical issues will prevail.

You can read more about the above pilot study in the June 2010 issue of Therapeutic Drug Monitoring.

Zelner, I., Shor, S., Gareri, J., Lynn, H., Roukema, H., Lum, L., Eisinga, K., Nulman, I., and Koren, G. (2010). Universal Screening for Prenatal Alcohol Exposure: A Progress Report of a Pilot Study in the Region of Grey Bruce, Ontario. Therapeutic Drug Monitoring, 32(3): 305-310. Abstract.

For an excellent overview of the meconium testing method and related physiology and ethical concerns about its use in screening, you may want to read the following article by University of Victoria professor, Lenora Marcellus.

Marcellus, L. (2007). Is Meconium Screening Appropriate for Universal Use? Science and Ethics Says No. Advances in Neonatal Care, 7(4): 207-214. Abstract.

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