Media coverage of meconium testing fails to raise important questions

Last week, CBC News reported on a study currently happening in PEI (Baby poop study tracks alcohol use, November 8, 2011). This study is testing the meconium (the first stools of a baby) of every baby born in the province to try and get a sense of the prevalence of alcohol-exposed pregnancies.

According to the article, the study is intended to provide the “first accurate data on the number of babies being affected by Fetal Alcohol Syndrome on P.E.I.” Of course, we know that is not true. Meconium testing for alcohol use during pregnancy only tells us about alcohol use in the second and third trimesters of pregnancy. Like all tests, it has a tendency to produce false positives and negative results. Further, positive test results do not equal a diagnosis of FASD in an infant – one study suggests that 40% of fetuses exposed to moderate to high amounts of alcohol during pregnancy may develop FASD (Koren, Huston, and Gareri, 2008).

The article also reports that researchers did not require consent from parents to do the test but did not provide a rationale for this.

In a recent post (The Ethics of Meconium Screening, October 3, 2011), I mentioned a 2 1/2 hour webinar on meconium testing held at the 12th Annual Fetal Alcohol Canadian Expertise (FACE) Research Roundtable. As well as being able to view the entire webinar on the Canadian Association of Pediatric Health Centres website, you can listen to a podcast of the webinar or read a summary paper recently published in the Journal of Population Therapeutics and Clinical Pharmacology.

Bernard Dickens, one of the speakers at the webinar, also just published a paper on legal and ethical issues surrounding meconium testing which I think is worth reading – often, issues like meconium testing become viewed primarily as public health issues and I think there are some civil rights issues in this instance that are being neglected. For example:

  • Who owns meconium?
  • How can we address the assumption by many parties that meconium test results, which tell us about potential alcohol use during pregnancy, are not by themselves a child protection concern?
  • If universal testing is considered too costly, is it even possible to conduct targeted testing of “high risk” groups in the population in a way that that does contribute to negative stereotyping or racial/ethnic profiling? (Let me be blunt: are Aboriginal groups being consulted with all these ongoing investigations into how meconium testing can be incorporated into newborn care?)

On the issue of testing a baby’s meconium without maternal consent, Dickens comments:

“The fact that meconium may lawfully be tested without a mother’s consent raises the issue of whether it is ethical to employ a power allowed by law (since not everything that is legal is ethical), and whether mothers should at least be informed that this test will be conducted. Where it is conducted for anonymous prevalence studies, no disclosure may be required, because the test result is not relevant to the individual child’s care.

If testing is undertaken to provide clinical evidence of children’s prenatal exposure to alcohol, however, some neonatal facilities not seeking consent do inform mothers that  their newborns’ meconium will be tested. They may also respect mothers who say that they object to such a test, by not conducting it. This is legally questionable, however, if the tests are proposed for the particular children’s care, since parents are legally required to provide or consent to medical services, including tests, that are in their children’s interests.”

References:

Dickens, B.M. (2011). Legal and Ethical Considerations in Meconium Testing for Fetal Exposure to Alcohol. Journal of  Population Therapeutics and Clinical Pharmacology, 18(3):e471-e474. (Free full text here).

Koren G, Hutson J, Gareri J. (2008). Novel methods for the detection of drug and alcohol exposure during pregnancy: implications for maternal and child health. Clin Pharmacol Ther, 83(4):631-4.

 Macleod, S. and Koren, G. (2011). Meconium Testing for Fatty Acid Ethyl Esters: A 2011 Status Report. Journal of  Population Therapeutics and Clinical Pharmacology, 18(3):e500-e502. (Free full text here)