Pilot study results suggest that meconium screening may not deliver on its promise
Meconium, the first stools of a newborn baby, can be tested following birth. Amongst other things, it can tell us about prenatal exposure to alcohol.
While it is a far from perfect test (e.g., it only tells us about alcohol use in the second and third trimesters of pregnancy, it is subject to false positives, and a positive test does not equal a diagnosis of FASD), it is believed by some that if meconium testing was to be routinely implemented that it would help with early diagnosis of FASD which would then in turn help with addressing some of the negative consequences of FASD later in life such as difficulties at school or problems with the law. (Meconium testing does not prevent FASD or help to reverse biological effects of alcohol consumption during pregnancy).
A recent study published in the journal Alcohol explores whether women would willingly participate in a neonatal screening program which involves meconium testing. The pilot screening project was conducted in a high-risk obstetric unit in a regional Ontario hospital.
First, the researchers conducted anonymous testing where mothers agreed to have meconium collected from their baby as long as the test results were not connected to individuals. Then, in order to compare, a second group of mothers were asked to participate in an open screening program. The results were significantly different in terms of participation and the rates of a positive test for alcohol exposure.
The participation rate in the screening program was significantly lower than when testing was conducted anonymously (78% vs. 95%) and the positivity rate was 3% in contrast to 30% observed under anonymous conditions. The researchers conclude that the majority of mothers who consumed alcohol during pregnancy refused to participate in a screening program.
The researchers comment on how these outcomes are likely due to embarrassment, guilt, and fears of stigma and child apprehension. One of the suggested ways of resolving this is to eliminate the need for maternal consent to the test. This is an extremely murky ethical area and not likely one to build trust between health care providers and women giving birth (I mean, how would you like it for a random nurse or doctor conducted tests on your child without you knowing about it? Is that really in the “best interests of a child”?).
But it also doesn’t get at the whole issue of how some mothers, regardless of whether they drank alcohol or not during pregnancy, may not be interested in this particular application of technology which is intent on scrutinizing their every move, especially when there is no evidence of spectacular outcomes from the test (FASD is, at present, incurable). In this pilot study, there was one positive case identified by the screening. This led to the identification of motor development delays at 6 months and referrals for further assessment – but it’s not even clear if these delays were related to prenatal alcohol exposure or other factors.
For more on meconium screening, see earlier posts:
- Testing for Fetal Exposure to Alcohol (November 15, 2011)
- The Ethics of Meconium Screening (October 3, 2011)
- Thinking About Meconium Screening (September 28, 2010)
Zelner, I., Shor, S., Lynn, H., Roukema, H., Lum, L., Eisinga, K., Koren, G. (2012). Neonatal screening for prenatal alcohol exposure: Assessment of voluntary maternal participation in an open meconium screening program. Alcohol, 1-8. Epub 22 March 2012. doi:10.1016/j.alcohol.2011.09.029
Zelner, I., Shor, S., Lynn, H., Roukema, H., Lum, L., Eisinga, K., Koren, G. (2012). Clinical use of meconium fatty acid ethyl esters for identifying children at risk for alcohol-related disabilities: the first reported case. Journal of Population Therapeutics and Clinical Pharmacology, 19(1):e26-31. (Free full-text)