Urinary alcohol and ethyl glucuronide as a screening tool for alcohol use in pregnancy: A multicenter prospective study

INTRODUCTION: Reports indicate that up to 60% of pregnant women in Ireland consume alcohol and Ireland may have the third highest prevalence of fetal alcohol syndrome in the world. We sought objective evidence of alcohol intake and the acceptability of urinary alcohol screening. MATERIAL AND METHODS: This was a multicenter, prospective study conducted at one urban and two semirural maternity units. Pregnant women at their first visit (≈13 weeks gestation) were invited to participate. Urinary samples were obtained with individual consent. Samples were anonymized and tested for alcohol and ethyl glucuronide at a central laboratory. The rate of sample positivity for ethanol (at a cut-off of 30 mg/dL) and ethyl glucuronide (at a cut-off of 500 ng/mL) was reported. The percentage of women consenting to testing was recorded. Results were compared with previous questionnaire or interview-based studies. RESULTS: One thousand fifty-three urine samples were analyzed. None tested positive for ethanol but 4/1053 (0.38%) contained ethyl glucuronide. Three samples were positive in the urban cohort, 3/730 (0.41%) and 1/323 (0.31%) in the semirural centers. Consent was obtained in 96% and 98% in two semirural centers compared to 78% in the urban center (565/722 vs. 323/336. p < 0.01). Acceptability in the urban center depended on who requested consent and varied between 65% and 100% (p < 0.01). Consent to participate was significantly higher and detected alcohol use was significantly lower than in previous, interview or questionnaire-based studies. CONCLUSIONS: Alcohol intake appears to be much less common than previously estimated. The consent rates for urinary alcohol testing are high and are influenced by who is requesting consent.