ORIGINAL ARTICLE Fatty acid ethyl esters (FAEEs) as markers for alcohol in meconium: method validation and implementation of a screening program for prenatal drug exposure Martin Hastedt • Franziska Krumbiegel • Rene ´ Gapert • Michael Tsokos • Sven Hartwig Accepted: 5 October 2012 / Published online: 5 November 2012 Ó Springer Science+Business Media New York 2012 Abstract Alcohol consumption during pregnancy is a widespread problem and can cause severe fetal damage. As the diagnosis of fetal alcohol syndrome is difficult, the implementation of a reliable marker for alcohol con- sumption during pregnancy into meconium drug screening programs would be invaluable. A previously published gas chromatography mass spectrometry method for the detec- tion of fatty acid ethyl esters (FAEEs) as alcohol markers in meconium was optimized and newly validated for a sample size of 50 mg. This method was applied to 122 cases from a drug-using population. The meconium sam- ples were also tested for common drugs of abuse. In 73 % of the cases, one or more drugs were found. Twenty per- cent of the samples tested positive for FAEEs at levels indicating significant alcohol exposure. Consequently, alcohol was found to be the third most frequently abused substance within the study group. This re-validated method provides an increase in testing sensitivity, is reliable and easily applicable as part of a drug screening program. It can be used as a non-invasive tool to detect high alcohol con- sumption in the last trimester of pregnancy. The intro- duction of FAEEs testing in meconium screening was found to be of particular use in a drug-using population. Keywords Fetal alcohol exposure Á Fetal alcohol spectrum disorder (FASD) Á Neonatal screening Á Biomarker Á Drug screening Á Alcohol abuse Introduction Drug abuse during pregnancy can lead to severe damage of the fetus. Premature birth, sudden abortion, as well as physical and mental retardation, may all be consequences of such abuse. Newborns of mothers addicted to drugs like opiates or alcohol often show nonspecific abstinence phe- nomenon symptoms (APSs) such as tremulousness, insomnia, sweating, hypertension, and tachycardia. In the worst cases they may also suffer pyrexia and convulsions. It is essential to know which substances were used by the mother in order to treat these symptoms as well as possible resulting illnesses. Sometimes the information provided by the mothers in these cases is not reliable. Gas chromatography mass spectrometry (GC/MS) has been in use as a non-invasive method for detection of prenatal drug exposure by screening meconium for several years [1–4]. The aim of this study is to demonstrate that the introduction of alcohol markers into the drug screening program is essential, especially in cases of known drug abuse by the mother or observed APSs in the newborn. In addition, it may be a reliable tool for the early diagnosis of fetal alcohol spectrum disorder (FASD). According to the Report on Drugs and Addiction in 2011 published by the German Federal Government [5], approximately 10,000 children suffer from the consequences of their mothers‘ alcohol consumption during pregnancy in Germany every year. Fetal alcohol syndrome had been observed in about 4,000 newborns annually. Impaired growth, physical deformation, mental retardation and behavioral pat- terns such as hyperactivity may be the result [5, 6]. M. Hastedt Á F. Krumbiegel Á R. Gapert Á M. Tsokos Á S. Hartwig Institute of Legal Medicine and Forensic Sciences, Charite ´, University Medicine Berlin, Berlin, Germany R. Gapert (&) Human Anatomy Laboratory, UCD School of Medicine & Medical Science, University College Dublin, Dublin, Ireland e-mail: rene.gapert@ucd.ie; renegapert@daad-alumni.de 123 Forensic Sci Med Pathol (2013) 9:287–295 DOI 10.1007/s12024-012-9385-3