Perfil clínico y bioquímico de Salud Medioambiental sobre el consumo de alcohol al inicio del embarazohoja Verde y biomarcadores

Resum

Introduction. Exposure to alcohol during pregnancy is the cause of Fetal Alcohol Spectrum Disorder (FASD) that affects 2-5% of schoolchildren in Europe and North America. Safe alcohol intake in pregnancy has not been reported. Individual factors, factors dependent on the couple, and those related to urban environment, have been associated with alcohol consumption by pregnant women. In Mediterranean countries, alcohol consumption is socially accepted and normalized. Its clinical approach during pregnancy continues to be a taboo, and it is scarcely standardized among health professionals. The gold standard in the detection of alcohol consumption is the maternal report, which can be carried out by direct inquiry or through standardized questionnaires. In the Region of Murcia, an environmental health screening tool called Hoja Verde (HV) for pregnancy and lactation was developed in 2009. The HV includes a set of basic and concise questions that allows detecting the main environmental risks during pregnancy and lactation, including exposure to legal and illegal drugs. FASD is 100% preventable, and a candidate for screening programs and biochemical markers to detect alcohol consumption in pregnancy. Objectives. To study the usefulness of questionnaires and biomarkers in the detection of alcohol consumption at the beginning of pregnancy, as well as to analyze individual factors associated with the couple and the urban environment as determinants of alcohol consumption in pregnant women. Methodology. Thesis made by compendium of publications. A) In the first article we analyze the questionnaires used in the detection of prenatal exposure to alcohol in pregnancy, as well as their comparison with the pregnancy HV. B) In the second article we analyze how the partner, the built environment, and the 'neighborhood', influence alcohol consumption in pregnant women in the metropolitan area of Murcia (Health Areas 1, 6, 7 and 9 of Murcia) integrating pregnancy HV in a geographic information system. C) In the third article, we measured carbohydrate-deficient transferrin levels and other classical biomarkers of alcoholism in the first trimester of pregnancy and compared them with the concurrent data on alcohol consumption obtained through the HV of pregnancy in 91 pregnant women from the Health Area 1 of the Region of Murcia. Conclusions. A high number of women and men drink alcohol in early pregnancy. HV is a simple, global and holistic tool that allows both parents to identify and manage exposures to environmental risks during pregnancy (including exposure to legal and illegal drugs), and also allows stimulating protective factors and health promoters in critical periods of pregnancy. Involving men in reproductive health programs, developing urban policies that focus on the built environment, and improving social support networks in the pregnant woman's neighborhood or community could be important elements in public health programs aimed at the control and the prevention of alcohol consumption during pregnancy. A mixed biochemical (CDT) and clinical (HV) screening at the beginning of pregnancy can help improve the efficacy of detecting pregnancies at risk of FASD in offspring. Integrating environmental health into the clinical practice of pregnancy and alcohol prevention programs will help develop new skills and professional profiles for environmental nurses or midwives.