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Kwak, Ho-Seok,Han, Jung-Yeol,Choi, June-Seek,Ahn, Hyun-Kyong,Ryu, Hyun-Mee,Chung, Hee-Jung,Cho, Dong-Hee,Shin, Chan-Young,Velazquez-Armenta, E. Yadira,Nava-Ocampo, Alejandro A. Informa Healthcare 2014 Clinical toxicology Vol.52 No.1
<P><I>Objective.</I> Phosphatidylethanol (PEth) is formed endogenously by the direct action of ethanol, and has a half-life long enough to make it a reliable biomarker of alcohol exposure in early pregnancy. In this study, we aimed to characterize PEth blood concentrations to differentiate different levels of alcohol exposure in pregnant women. <I>Methods.</I> The study consisted of 305 consecutive pregnant women who had been referred to our hospital for antenatal care. Of them, 117 self-reported alcohol ingestion in the first trimester of pregnancy and 188 were abstainers. Total PEth concentration in whole blood was quantified by liquid chromatography-mass spectrometry (LC-MS/MS). Alcohol ingestion was classified according to the United States National Institute on Alcohol Abuse and Alcoholism into light drinkers: ≤ 3 drinks/week, moderate drinkers: 3-7 drinks/week, and heavier drinkers: > 7 drinks/week (a standard drink = 14 g of ethanol). <I>Results.</I> Participants had quantifiable PEth blood levels 3-4 weeks after the last drink. There were 4.8% abstainers who had positive PEth concentrations; all of them reported a positive history of alcohol consumption before conception. PEth blood concentrations were significantly correlated to drinks per occasion (<I>r</I> = 0.44; <I>P</I> < 0.001) and days drinking per week (<I>r</I> = 0.34; <I>P</I> < 0.001). However, almost 74% of participants with ≤ 3 drinks/week of alcohol, and 46% with 3-7 drinks/week, had PEth blood concentrations below the lower limit of quantification (LLOQ). The area under the curve (AUC) generated by a receiver operation characteristic curve (ROC) analysis increased as the cutoff value of PEth blood concentration increased. However, the cutoff values were below or close to the LLOQ. <I>Conclusions:</I> Our study presents a formal characterization of PEth blood concentrations for screening alcohol ingestion in first-trimester pregnant women. However, caution is recommended for overrepresenting either negative or positive results.</P>
Kwak, Ho Seok,Han, Jung-Yeol,Ahn, Hyun-Kyong,Kim, Min-Hyoung,Ryu, Hyun-Mee,Kim, Moon-Young,Chung, Hee-Jung,Cho, Dong-Hee,Shin, Chan-Young,Velazquez-Armenta, Elvia Y.,Nava-Ocampo, Alejandro A. Informa Healthcare 2012 Clinical toxicology Vol.50 No.10
<P><I>Objective.</I> A reliable biomarker of low alcohol exposure during pregnancy is needed to clarify the controversy on the teratogenicity of low-to-moderate alcohol levels. <I>Methods.</I> Blood samples were obtained from 13 pregnant women who self-reported alcohol ingestion between 2.5 and 20 drinks/week, and from 26 controls. Total lipids were extracted, and phosphatidylethanol (PEth) species 16:0/16:0, 16:0/18:1, and 16:0/18:1 were separated by high-performance liquid chromatography (HPLC) on a reverse-phase phenyl column. These PEth species were quantified by MS/MS using phosphatidylpropanol as internal standard, with electrospray ionization and MRM. <I>Results.</I> PEth species were not detected in women who abstained from alcohol ingestion during pregnancy, whereas PEth-16:0/18:1 was > 5 nmol/L in those with positive alcohol ingestion. PEth species were detected for up to 4 weeks after cessation of exposure. <I>Conclusions.</I> PEth-16:0/18:1 was detected in pregnant women at 4-6 weeks after their last low-to-moderate alcohol ingestion, and therefore appears to be a reliable biomarker of prenatal alcohol exposure to study the teratogenicity of alcohol at these exposure levels.</P>
홍순철,최준식,한정열,Nava -Ocampo Alejandro A,Gideon Koren 대한의사협회 2011 대한의사협회지 Vol.54 No.8
Since the 1980’s, prenatal care for pregnant women and their babies has improved maternal and neonatal health. However, despite prenatal care, the rate of some complications, such as major fetal anomalies, preterm labor, and low birth weight have not improved. Only 10.3% of Korean women of childbearing age take folic acid supplementation and approximately 14% still consume alcohol during pregnancy. Because in Korea about 50% of pregnancies are unintended,those women have higher exposure rates to alcohol, drugs, and ionizing radiation. Because most fetal anomalies occur between 5 to 10 gestational weeks, the initial prenatal care provided at 7 to 8 gestational weeks is too late to prevent fetal anomalies. Preconception care may identify and modify adverse health, behavioral, and social outcomes for women and their unborn babies. Recently, a number of preconception interventions have been reported to have evidence-based effectiveness in improving pregnancy outcomes. These include folic acid supplementation,avoiding alcohol intake, smoking cessation, counseling on potentially teratogenic drugs, infection control, immunizations, and control of chronic diseases such as diabetes, hypothyroidism,obesity. For the improvement of maternal and fetal health, guidelines for preconception care must be developed in Korea. All health care providers should understand the clinical importance of evidence-based preconception care.