A utilitarian comparison of two alcohol use biomarkers with self-reported drinking history collected in antenatal clinics

Reprod Toxicol. 2018 Apr;77:25-32. doi: 10.1016/j.reprotox.2018.02.002. Epub 2018 Feb 6.


Background: Alcohol use is reported accurately among pregnant women in some populations.

Methods: Self-reported alcohol use via the AUDIT and 90-day recall for 193 women from antenatal clinics was compared to biomarker results: phosphatidylethanol (PEth) from bloodspots and ethyl glucuronide (EtG) in fingernails.

Results: AUDIT was positive for 67.9% of respondents, and 65.3% directly reported drinking. Individual biomarkers detected less drinking (PEth = 57.0%, EtG = 38.9%) than self-report. But 64.8% had drinking-positive values (>8 ng) on one or both biomarkers, which was not significantly different from self-report. Biomarkers indicated that 3.1% -6.8% of drinkers denied drinking. Combined biomarker sensitivity was 95% -80% and specificity 49% -76% for drinking in the previous 7-90 days. Combined biomarker results have their best yield (89.6%) and accuracy (78.8%) when measuring 90 day drinking.

Conclusions: Women reported their alcohol use accurately, and the combined use of PEth and EtG is supported.

Keywords: AUDIT; Alcohol; Biomarkers of alcohol use; Ethyl glucuronide (EtG); Phosphatidylethanol (PEth); Quantity and frequency of drinking; Self-report of alcohol use.

MeSH terms

  • Alcohol Drinking / blood
  • Alcohol Drinking / metabolism*
  • Ambulatory Care Facilities
  • Biomarkers / analysis
  • Biomarkers / blood
  • Female
  • Glucuronates / analysis*
  • Glycerophospholipids / blood*
  • Humans
  • Nails / chemistry*
  • Pregnancy / blood
  • Pregnancy / metabolism*
  • Prenatal Care
  • Self Report


  • Biomarkers
  • Glucuronates
  • Glycerophospholipids
  • phosphatidylethanol
  • ethyl glucuronide