Many pregnant women struggle with the question: to drink or not to drink? Typically, expectant mothers abstain from drinking alcohol to prevent endangering the baby’s health, but others do imbibe and are reluctant to reveal how much they consumed during pregnancy because of the stigma — hence prenatal alcohol exposure being missed. However, a baby’s first dirty diaper can reveal alcohol exposure in utero and long-term cognitive development issues, according to a recent study published in the The Journal of Pediatrics.

To investigate, researchers from the Jack, Joseph and Morton Mandel School of Applied Social Sciences at Case Western Reserve University studied whether fatty acid ethyl esters (FAEE) — a group of products from metabolizing alcohol — found in meconium (a newborn’s first stool) can predict alcohol use during pregnancy and whether the baby is at risk for problems with intelligence and reasoning. The research is part of the ongoing Project Newborn study, a longitudinal research project funded by the National Institutes of Health’s National Institute on Drug Abuse that follows the physical, social, and cognitive developments of babies born to mothers who used cocaine, alcohol, and other drugs during their pregnancies. Project Newborn has studied approximately 400 children for 20 years since their births in the mid-1990s.

This current study analyzed a total of 216 children for levels of FAEE: ethyl myristate, ethyl oleate ethyl linoleate, and ethyl linolenate. Intelligence tests were also conducted on the participants at ages 9, 11, and 15.

The findings revealed there is a link between babies with high levels of FAEE present in their first stool and lower IQ scores. The association between FAEEs in meconium and cognitive development shows the significance of uncovering an early biomarker that supports the validity of FAEEs for determining alcohol exposure during pregnancy.

“FAEE can serve as a marker for fetal alcohol exposure and developmental issues ahead,” said Dr. Meeyoung O. Min, the study’s leader researcher and research assistant professor at the Mandel School, in the news release.

This is instrumental since many mothers can fib about how much they drank during pregnancy. This biomarker can help identify alcohol exposure in utero, regardless of whether mothers report alcohol use or not during pregnancy.

A similar 2006 study published in the journal Alcoholism, Clinical, and Experimental Research found FAEE levels in meconium, particularly ethyl linoleate and ethyl AA, are biomarkers that highly predict prenatal exposure to alcohol in newborn infants. Moreover, the researchers believe that ethyl AA and DHA could be potential biomarkers of fetal alcohol effects on the developing fetal brain and should be further investigated.

FAS is estimated to occur in one to two live births per every 1,000 in certain areas of the U.S. Distinctive fetal alcohol facial characteristics include a smaller head and eyes, thin upper lip, and a smooth ridge between the upper lip and nose. However, many babies exposed to alcohol can still appear physically normal. Revealing biomarkers of fetal exposure to alcohol are essential for early detection and intervention to prevent undesirable outcomes for these infants.

The truth is there is neither a known safe amount of alcohol use during pregnancy or while trying to get pregnant, nor is there a safe time during pregnancy to drink. Fetal alcohol spectrum disorders ( FASDs ) occur in babies whose mothers drank alcohol during pregnancy and come with side effects, including physical problems and problems with behavior and learning, according to the Centers for Disease Control and Prevention.

Babies are affected by FASD when an expectant mother drinks alcohol, which passes on to the baby through the umbilical cord. In other words, when a woman drinks alcohol, so does her baby. Cognitive development affected by alcohol can lead to the baby having problems with learning, memory, attention span, communication, vision, or hearing. They can even face a hard time in school and getting along with others.

Sources: Bearer CF, Min MO, Minnes S et al. Association of Fatty Acid Ethyl Esters in Meconium and Cognitive Development during Childhood and Adolescence. The Journal of Pediatrics. 2015.

Abela MB, Ager JW, Church MW et al. Fatty acid ethyl esters in meconium: are they biomarkers of fetal alcohol exposure and effect? Alcoholism, Clinical, and Experimental Research. 2006.