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As self\u2010reports by mothers are known to be unreliable for assessing prenatal alcohol exposure, there is a need for sensitive and specific biomarkers for identifying those at risk for alcohol\u2010affected offspring.<\/jats:p><\/jats:sec>Methods<\/jats:title>We measured serum gamma\u2010glutamyl transferase (GGT<\/jats:styled-content>), carbohydrate\u2010deficient transferrin (CDT<\/jats:styled-content>), a mathematically formulated combination of GGT<\/jats:styled-content> and CDT<\/jats:styled-content> (GGT<\/jats:styled-content>\u2013CDT<\/jats:styled-content>), and ethylglucuronide (EtG) concentrations from 1,936 mothers with a positive (n\u00a0=\u00a0<\/jats:italic>480) or negative (n\u00a0=\u00a0<\/jats:italic>1,456) history of alcohol use at the time of pregnancy. The material included 385 alcohol\u2010abusing mothers who subsequently gave birth to children with fetal alcohol syndrome (FAS<\/jats:styled-content>) and 1,551 mothers without FAS<\/jats:styled-content> children including 95 women who reported a median of 1.0 standard drinks of alcohol per day during pregnancy and 1,456 nondrinking controls. Among those without FAS<\/jats:styled-content> outcome, there were 405 mothers with gestational diabetes mellitus (GDM) and 745 mothers representing lifelong abstainers.<\/jats:p><\/jats:sec>Results<\/jats:title>Mothers of FAS<\/jats:styled-content> children had higher mean GGT<\/jats:styled-content>, CDT<\/jats:styled-content>, GGT<\/jats:styled-content>\u2013CDT<\/jats:styled-content>, and EtG levels than abstainers (p\u00a0<\/jats:italic><\u00a0<\/jats:italic>0.001 for all comparisons) or mothers reporting some alcohol consumption but whose children were not diagnosed with FAS<\/jats:styled-content> (p\u00a0<\/jats:italic><\u00a0<\/jats:italic>0.001 for all comparisons). In receiver operating characteristic analyses using cutoffs based on abstainers, the area under the curves (AUCs) for GGT<\/jats:styled-content>\u2013CDT<\/jats:styled-content> (0.873) were higher than those of GGT<\/jats:styled-content> (0.824), CDT<\/jats:styled-content> (0.776), or EtG (0.584) for differentiating the mothers of FAS<\/jats:styled-content> children and abstainers. Unlike CDT<\/jats:styled-content>, this combination marker also differed significantly between drinking mothers without FAS<\/jats:styled-content> outcome and abstainers (AUC<\/jats:styled-content>\u00a0=\u00a00.730, p\u00a0<\/jats:italic><\u00a0<\/jats:italic>0.001). In comparisons adjusted for GDM and body mass index, the group of mothers who had reported a median of 1.0 standard drinks of alcohol per day during pregnancy also differed from the group reporting no current alcohol intake in GGT<\/jats:styled-content> (p\u00a0<\/jats:italic><\u00a0<\/jats:italic>0.02) and GGT<\/jats:styled-content>\u2013CDT<\/jats:styled-content> (p\u00a0<\/jats:italic><\u00a0<\/jats:italic>0.01) levels.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Combination of GGT<\/jats:styled-content> and CDT<\/jats:styled-content> improves the identification of prenatal alcohol exposure and associated high\u2010risk pregnancies. A more systematic use of biomarkers may help intervention efforts to prevent alcohol\u2010induced adverse effects on fetal development.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.13207","type":"journal-article","created":{"date-parts":[[2016,9,21]],"date-time":"2016-09-21T11:36:39Z","timestamp":1474457799000},"page":"2385-2393","source":"Crossref","is-referenced-by-count":13,"title":["Assays of Gamma\u2010Glutamyl Transferase and Carbohydrate\u2010Deficient Transferrin Combination from Maternal Serum Improve the Detection of Prenatal Alcohol Exposure"],"prefix":"10.1111","volume":"40","author":[{"given":"Onni","family":"Niemel\u00e4","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine and Medical Research Unit Sein\u00e4joki Central Hospital University of Tampere Sein\u00e4joki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solja","family":"Niemel\u00e4","sequence":"additional","affiliation":[{"name":"Research Unit of Clinical 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