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Fetal protein loss in gastroschisis as an explanation of associated morbidity
S G Carroll1, P Y Kuo, P M Kyle
1Fetal Medicine Unit, St Michael's Hospital, Bristol, United Kingdom.
Insights
Fetuses with gastroschisis exhibit significant protein deficiency, indicated by lower cord serum total protein levels. This protein loss may contribute to the morbidity associated with gastroschisis in newborns.
Area of Science:
- Perinatal Medicine
- Fetal Development
- Biochemistry
Background:
- Gastroschisis is a congenital anomaly where abdominal organs protrude through a defect in the abdominal wall.
- The impact of gastroschisis on fetal nutritional status, particularly protein levels, is not fully understood.
Purpose of the Study:
- To investigate the presence and extent of protein deficiency in fetuses diagnosed with gastroschisis.
Main Methods:
- Comparison of cord serum total protein, amniotic fluid total protein, and alpha-fetoprotein concentrations between infants with gastroschisis and control groups.
- Analysis of birth weights in neonates with and without gastroschisis.
Main Results:
- Infants with gastroschisis showed significantly lower median cord serum total protein levels compared to controls.
- Elevated median amniotic fluid total protein and alpha-fetoprotein concentrations were observed in gastroschisis cases.
- Neonates with gastroschisis had significantly lower median birth weights.
Conclusions:
- Fetuses with gastroschisis experience protein loss, potentially explaining some associated morbidity.
- Further research is needed to determine if this protein loss is a primary factor in poor fetal outcomes.
Objective:
Our purpose was to examine whether protein deficiency in utero develops in fetuses with gastroschisis.
Study Design:
Twelve infants with prenatally diagnosed gastroschisis were compared with 29 control infants without gastroschisis and 2 infants with exomphalos who were delivered between 35 and 42 weeks of gestation. The groups were compared for birth weight, cord serum total protein and amniotic fluid total protein, and alpha-fetoprotein concentrations. The amniotic fluid samples were collected when the amniotic membranes were ruptured either during cesarean delivery or at artificial rupture of the membranes, and umbilical cord blood was obtained after delivery.
Results:
In the 10 cases of gastroschisis in which cord serum total protein was measured, the median concentration was 51 g/L (range, 43-61 g/L) and was significantly lower than the median level of 62 g/L (range, 47-78 g/L) in the control group (P <.001). In the 8 cases of gastroschisis in which amniotic fluid total protein and alpha-fetoprotein concentrations were measured, the respective median levels were 5.1 g/L (range, 4.3-18.4 g/L) and 5.0 g/L (range, 2.4-13.2 g/L), which were significantly higher than the median levels of 2.0 g/L (range, 0.5-5.4 g/L) and 0.8 g/L (range, 0.5-1.7 g/L) in the control group (P <.0001). The ratio of amniotic fluid to cord serum total protein was significantly higher than that in the cases of exomphalos and in the control group (P <.001). The median birth weight in the neonates with gastroschisis was 2400 g (range, 1192-3155 g) and was significantly lower than the median value of 3535 g (range, 2520-4680 g) in the control group (P <.0001).
Conclusions:
Fetuses with gastroschisis have protein loss that could partly explain associated morbidity. However, whether this is a major contributor to poor fetal outcome remains to be shown.
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