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American Journal of Clinical Nutrition, Vol. 88, No. 4, 997-1003, October 2008
© 2008 American Society for Nutrition

ORIGINAL RESEARCH COMMUNICATION

Human fetal albumin synthesis rates during different periods of gestation1,2,3

Chris HP van den Akker, Henk Schierbeek, Trinet Rietveld, Andras Vermes, Johannes J Duvekot, Eric AP Steegers and Johannes B van Goudoever

1 From the Department of Pediatrics, Division of Neonatology, Erasmus MC–Sophia Children's Hospital, Rotterdam, Netherlands (CHPvdA, HS, and JBvG); the Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands (TR); Hospital Pharmacy, Erasmus MC, Rotterdam, Netherlands (AV); and the Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam, Netherlands (JJD and EAPS)

Background: Despite nutritional intervention, albumin concentrations are often low in critically ill premature neonates.

Objective: Our aim was to quantify albumin synthesis rates during early life under physiologic circumstances. Human fetuses thereby reflect the developmentally related optimal condition.

Design: Pregnant women undergoing elective cesarean delivery received 3 different labeled amino acid infusions starting at different times before surgery. With the use of mass spectrometry techniques, this novel model enabled us to quantify fetal albumin synthesis from a single blood sample taken from the umbilical cord after cesarean delivery. The fractional synthesis rate reflects the fraction of the albumin pool that is daily renewed. The absolute synthesis rate is the absolute amount of albumin that is daily synthesized. Results are expressed as medians (25th-75th percentile).

Results: We studied 8 fetuses at 29.9 (28.4–35.4) weeks of gestation and 8 fetuses around term. Fractional synthesis rates in premature fetuses [17.5 (12.1–24.4) %/d] were higher (P = 0.02) than in mature fetuses [10.4 (9.1–13.7) %/d]. Absolute synthesis rates were also higher (P = 0.02) in premature than in mature fetuses: 280 (227–365) versus 205 (184–238) mg · kg–1 · d–1.

Conclusions: On a weight basis, albumin synthesis rates in premature fetuses were higher than in fetuses at term and were higher than the rates previously found in neonates after preterm birth. Considering that the premature fetal liver can synthesize albumin at a high rate, the observed hypoalbuminemia in premature infants therefore seems to suggest that current (nutritional) therapies fail to meet requirements necessary to sustain optimum albumin synthesis rates.






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