Fetal protein loss in gastroschisis as an explanation of associated morbidity

OBJECTIVE: Our purpose was to examine whether protein deficiency in utero d evelops in fetuses with gastroschisis. STUDY DESIGN: Twelve infants with prenatally diagnosed gastroschisis were c ompared with 29 control infants without gastroschisis and 2 infants with ex omphalos who were delivered between 35 and 42 weeks of gestation. The group s were compared for birth weight, cord serum total protein and amniotic flu id total protein, and alpha -fetoprotein concentrations. The amniotic fluid samples were collected when the amniotic membranes were ruptured either du ring cesarean delivery or at artificial rupture of the membranes, and umbil ical 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 w as significantly lower than the median level of 62 g/L (range, 47-78 g/L) i n the control group (P <.001). In the 8 cases of gastroschisis in which amn iotic fluid total protein and <alpha>-fetoprotein concentrations were measu red, 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 media n 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) i n the control group (P <.0001). The ratio of amniotic fluid to cord serum t otal 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 lo wer than the median value of 3535 g (range, 2520-4680 g) in the control gro up (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.