The hypoalbuminemia in pregnancy <br /><br />Albumin is the predominant plasma protein, with a molecular weight of about 65 kDa, is synthesized by the liver. It has a normal plasma biological half-life of about 20 days. About 60 per cent in the extracellular fluid is in the interstitial compartment. However, the concentration of albumin in the smaller intravascular compartment is much higher because of the relative impermeability of the blood vessel wall. This concentration gradient across the capillary membrane is important in maintaining plasma volume.<br />The albumin makes the major contribution (about 80%) to the oncotic pressure of plasma.<br /><br /> <br /><br />The albumin has functions in the human body :<br /><br />● Albumin maintains the intravascular pressure, preventing fluid leakage into the extravascular space. Without enough albumin, fluid can leak out of your blood and build up in your lungs, abdomen , or other parts of your body.<br />● Albumin functions as a carrier of several different endogenous (e.g., long chain fatty-acids, steroids) and exogenous (various medications) compounds in the blood. The binding of those substances to albumin <br />can reduce their toxicity .<br />● Albumin has an important role in the endogenous metabolism of calcium, fatty acids, bilirubin, drugs, and hormones. <br /><br /> <br /><br /><br />What is hypoalbuminemia ?<br /><br />Hypoalbuminemia (or hypoalbuminemia) is a medical sign in which the level of albumin in the blood is low.<br /><br />Some common symptoms of hypoalbuminemia include:<br /><br />● Fluid retention that causes swelling especially of the feet or hands<br />● Weakness, exhaustion<br />● Rapid heartbeat<br />● Vomiting, diarrhea and nausea<br />● Appetite changes<br />● Abnormal renal and liver function<br />● Ascites, pleural and pericardial effusion<br /><br />Hypoalbuminemia can cause obstetric complications:<br /><br />● PE (pre-eclampsia) : Increased Risk of Preeclampsia : Hypoalbuminemia is often associated with preeclampsia, which can lead to complications for both mother and baby<br />● PTL (preterm labour)<br />● IUGR ( Intrauterine growth restriction)<br />● Placental insufficiency<br />● Abruption placentae<br />● Higher rate of LSCS<br />● Delayed Wound Healing & Increased Risk of Infections : Low albumin can impair immune function and recovery postpartum.<br /><br />Hypoalbuminemia is causes effects on foetus:<br /><br />● IUGR (Intrauterine growth restriction)<br />● Higher rate of fetal distress and<br />● Nm immune hydrops foetal.<br />● Fetal Growth Restriction (FGR) : Poor maternal nutrition and low albumin levels can contribute to inadequate fetal growth.<br /><br /><br /><br />Pregnancy with hypoalbuminemia :<br /><br /><br />Low level of albumin is common in pregnancy Hypoalbuminemia related with many obstetric complications during pregnancy. We should be concerned about its early detection and its correction.<br /><br />Why hypoalbuminemia occurs in pregnancy?<br /><br />Albumin is the fraction that is usually lost during proteinuria in pregnancy .Thus, hypoalbuminemia in pregnancy not necessarily be only due to decrease in production but also due to dilution (due to increased volume) and increase loss in urine (proteinuria). Pregnancy decreased albumin level 1 gm/dl.<br /><br />● Dilution blood : The total amount of blood in a pregnant woman’s body has increased by approximately 25 percent by the time of delivery. The increase is accounted for by the augmented volume of blood plasma (the liquid part of the blood), which is caused by fluid retention, plus an increase in the total number of red blood cells. Additional blood is needed to fill the large vessels of the uterus. Also, more blood is required to carry the oxygen and nutrients needed by the fetus and the maternal tissues and to carry away waste products. Furthermore, it is a protective reserve in case of hemorrhage during delivery.<br />● Proteinuria during pregnancy : In a healthy pregnancy, an approximate doubling of urine protein level can be expected. Early maternal renal adaptation to pregnancy includes a 75% increase in renal plasma flow by 16 weeks’ gestation and a 50% increase in GFR by 5 to 7 weeks’ gestation compared with nonpregnant levels. GFR remains 50% above the nonpregnant level throughout pregnancy.Creatinine clearance is the most commonly utilized method for estimating glomerular filtration, although it is the least precise. This is because creatinine is secreted by the tubules in addition to being cleared by the glomeruli. Creatinine clearance is moderately increased in pregnancy (to 110–150 mL/minute).<br />Increased protein excretion during pregnancy is thought to be caused by the increase in GFR. The increase in GFR could result from a combination of the following: (1) hypervolemia and hemodilution lowering protein concentration and oncotic pressure and (2) the increase in renal blood flow. This theory is challenged by the timing of proteinuria in serial studies; the increase in proteinuria occurs in the second half of pregnancy, which does not correspond to the timing of the peak increase in glomerular filtration. There is also evidence from studies using dextran sieving that the physiological increase in total protein excretion in normal pregnancy is related to increased ultrafiltration coefficients and glomerular basement membrane permeability in late pregnancy.<br />These 2 bodies of evidence suggest that the increase in GFR hypothesis does not completely explain the timing and<br />pathophysiology of proteinuria in normal pregnancy. Alterations in<br />Tubular reabsorption capacity may also play a role in increased protein excretion during pregnancy.<br /><br /><br />Management<br /><br />● Nutritional Support – Ensuring adequate protein intake (eggs, dairy, lean meat, legumes) can help maintain albumin levels.<br />● Monitoring & Treating Underlying Conditions – Regular screening for kidney, liver, or hypertensive disorders is essential<br />● Fluid Management – In severe cases, albumin infusions may be required to manage fluid balance.<br /><br />جامعة المستقبل الجامعة الاولى في العراق<br />قسم تقنيات المختبرات الطبية الاول في التصنيف الوطني العراقي<br /><br /><br /> <br /><br />