ABSTRACT. Much evidence suggests that lactate may play a relevant role as a metabolic substrate for the brain immediately after delivery. In this work, the rate of lactate, glucose, and 3-hydroxybutyrate incorporation into COz, phospholipids, and sterols was studied in fetal rat brain slices during the last 3 d of gestation. Lactate was the best substrate for the brain during the late gestation, not only as a source of energy, but also as precursor of brain phospholipids and sterols. The rates of oxidation and lipogenesis from glucose and 3-hydroxybutyrate showed a progressive decrease during late gestation (10-15% reduction on d 2 0 . 5 ,~ < 0.05, and 22-33% on d 21.5, p < 0.01, for oxidation; 14-18% on d 20.5, p < 0.05, and 20-22% on d 21.5, p < 0.05, for lipogenesis), whereas lactate maintained its rate of utilization in the same circumstances. The main phospholipid synthesized throughout the late gestation was phosphatidylcholine. The synthesis of phosphatidylcholine and phosphatidylethanolamine from lactate, glucose, and 3-hydrokybutyrate decreased during late gestation. Under these circumstances. however. the rate of ~h~s~hatidylserine synthesis from gl"cose was'un~han~ed; it decreased from 3-hydroxybutyrate and increased from lactate. The rate of desmosterol synthesis was about 3-to 4-fold higher than those of cholesterol and lanosterol. Our results suggest that the capacity of fetal brain for lactate utilization remains high during late gestation, but the capacities for the utilization of glucose and 3-hydroxybutyrate decrease until term. This may indicate that lactate is an important substrate for brain development during late gestation. (Pediatr Res 33: 66-71, 1993) Abbreviations PC, pbosphatidylcholine PE, phosphatidylethanolamine PI, phosphatidylinositol PS, phosphatidylserine It is well established that ketone bodies (3-hydroxybutyrate and acetoacetate) are important substrates for the developing brain and that, together with glucose, they are able to meet most of the brain's metabolic requirements during the suckling period (1). However, just before the onset of lactation, i.e. during the presuckling period, there is a very low concentration of ketone bodies in rat blood (2). Moreover, the newborn rat shows a