DISCUSSION
The aim of this study was to investigate whether CBC variables were
correlated with birthweight, gestational age at birth and severity of
prematurity. The results demonstrated that there was a weak negative
correlation of PLR with birthweight and gestational age at birth and NLR
was a weak positive independent variable for birthweight.
The Hb value was determined to be lower in the preterm group. When the
groups were separated on the basis of infant birthweight according to
gestational week, the highest Hb value was observed in the SGA group and
the lowest Hb value in the AGA group.
There is only one study in literature related to the effect of NLR and
PLR on birthweight and gestational age at birth (25). In that study, it
was concluded that an increased NLR was associated with early birth and
low birthweight. In the current study, no correlation was determined
between increased NLR and preterm births, but a weak positive
relationship was determined with birthweight. When the increase in NLR
is measured in the first trimester of pregnancy, it may be associated
with various pregnancy complications as a link with underlying
inflammatory processes (9-13).
For example, the NLR has been observed to be increased in pre-eclampsia
and especially in the severe form. Therefore, it has been recommended
that it could be a useful marker in the first trimester of pregnancy
(26). Moreover, in healthy pregnancies with no complications, as in the
current study population, no increased NLR values have been observed
(27).
In a study by Akgun et al, a negative correlation was observed between
the PLR and birthweight and gestational age at birth (25). In the
current study, a similar result was obtained in this context. However,
while there was no significant relationship in the comparisons made
according to preterm, term, or birthweight, a correlation was determined
when all the patients were examined independently of the groups.
Furthermore, it was concluded in this study that low PLR was an
independent risk factor for birthweight. While Akgun et al stated that
PLR was related to early births because of prematurity rather than
birthweight (25), the results of the current study showed that in
contrast there was a greater relationship with birthweight according to
gestational age rather than prematurity. In literature, it has been
reported that maternal inflammation affects birthweight according to
gestational age through various inflammatory cytokines, and leads to low
birthweight (28). The results of the current study support these
findings in literature.
In the current study, the lowest RDW value was observed in the SGA
group, which was consistent with the findings of Akgun et al (25). In
addition, in the comparison of the preterm subgroups, the lowest value
was observed in the 31+0-32+6 weeks gestational age group, at a
statistically signficant level (p=0.001). This suggested that the RDW
was directly proportional to both gestational age and the severity of
prematurity. In literature, some authors have reported a higher result
of RDW in IUGR and preterm infants (29, 30), while others in studies of
neonatal populations have shown a negative correlation of RDW and
gestational age (31).
In the study by Akgun et al, although PDW and MPV values were observed
to be lower in preterm and IUGR groups, a positive correlation was
determined with birthweight (25). In the currrent study, while PDW and
MPV values were observed to be lower in the preterm group, the highest
value was seen in the LGA group. The relationship between PDW and MPV
values and prematurity has been reported in literature (32, 33).
However, no clear data have been obtained in respect of the effect on
birthweight.
In the study by Akgun et al, the leukocyte value was determined to be
higher in male fetal gender (25), and in the current study, although not
statistically significant, a higher value was seen in female infants.
These conflicting results lead to hesitation in suggesting that there
could be a relationship between CBC variables and fetal gender.
There is only one study in literature about the effect of NLR and PLR on
gestational age at birth and birthweight (25). However, the current
study is the first to have evaluated whether or not there is an effect
of NLR and PLR on the severity of prematurity. There are of course many
factors affecting prematurity, but the patients included in this study
were healthy pregnant patients with no other disease, and thus it was
attempted to minimise additional factors. A limitation of the current
study could be said to be that the study group was heterogenous as it
included patients of different ethnic origins.
From the results of the current study, it was concluded that elevated
NLR was an independent risk factor for birthweight. Although not
statistically significant, the lowest NLR was obtained in the SGA group.
This result is consistent with the only study in literature on this
subject, but as Akgun et al also stated, this result should be
investigated independently of gestational week, and there is a need for
further studies on this subject. In the current study, no relationship
was observed of the NLR with preterm or term pregnancies and no
correlation was determined with the severity of prematurity. A negative
correlation was determined between the PLR and both gestational age at
birth and birthweight, and it was concluded that a decreased PLR was an
independent risk factor for birthweight. Furthermore, although not
statistically significant, the PLR was determined to be directly
proportional to the severity of prematurity.
CONCLUSION
In conclusion, the results of this study revealed a negative correlation
between NLR and gestational age at birth and birthweight, and although
this does not support the findings of Akgun et al (25), in the first
study published on this subject, similar results were obtained in
respect of the negative correlation between PLR and gestational age at
birth and birthweight. In addition, the current study results showed
that although low Hb was associated with early births, there was no
association with low birthweight and the highest Hb value was observed
at low birthweight. There is a need for further studies to determine the
effects of maternal CBC variables on perinatal outcomes, and this easily
applicable method can be considered useful for the pre-determination of
perinatal outcomes.
ACKNOWLEDGEMENT
None
CONFLICIT OF INTEREST
The authors certify that they have NO affiliations with or involvement
any organization or entity with any financial interest (such as
honoraria; educational grants; participation in speakers’ bureaus;
membership, employment, consultancies, stock ownership, or other equity
interest; and expert testimony or patent-licensing arrangements), or
non-financial interest (such as personal or professional relationships,
affi liations, knowledge or beliefs) in the subject matter or materials
discussed in this manuscript.
CONTRIBUTION TO AUTHORSHIP
Planning and writing carried out by A.N.Bulut
Data scanning carried out by V.Ceyhan
ETHICS APPROVAL
This study has received the approval of erciyes university ethics
committee.
Date:29.01.2020. Referance number: 2020/53.
FUNDING
None
REFERANCES
- Roland MCP, Friis CM, Godang K, Bollerslev J, Haugen G, Henriksen T.
Maternal Factors Associated with Fetal Growth and Birthweight Are
Independent Determinants of Placental Weight and Exhibit Differential
Effects by Fetal Sex. Plos One. 2014;9(2):1-5.
- Naeye RL, Dixon JB. Distortions in Fetal Growth Standards. Pediat.
Res.1978;12: 987-991.
- Romero R, Dey SK, Fisher SJ. Preterm labor: One syndrome, many causes.
SCIENCE 2014 ;345(6198):760-766.
- Mayer C, Joseph KS. Fetal growth: a review of terms, concepts and
issues relevant to obstetrics. Ultrasound Obstet Gynecol 2013; 41:
136–145.
- Patrick Chukwuyenum Ichipi-Ifukor,1 Juliet Jacobs,2 Rita Ngozi
Ichipi-Ifukor,3 and Oberhiri Lawrence Ewrhe4,5. Changes in
Haematological Indices in Normal Pregnancy. Physiology Journal.
2013:1-5
- R. Yip, “Significance of an abnormally low or high hemoglobin
concentration during pregnancy: special consideration of iron
nutrition,” The American Journal of Clinical Nutrition.
2000;72(1):272-79.
- Chandra S, Tripathi AK, Mishra S, Amzarul M, Vaish AK. Physiological
Changes in Hematological Parameters During Pregnancy. Indian J Hematol
Blood Transfus. 2012;28(3):144-46.
- Kaur S, Khan S, Nigam A. Hematological profile and pregnancy: a
review. Int. J Adc. Med. 2014;1(2):68-70.
- Mannaerts D, Heyvaert S, De Cordt C, Macken C, Loos C, Jacquemyn Y.
Are neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio
(PLR), and/or mean platelet volume (MPV) clinically useful as
predictive parameters for preeclampsia? The Journal of Maternal-Fetal
& Neonatal Medicine. 2017;32(9):1412-1419.
- Gezer C, Ekin A, Ertas IE, Ozeren M, Solmaz U, Mat E, Taner CE. High
first-trimester neutrophil-to-lymphocyte and platelet-to-lymphocyte
ratios are indicators for early diagnosis of preeclampsia. Ginekologia
Polska. 2016;87(6):431-435.
- H. Yilmaz, H. T. Celik, M. Namuslu, O. Inan, Y. Onaran, F. Karakurt,
A. Ayyildiz, M. A. Bilgic, N. Bavbek, A. Akcay. Benefi ts of the
Neutrophil-to Lymphocyte Ratio for the Prediction of Gestational
Diabetes Mellitus in Pregnant Women. Exp Clin Endocrinol Diabetes.
2014;122:39-43.
- Caglayan EK, Engin-Ustun Y, Gocmen AY, Sarı N, Seckin L, Kara M, Polat
MF. 2016. Is there any relationship between serum sirtuin-1 level and
neutrophil-lymphocyte ratio in. hyperemesis gravidarum? Journal of
Perinatal Medicine 44:315–320.
- Kim MA, Lee YS, Seo K. 2014. Assessment of predictive markers for
placental inflammatory response in preterm births. PLoS One 9:e107880.
- Huang QT, Zhou L, Zeng WJ, Ma QQ, Wang W, Zhong M, Yu YH. 2017.
Prognostic significance of neutrophil-to-lymphocyte ratio in ovarian
cancer: a systematic review and meta-analysis of observational
studies. Cellular Physiology and Biochemistry: International Journal
of Experimental Cellular Physiology, Biochemistry, and Pharmacology
41: 2411–2418.
- Akinci Ozyurek B, Sahin Ozdemirel T, Buyukyaylaci Ozden S, Erdogan Y,
Kaplan B, Kaplan T. 2017. Prognostic value of the neutrophil to
lymphocyte ratio (NLR) in lung cancer cases. Asian Pacific Journal of
Cancer Prevention 18:1417–1421.
- Iwase T, Sangai T, Sakakibara M, Sakakibara J, Ishigami E, Hayama S,
et al. 2017. An increased neutrophil-to-lymphocyte ratio predicts
poorer survival following recurrence for patients with breast cancer.
Molecular and Clinical Oncology 6:266–270.
- Piciucchi M, Stigliano S, Archibugi L, Zerboni G, Signoretti M,
Barucca V, et al. 2017. The neutrophil/lymphocyte ratio at diagnosis
is significantly associated with survival in metastatic pancreatic
cancer patients. International Journal of Molecular Sciences
18:pii:730.
- Tang X, Du P, Yang Y. 2017. The clinical use of
neutrophil-to-lymphocyte ratio in bladder cancer patients: a
systematic review and meta-analysis. International Journal of Clinical
Oncology 22:817–8255.
- Brooks SD, Spears C, Cummings C, VanGilder RL, Stinehart KR, Gutmann
L, Domico J. 2014. Admission neutrophil-lymphocyte ratio predicts 90
day outcome after endovascular stroke therapy. Journal of
NeuroInterventional Surgery 6:578–583.
- Lattanzi S, Cagnetti C, Rinaldi C, Angelocola S, Provinciali L,
Silvestrini M. 2018. Neutrophil-to-lymphocyte ratio improves outcome
prediction of acute intracer
- Aktas G, Sit M, Dikbas O, Erkol H, Altinordu R, Erkus E, Savli H.
2017. Elevated neutrophil-to-lymphocyte ratio in the diagnosis of
Hashimoto’s thyroiditis. Revista da Associacao Medica Brasileira
(1992) 63:1065–1068.
- Hwang SY, Shin TG, Jo IJ, Jeon K, Suh GY, Lee TR, et al. 2017.
Neutrophilto- lymphocyte ratio as a prognostic marker in
critically-ill septic patients. The American Journal of Emergency
Medicine 35:234–239.
- Surendar J, Indulekha K, Mohan V, Pradeepa R. 2016. Association of
neutrophil- lymphocyte ratio with metabolic syndrome and its
components in Asian Indians (CURES-143). Journal of Diabetes and its
Complications 30:1525–1529.
- Kirbas A, Biberoglu E, Daglar K, _Iskender C, Erkaya S, Dede H, et
al. Neutrophil-to-lymphocyte ratio as a diagnostic marker of
intrahepatic cholestasis of pregnancy. European Journal of Obstetrics,
Gynecology, and Reproductive Biology. 2014;180:12–15.
- Akgun N, Kalem MN, Yuce E, Kalem Z, Aktas H. Correlations of maternal
neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio
(PLR) with birth weight. The Journal of Maternal-Fetal & Neonatal
Medicine 2019;30(17):2086-2091.
- Serin S, Avcı F, Ercan O , Köstü B, Bakacak M, Kıran H. Is
neutrophil/lymphocyte ratio a useful marker to predict the severity of
pre-eclampsia? Pregnancy Hypertension: An International Journal of
Women’s Cardiovascular Health . 2016;6: 22–25.
- Kurtoglu E, Kokcu A, Celik H, Migraci Tosun M, Malatyalioglu E. May
ratio of neutrophil to lymphocyte be useful in predicting the risk of
developing preeclampsia? A pilot study. The Journal of Maternal-Fetal
& Neonatal Medicine 2014;28(1):97-99.
- Amarilyo G, Oren A, Mimouni FB, Ochshorn Y, Deutsch V, Mandel D.
Increased cord serum inflammatory markers in small-for-gestational-age
neonates. Journal of Perinatology 2011;31:30–32 .
- Erkenekli K, Öztaş E, Özler S, Yücel A, Uygur D, Danışman N. Complete
Blood Count Indices in Pregnancies With Isolated Intrauterine Growth
Restriction. The Journal of Gynecology - Obstetrics and Neonatology
2015;12(1):18 – 21.
- Shehata HA, Ali MM, Evans-Jones JC, Upton GJG, Manyonda IT. Red cell
distribution width _RDW. changes in pregnancy. International Journal
of Gynecology & Obstetrics 1998;62:43-46.
- Garofoli F, Ciardelli L, Mazzucchelli I, Borghesi A, Angelini M,
Bollani L, Genini E, Manzoni P, Paolillo P, Tinelli C, Merlini G,
Stronati M. The red cell distribution width (RDW): Value and role in
preterm, IUGR (intrauterine growth restricted), full-term infants.
Hematology 2014;19( 6);365-370.
- Ulkumen BA, Pala HG, Calik E, Koltan So. Platelet distribution width
(PDW): A putative marker for threatened preterm labour. Pak J Med Sci
2014;30(4):745-748.
- Farhan FS. Mean Platelet Volume and Platelet Distribution Width as
Predictors for Preterm Labour. Iraqi Medical Journal 2016;62(2);95-99.