Can systemic inflammation markers obtained from complete blood count in the first trimester play a role in predicting early pregnancy loss?
Keywords:Early pregnancy loss, Systemic inflammation, Inflammatory markers, Thrombocyte activation markers, Allergy markers
Aim: Ten percent of pregnancies result in early pregnancy loss, and in 40%, the cause is unknown. The purpose of this study is to evaluate the relationship between first trimester hematological inflammatory markers and early pregnancy loss. Methods: This retrospective case-control study was conducted at Department of Obstetrics and Gynecology at The Private Nisa Hospital between 1 January 2015 and 1 October 2020. A total of 611 patients were evaluated, including 310 patients with early pregnancy loss, and 301 patients, who were included in the study as the healthy control group. Sociodemographic data and complete blood count results of the groups were obtained by scanning hospital files and computer registration systems. Results: No statistically significant differences were detected between the two groups in terms of Red Cell Distribution Width (RDW), plateletcrit (PCT), Eosinophil and NLR (Neutrophil Lymphocyte Ratio) values (P>0.05 for all). In the early pregnancy loss group, PLT(P=0.004), MPV(P<0.001), PDW(P=0.005), PLR (platelet lymphocyte ratio) (P<0.001), ELR (eosinophil lymphocyte ratio) (P<0.001), and ENR (eosinophil neutrophil ratio) (P=0.004) values were higher, while WCB (P<0.001), Hemoglobin (P=0.007), Neutrophil (P<0.001), and Lymphocyte (P<0.001) values were lower, compared to the healthy control group. Conclusions: PLT, MPV, PDW, PLR, ELR and ENR were related with early pregnancy loss. Inflammation markers, thrombocyte activation markers and allergy markers obtained from Complete Blood Count (CBC) in the first trimester pregnancy constitute a cost-effective, and easy method to predict early pregnancy loss.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletin Gynecology ACOG Practice Bulletin No. 200. Early Pregnancy Loss. Obstet Gynecol. 2018;132(5):197–207.
Kolte AM, Bernardi LA, Christiansen OB, Quenbay S, Farquharson RG, Goddijn M et al. Terminology for pregnancy loss prior to viability: a consensus statement from the ESHRE early pregnancy special interest group. ESHRE Special Interest Group, Early Pregnancy. Hum Reprod. 2015;30(3):495-8.
Shorter JM, Atrio JM, Schreiber CA. Management of early pregnancy loss, with a focus on patient centered care. Semin Perinatol. 2019;43(2):84-94.
Pinar MH, Gibbins k, He M, Kostadinov S, Silver R. Early Pregnancy Losses: Review of Nomenclature, Histopathology, and Possible Etiologies. Fetal Pediatr Pathol. 2018;37(3):191–209.
Calleja-Agius J, Jauniaux E, Pizzey AR, Muttikrishna S et al. Investigation of systemic inflammatory response in first trimester pregnancy failure. Hum Reprod. 2012;27(2): 349–57.
Oğlak SC, Aydın MF. Are neutrophil to lymphocyte ratio and platelet to lymphocyte ratio clinically useful for the prediction of early pregnancy loss? Ginekologia Polska. 2020;30(9):524–27.
Ata N, Kulhan M, Kulhan NG, Turkler C. Can neutrophil-lymphocyte and platelet-lymphocyte ratios predict threatened abortion and early pregnancy loss? Ginekologia Polska. 2020;91(4): 210–15.
Ethier JL, Desautels DN, Templeton AJ, Oza A, Amir E, Lheureux S. Is the neutrophil-to-lymphocyte ratio prognostic of survival outcomes in gynecologic cancers? A systematic review and meta-analysis. Gynecol Oncol. 2017;145(3): 584–94.
Verit FF, Cetin O, Yildirim O, Keskin S, Yucel O, Yalcinkaya S. Neutrophil to lymphocyte ratio is superior to platelet to lymphocyte ratio as an early predictor of moderate/ severe ovarian hyperstimulation syndrome. J Obstet Gynaecol. 2014;34(7):639–43.
Ilhan G, Verit FF, Altan E, Zebitay AG, Sozen H, Akyol H, Eken M. Evaluation of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Red Blood Cell Distribution Width-Platelet Ratio for Diagnosis of Premature Ovarian Insufficiency. J Family Reprod Health. 2016;10(4):211–16.
Cho S, Cho H, Nam A, Kim HY, Choi YS, Park KH, Cho DJ, Lee BS. Neutrophil-to-lymphocyte ratio as an adjunct to CA-125 for the diagnosis of endometriosis. Fertil Steril. 2008;90(6):2073–79.
Caglayan EK, Ustun YE, Gocmen AY, Sarı N, Seckin L, Kara M, et al. Is there any relationshipbetween serum sirtuin-1 level and neutrophil-lymphocyte ratio in hyperemesis gravidarum? J Perinat Med. 2016;44(3):315–20.
Colak E , Ozcimen EE, CeranMU , Tohma YA , Kulaksızoglu S. Role of mean platelet volume in pregnancy to predict gestational diabetes mellitus in the first trimester. J Matern Fetal Neonatal Med. 2020;33(21):3689-94.
Serin S, Avcı F, Ercan O, Köstü B, Bakacak M, Kıranet H. Is neutrophil/lymphocyte ratio a useful marker to predict the severity of pre-eclampsia? Pregnancy Hypertens. 2016;6(1):22-5.
Abide Ç, Vural F, Kılıççı Ç, Ergen EB, Yenidede I, Eser A, Pekinet O. Can we predict severity of intrahepatic cholestasis of pregnancy using inflammatory markers? Turk J Obstet Gynecol. 2017;14:160-5.
Akdemir N, Cevrioglu AS, Ozden S, Kuru B, Bilir F, Bilir C Platelet Indices and Blood Groups in Early Recurrent Miscarriage: A Study in Pregnant Women J Clin Gynecol Obstet. 2013;2(1):27-30.
Challis JR Lockwood CJ, Myatt L, Norman JE, Strauss JF, Petragliaet F. Inflammation and pregnancy. Reprod Sci. 2019;16(2):206–15.
Yiyenoğlu OB. Uğur MG, Özcan HÇ, Can G, Öztürk E, Balat Ö, et al. Assessment of oxidative stress markers in recurrent pregnancy loss: a prospective study. Arch Gynecol Obstet. 2014;289(6):1337-40.
Kim KJ, Yang KM, Sachs AG. Recurrent pregnancy loss: A disease of inflammation and coagulation. J Obstet Gynaecol Res. 2019; 35:609-22.
Kosus N, Kosus A, Yildirim M, Duran M, Turhan NO. Mean platelet volume as a marker of thrombosis in patients with missed abortion. Acta Haematol. 2011;125(4):208–9.
Aynıoglu O, Isık H, Sahbaz A, Harma MI, Isık M, Kokturk F. Can Plateletcrit be a Marker for Recurrent Pregnancy Loss? Clin Appl Thromb Hemost. 2016;22(5):447–52.
Christoforaki V,, Zafeiriou Z, Daskalakis G, Katasos T, Siristatidis C. First trimester neutrophil to lymphocyte ratio (NLR) and pregnancy outcome. J Obstet Gynaecol. 2020;40(1):59–64.
Nording HM, Seizer P, Langer HF. Platelets in inflammation and atherogenesis. Front Immunol. 2015;98(6):1-11.
Zhou X, Du Y, Huang Z, Xu J, Qiu T, Wanget J et al. Prognostic value of PLR in various cancers: a meta-analysis. PLoS One. 2014;9(6):101-19.
Sargın MA, Yassa M, Taymur BD, Celik A, Ergun E, Tug N. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: are they useful for predicting gestational diabetes mellitus during pregnancy? Ther Clin Risk Manag. 2016;12:657–65.
Ekin A, Gezer C, Taner CE, Ozeren M, Uyar I, Gulhanet I. Risk factors and perinatal outcomes associated with latency in preterm premature rupture of membranes between 24 and 34 weeks of gestation. Arch Gynecol Obstet. 2014;290(3):449–55.
Tola EN. The association between in vitro fertilization outcome and the inflammatory markers of complete blood count among nonobese unexplained infertile couples. Taiwan J Obstet Gynecol. 2018;57(2):289–94.
Sahoo D, Gosaib H, Harsodaa JM, Palana BM. A Comparative Hematological Profile Study Among Young Individuals. Canadian Journal of Basic and Applied Sciences. 2015;3:178-81.
Tembe N, Joaquim O, Alfai E, Sitoe N, Viegas E, Macovela E,et al. Reference Values for Clinical Laboratory Parameters in Young Adults in Maputo, Mozambique. PLoS ONE. 2014;9:973-91.
Chandra S, Tripathi AK, Mishra S, Amzarul M, Vaish AK. Physiological Changes in Hematological Parameters During Pregnancy. Indian J Hematol Blood Transfus. 2014;28:144-6.
Elmas B, Kıncı MF, Gök İE, Alkan A, Toğrul C, Sarıkaya S. Is higher IgE levels in preeclamptic pregnancies suggest autoimmune pathophysiology? Cukurova Med J. 2019;44(1):547-54.
Keski-Nisula L, Heinonen S, Remes S, Pekkanen J Pre-eclampsia, placental abruption and increased risk of atopic sensitization in male adolescent offspring. Am J Reprod Immunol. 2009;62:293-300.
How to Cite
Copyright (c) 2020 Derya Kanza Gül
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.