Comparison of the progressive changes in hemogram parameters of normal glycemic and gestational diabetic patients throughout the first two trimesters and predictive ability of these indices for gestational diabetes mellitus

Abstract

Aim: To assess the predictive role of hematological indices in the first trimester of pregnancy for gestational diabetes mellitus (GDM) and to compare the progressive changes in these indices between patients with and without GDM in their first and second trimesters. Materials and Methods: Pregnant women screened for GDM in 24-28 gestational weeks and who had CBC test in the first and second trimesters were retrospectively investigated. Platelet mass index (PMI), neutrophil-to-lymphocyte ratios (NLR) and platelet-to-lymphocyte ratios (PLR) were calculated. The first trimester hematological indices were compared between normal glycemic patients and the patients with subsequent GDM. The progressive changes of these indices were compared. Results: Three-hundred-sixty-eight women were enrolled and 17.9% had GDM. There was no difference between first trimester hematological indices, except PLR which was lower in GDM group, however, PLR was not an independent predictor. In normal-glycemic pregnant women hemoglobin, hematocrit, lymphocytes, platelets, mean-platelet-volume (MPV), plateletcrit (PCT), platelet-large-cell-ratio (PLCR) and PMI decreased significantly from first trimester to second trimester. White-blood-cells(WBC), neutrophils, nucleated-red-blood-cells(NRBC), immature granulocytes and NLR increased significantly, while no significant changes were detected in red-cell-distribution-width(RDW), platelet-distribution-width(PDW) and PLR. In GDM patients, hemoglobin, hematocrit, lymphocytes, platelets and PMI significantly decreased while WBC, neutrophils, MPV, immature granulocytes and NLR increased from first trimester to second trimester. RDW, PDW, PCT, PLCR, NRBC and PLR did not change. Conclusion: None of the first trimester hematological indices have a predictive ability for subsequent GDM. The progressive changes in MPV can be used as an indicator to assess the development of GDM.

Keywords

• Hematological indices
• gestational diabetes mellitus
• mean platelet volume
• inflammatory markers
• change in complete blood count parameters

Normal glisemik ve gestasyonel diyabetli hastalarda ilk iki trimester boyunca hemogram parametrelerindeki progresif değişimlerin karşılaştırılması ve bu endekslerin gestasyonel diyabetes mellitusu öngörme yetenekleri

Abstract

Amaç: Gebeliğin ilk trimesterindeki hematolojik endekslerin gestasyonel diyabetes mellitusun (GDM) öngörülmesindeki rollerinin araştırılması ve ilk iki trimesterde bu parametrelerdeki değişimlerin GDM’si olan ve olmayan hastalarda karşılaştırılması Materyal ve Metot: GDM için 24-28. gebelik haftalarında taranan ve ilk iki trimesterde de hemogram testi yapılmış olan gebeler retrospektif olarak araştırıldı. Trombosit kütle endeksi (TKE), nötrofil-lenfosit oranı (NLO) ve trombosit-lenfosit oranı (TLO) hesaplandı. İleride GDM gelişen ve gelişmeyen hastaların ilk trimester hematolojik endeksleri ve bu endekslerin progressif değişimleri karşılaştırıldı. Sonuçlar: Üç yüz atmış sekiz hasta çalışmaya dahil edildi ve GDM %17,9 oranında saptandı. İlk trimester endeksleri arasında PLO haricinde fark tespit edilmedi. PLO GDM’li hastalarda daha düşük idi fakat bağımsız bir prediktör olarak bulunmadı. Normal glisemik gebelerde hemoglobin, hematokrit, lenfosit, trombosit, ortalama trombosit hacmi (MPV), plateletkrit (PCT), trombosit büyük hücre oranı (PLCR) ve TKE değerlerinde ilk trimestere oranla ikinci trimesterde anlamlı düşüş olduğu görüldü. Beyaz küre (WBC), nötrofiller, çekirdekli kırmızı kan hücreleri (NRBC), immatür granülositler ve NLO anlamlı olarak yükselirken, kırmızı hücre dağılım genişliği (RDW), trombosit dağılım genişliği (PDW) ve PLO’da anlamlı değişim gözlenmedi. GDM’li hastalarda ise hemoglobin, hematokrit, lenfosit, trombosit ve TKE’de belirgin düşüş görülürken, WBC, nötrofiller, MPV, immatür granülositler ve NLO birinci trimestere göre yükselmişti. RDW, PDW, PCT, PLCR, NRBC ve PLO’da değişim gözlenmedi. Sonuç: İlk trimesterdeki hiçbir hematolojik endeks, gelişecek GDM’yi öngörme yetisine sahip değildir. MPV’de gözlenen progresif değişimler GDM gelişmesinin değerlendirilmesi için bir indikatör olarak kullanlılabilir.

Keywords

• Hematolojik endeksler
• gestasyonel diyabetes mellitus
• ortalama trombosit hacmi
• inflamatuvar belirteçler
• tam kan sayımındaki değişimler

References

1. ACOG Practice Bulletin No. 190 Summary: Gestational Diabetes Mellitus. Obstet Gynecol 2018:131(2):406-8.
2. Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA 2001; 286(3):327- 34
3. Fowler AJ, Agha RA. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography-the growing versatility of NLR. Atherosclerosis 2013;228(1):44-5.
4. Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Haematol 2013;88(1):218-30.
5. Yılmaz Z, Yılmaz E, İçer B, Küçüközkan T. Association of complete blood count parameters with gestational diabetes mellitus. Gynecology Obstetrics & Reproductive Medicine 2017;23(2):65-9.
6. Sun T, Meng F, Zhao H, Yang M, Zhang R, Yu Z, et al. Elevated first-trimester neutrophil count is closely associated with the development of maternal gestational diabetes mellitus and adverse pregnancy outcomes. Diabetes 2020;69(7):1401-10
7. Fashami MA, Hajian S, Afrakhteh M, Khoob MK. Is there an association between platelet and blood inflammatory indices and the risk of gestational diabetes mellitus? Obstet Gynecol Sci 2020;63(2):133-40.
8. Zhou Z, Chen H, Sun M, Ju H. Mean platelet volume and gestational diabetes mellitus: a systematic review and meta-analysis. J Diabetes Res 2018;2018:1985026.

9. Yang H, Zhu C, Ma Q, Long Y, Cheng Z. Variations of blood cells in prediction of gestational diabetes mellitus. J Perinat Med 2015;43:89–93.
10. Aytan P, Bozkurt Babuş S, Sakarya Ö, Sakarya Ö, Çi̇ftçi̇ R, Aytan H. Can a simple complete blood count predict gestational diabetes mellitus?. J Contemp Med. 2020;10(3):336-41.
11. Sargin MA, Yassa M, Taymur BD, Celek 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 2016:657-66.
12. Chen X, Fang L, Lin H, Shen P, Zhang T, Li H, et al. The relationship between type 2 diabetes and platelet indicators. Iran J Public Health 2017;46:1211–6.
13. Erdoğan S, Ozdemir O, Doğan HO, Sezer S, Atalay CR, Meriç F, et al. Liver enzymes, mean platelet volume, and red cell distribution width in gestational diabetes. Turk J Med Sci 2014;44:121–5.
14. Mertoglu C, Gunay M, Gungor M, Kulhan M, Kulhan NG. A study of inflammatory markers in gestational diabetes mellitus. Gynecology Obstetrics & Reproductive Medicine 2019;25(1):7-11
15. Gorar S, Abanonu GB, Uysal A, Erol O, Unal A, Uyar S, et al. Comparison of thyroid function tests and blood count in pregnant women with versus without gestational diabetes mellitus. J Obstet Gynaecol Res 2017;43:848–54.
16. Beneventi F, Simonetta M, Lovati E, Albonico G, Tinelli C, Locatelli E, et al. First trimester pregnancy-associated plasma protein-A in pregnancies complicated by subsequent gestational diabetes. Prenat Diagn. 2011;31(6):523-8
17. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. International association of diabetes and pregnancy study groups consensus panel. Diabetes Care 2010;33:676–82.
18. Carlin A, Zarko A. Physiological changes of pregnancy and monitoring. Best Pract Res Clin Obstet Gynaecol. 2008;22(5):801–23.
19. Heidemann BH, McClure JH. Changes in maternal physiology during pregnancy. Br J Anaesth. 2003;3(3):65–8.
20. Li A, Yang S, Zhang J, Qiao R. Establishment of reference intervals for complete blood count parameters during normal pregnancy in Beijing. J Clin Lab Anal. 2017;31(6):e22150.
21. Amah-Tariah FS, Ojeka SO, Dapper DV. Haematological values in pregnant women in Port Harcourt, Nigeria II: Serum iron and transferrin, total and unsaturated iron binding capacity and some red cell and platelet indices. Niger J Physiol Sci. 2011;26(2):173-8.
22. Chandra S, Tripathi AK, Mishra S, Amzaru M, Vaish AK. Physiological changes in hematological parameters during pregnancy. Indian J Hematol Blood Transfus. 2012;28(3):144–6.
23. Kline AJ, Williams GW, Hernandez-Nino J. D-Dimer concentration in normal pregnancy: new diagnostic thresholds are needed. Clin Chem. 2005;51(5):825–9.
24. Edlestam G, Lowbeer C, Kral G, Gustafsson SA, Venge P. New reference values for routine blood samples and human neutrophilic lipocalin during third trimester pregnancy. Scand J Clin Lab Inv. 2001;61:583–92.
25. Shehlata N, Burrows RF, Kelton JG. Gestational thrombocytopenia. Clin Obstet Gynecol. 1999;42:327–34.
26. Ahmed Y, van Iddekinge B, Paul C, Sullivan MHF, Elder MG. Retrospective analysis of platelet numbers and volumes in normal pregnancy and pre-eclampsia. Br J Obstet Gynaecol. 1993;100:216–20.
27. Ranjith MP, Divya R, Mehta VK, Krishnan MG, Raj RK, Kavishwar A. Significance of platelet volume indices and platelet count in ischaemic heart disease. J Clin Pathol, 2009;62:830–33.
28. Jagroop IA, Tsiara S, Mikhailidis DP. Mean platelet volume as an indicator of platelet activation: methodological issues. Platelets. 2003;14(5):335-6.
29. Yang H, Zhu C, Ma Q, Long Y, Cheng Z. Variations of blood cells in prediction of gestational diabetes mellitus. J Perinat Med. 2015;43(1):89-93.
30. Shah B, Sha D, Xie D, Mohler ER 3rd, Berger JS. The relationship between diabetes, metabolic syndrome, and platelet activity as measured by mean platelet volume: The National Health and Nutrition Examination Survey, 1999-2004. Diabetes Care 2012;35:1074-8.
31. Lekva T, Norwitz ER, Aukrust P, Ueland T. Impact of systemic inflammation on the progression of gestational diabetes mellitus. Curr Diab Rep 2016;16(4):26.
32. Hernandez TL, Van Pelt RE, Anderson MA, Reece MS, Reynolds RM, de la Houssaye BA, et al. Women with gestational diabetes mellitus randomized to a higher-complex carbohydrate/low-fat diet manifest lower adipose tissue insulin resistance, inflammation, glucose, and free fatty acids: a pilot study. Diabetes Care 2016;39(1):39-42.
33. Kim JH, Bae HY, Kim SY. Response: clinical marker of platelet hyperreactivity in diabetes mellitus. Diabetes Metab J 2013;37:423-8.
34. Sefil F, Ulutas KT, Dokuyucu R, Sumbul AT, Yengil E, Yagiz AE, et al. Investigation of neutrophil lymphocyte ratio and blood glucose regulation in patients with type 2 diabetes mellitus. J Int Med Res 2014;42(2):581-8.
35. Paliogiannis P, Zinellu A, Mangoni AA, Capobianco G, Dessole S, Cherchi PL, et al. Red blood cell distribution width in pregnancy: a systematic review. Biochem Med (Zagreb). 2018;28(3):030502.
36. Wang J, Zhang Y, Wan Y, Fan Z, Xu R. The relationship between red blood cell distribution width and ıncident diabetes in chinese adults: a cohort study. J Diabetes Res 2020;2020:1623247.
37. Okur N, Buyuktiryaki M, Uras N, Oncel MY, Ertekin O, Canpolat FE, et al. Platelet mass index in very preterm infants: can it be used as a parameter for neonatal morbidities? J Matern Fetal Neonatal Med 2016;29:3218-22.