Evaluation of third-trimester neutrophil-lymphocyte and platelet-lymphocyte ratios and their correlation with birth weight

Abstract

Background/Aim: Fetal development is affected by the maternal environment and one of the environment determinants is inflammation. Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) have been used as markers of inflammation in many disciplines. The aim of this study is to evaluate the relationship between the value of these easily accessible markers in the 3rd trimester and birth weight, which is the result of fetal development. Methods: This retrospective cohort study comprised 442 pregnant women who delivered within the last 2 years and met the inclusion criteria. As a result of a percentile adjustment made according to the Alexander growth curves, pregnant women were grouped according to the birth weight of their neonates, as normal birth weight (AGA) and large birth weight (LGA). Statistical analyses were conducted using the birth weights and hemogram parameters between the groups. Results: There was no significant difference in hemoglobin, neutrophil, platelet, NLR and PLR levels (P>0.05 for each) between the groups; however, a negative correlation was observed between lymphocyte and gestational weight (P=0.014). When comparing hemogram parameters between the groups, hemoglobin, neutrophil, platelet, NLR, and PLR counts were similar (P>0.05 for each). We observed that the lymphocyte counts were lower in the LGA group (P=0.019). There was no significant relationship between birth weight, and NLR and PLR counts during the third trimester (P=0.100, P=0.997, respectively). Conclusion: NLR and PLR counts are used in many disciplines as indicators of inflammation and have been used to predict many perinatal complications during pregnancy. In the present study, no relationship was found between fetal weight and third trimester NLR and PLR counts.

Keywords

• Neutrophil lymphocyte ratio
• NLR
• Platelet lymphocyte ratio
• PLR
• Birth weight

References

1. 1. Ragsdale HB, Kuzawa CW, Borja JB, Avila JL, McDade TW. Regulation of inflammation during gestation and birth outcomes: Inflammatory cytokine balance predicts birth weight and length. American Journal of Human Biology. 2019;31(3):e23245.
2. 2. Verit F, 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. Journal of Obstetrics and Gynaecology. 2014;34(7):639-43.
3. 3. Akdemir N, Bostanci MS, Tozlu F, Özden S, Ünal O, Cevrioglu AS. Neutrophil/lymphocyte ratio as new-inflammatory biomarkers Primary ovarian insufficiency (POI) patients. Journal of The Turkish German Gynecological Association. 2016;17:S6.
4. 4. Turgut A, Hocaoglu M, Ozdamar O, Usta A, Gunay T, Akdeniz E. Could hematologic parameters be useful biomarkers for the diagnosis of endometriosis? Bratisl Lek Listy. 2019;120(12):912-8.
5. 5. Aydın F, Biler A, Taner CE, Ertaş İE. Tubo-Ovaryan Apse Tanılı Olgularda Tedavi Öncesi Nötrofil/Lenfosit ve Platelet/Lenfosit Oranları Medikal Tedavi Başarısını Predikte Eder mi? Kocaeli Tıp Dergisi. 2018;7(3):165-71.
6. 6. Madendag Y, Sahin E, Aydin E, Madendag IC, Acmaz G, Karaman H. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can be useful markers for distinguishing uterine adenomyosis and leiomyoma. Gynecology Obstetrics & Reproductive Medicine. 2018;24(3):147-50.
7. 7. Ethier J-L, 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. Gynecologic oncology. 2017;145(3):584-94.
8. 8. Caglayan EK, Engin-Ustun Y, Gocmen AY, Sarı N, Seckin L, Kara M, et al. Is there any relationship between serum sirtuin-1 level and neutrophil-lymphocyte ratio in hyperemesis gravidarum? Journal of perinatal medicine. 2016;44(3):315-20.

9. 9. 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? Therapeutics and clinical risk management. 2016;12:657.
10. 10. Kirbas A, Biberoglu E, Daglar K, İskender 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;180:12-5.
11. 11. 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(1):22-5.
12. 12. Daglar H, Kirbas A, Kaya B, Kilincoglu F. The value of complete blood count parameters in predicting preterm delivery. Eur Rev Med Pharmacol Sci. 2016;20(5):801-5.
13. 13. Bhat T, Teli S, Rijal J, Bhat H, Raza M, Khoueiry G, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert review of cardiovascular therapy. 2013;11(1):55-9.
14. 14. Lieto E, Galizia G, Auricchio A, Cardella F, Mabilia A, Basile N, et al. Preoperative neutrophil to lymphocyte ratio and lymphocyte to monocyte ratio are prognostic factors in gastric cancers undergoing surgery. Journal of gastrointestinal surgery. 2017;21(11):1764-74.
15. 15. Feng J-R, Qiu X, Wang F, Chen P-F, Gao Q, Peng Y-N, et al. Diagnostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in Crohn’s disease. Gastroenterology research and practice. 2017;2017.
16. 16. Diem S, Schmid S, Krapf M, Flatz L, Born D, Jochum W, et al. Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR) as prognostic markers in patients with non-small cell lung cancer (NSCLC) treated with nivolumab. Lung cancer. 2017;111:176-81.
17. 17. Hong T, Shen D, Chen X, Cai D, Wu X, Hua D. A novel systematic inflammation related index is prognostic in curatively resected non-metastatic colorectal cancer. The American Journal of Surgery. 2018;216(3):450-7.
18. 18. Çöl İ, Şahin ME. Gebelik yaşına göre büyük doğum ağırlığı bulunan komplike olmayan term gebelerde doğum ağırlığı persentillerinin perinatal sonuçlar ile ilişkisinin değerlendirilmesi. Cukurova Medical Journal.45(1):195-9.
19. 19. Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstetrics & Gynecology. 1996;87(2):163-8.
20. 20. İlhan M, İlhan G, Gök AFK, Bademler S, Verit Atmaca F, Ertekin C. Evaluation of neutrophil–lymphocyte ratio, platelet–lymphocyte ratio and red blood cell distribution width–platelet ratio as early predictor of acute pancreatitis in pregnancy. The Journal of Maternal-Fetal & Neonatal Medicine. 2016;29(9):1476-80.
21. 21. Cho S, Cho H, Nam A, Kim HY, Choi YS, Park KH, et al. Neutrophil-to-lymphocyte ratio as an adjunct to CA-125 for the diagnosis of endometriosis. Fertility and sterility. 2008;90(6):2073-9.
22. 22. Kuzawa C, Fried R, Borja J, McDade T. Maternal pregnancy C-reactive protein predicts offspring birth size and body composition in metropolitan Cebu, Philippines. Journal of developmental origins of health and disease. 2017;8(6):674-81.
23. 23. McDade TW, Borja JB, Largado F, Adair LS, Kuzawa CW. Adiposity and chronic inflammation in young women predict inflammation during normal pregnancy in the Philippines. The Journal of nutrition. 2016;146(2):353-7.
24. 24. Kim M-A, Lee YS, Seo K. Assessment of predictive markers for placental inflammatory response in preterm births. PloS one. 2014;9(10):e107880.
25. 25. Christoforaki V, Zafeiriou Z, Daskalakis G, Katasos T, Siristatidis C. First trimester neutrophil to lymphocyte ratio (NLR) and pregnancy outcome. Journal of Obstetrics and Gynaecology. 2020;40(1):59-64.
26. 26. Akgun N, Namli Kalem M, 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. 2017;30(17):2086-91.
27. 27. Yücel B, Ustun B. Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume, red cell distribution width and plateletcrit in preeclampsia. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health. 2017;7:29-32.
28. 28. Aktulay A, Engin-Ustun Y, Ozkan MS, Erkaya S, Kara M, Kaymak O, et al. Gestational diabetes mellitus seems to be associated with inflammation. Acta Clin Croat. 2015;54(4):475-8.
29. 29. Lee JS, Kim NY, Na SH, Youn YH, Shin CS. Reference values of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, and mean platelet volume in healthy adults in South Korea. Medicine. 2018;97(26).