The Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios of Pregnant Women Who Underwent the 75-g Oral Glucose Tolerance Test to Predict Gestational Diabetes

Year 2023, , 83 - 88, 26.05.2023

Yunus Emre Topdağı , Çağdaş Demiroğlu , Ahmet Ziya Şahin

https://doi.org/10.56766/ntms.1199230

Abstract

Background: Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. Early diagnosis and treatment are important; the condition can cause both maternal and foetal complications. Today, single-/double-bolus oral 50–100-g glucose tolerance tests (OGTTs) are preferred. We explored whether the peripheral blood platelet/lymphocyte ratio (PLR) and/or neutrophil/lymphocyte ratio (NLR) could guide diabetes screening of a target group (rather than all pregnant women).
Materials and Methods: This retrospective study was conducted at the Obstetrics and Gynecology Clinic of Sanko University Hospital from January 2010 to January 2020. Pregnant women in gestational weeks 24 to 28 who underwent 75-g OGTTs were included. Patients were evaluated by dividing them into two groups. Group 1 included 300 women with GDM. Group 2 included 300 healthy pregnant women who were negative on the OGTT test. We retrieved patient ages, gestational weeks, all blood count data derived during pregnancy, fasting blood glucose levels, heights and weights, and body mass indices.
Results: Leukocyte and neutrophil counts were significantly higher in the diabetic patient group than in the control group (both p < 0.01). The NLR and PLR differed significantly between the two groups (both p < 0.01), but the demographic data did not.
Conclusion: Increase in white blood cell count, and elevations in the PLR and NLR, independently predicted GDM. Blood NLR and PLR can also be used as a GDM screening test. The NLR and PLR (markers of inflammation) were significantly increased in pre-diabetic and diabetic patients. The NLR and PLR may usefully predict pre-diabetes and GDM.

Keywords

Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, pregnancy, gestational diabetes

References

• 1. Committee on Practice Bulletins--Obstetrics. Practice Bulletin No. 137: Gestational diabetes mellitus. Obstet Gynecol. 2013 Aug;122(2 Pt 1):406-16. doi: 10.1097/01.AOG.0000433006.09219.f1.
• 2. Li Y, Cooper A, Odibo IN, et al. Discrepancy in Insulin Regulation between Gestational Diabetes Mellitus (GDM) Platelets and Placenta. J Biol Chem. 2016 Apr 29;291(18):9657-65. doi: 10.1074/jbc.M116.713693. Epub 2016 Feb 26.
• 3. Bergenstal, Fonseca V, Gregg E, et al. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(1):81-90.
• 4. American Diabetes Association. "Diagnosis and classification of diabetes mellitus." Diabetes care 37.Supplement 1 (2014): S81-S90.
• 5. Pridjian G, Benjamin TD. Update on gestational diabetes. Obstet Gynecol Clin North Am 2010;37:255-67.
• 6. Aviram A, Yogev Y. Metabolic and hormonal changes in normal and diabetic pregnancy. In: Langer O, editor. The Diabetes in Pregnancy Dilemma: Leading Change with Proven Solutions. Shelton: People’s Medical Publishing House; 2015:56–57.
• 7. The American College of Obstetricians and Gynocologists. Gestational diabetes mellitus. Practice Bullletin 2013;122: 406-16.
• 8. Salzer L, Yogev Y. Complications of gestational diabetes. In: Petry CJ, editor. Gestational Diabetes: Origins, Complications, and Treatment. Boca Raton: Taylor & Francis Group; 2014:97–107.
• 9. Panel, IADPSG Consensus. International association of diabetes and pregnancy study groups recommendations on the diagnosis and clas¬sification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–682.
• 10. ACOG. Practice bulletin clinical management guidelines for obstetrician-gynaecologists. No 137. Obstet Gynecol. 2013;122:406–416.
• 11. Şen C, Yayla M, Api O, ve ark. Gebelikte diabet: Tanı ve tedavi. Türk Perinatoloji Derneği Uygulama Rehberi. Perinatoloji Dergisi, 2016;24(2):110-127.
• 12. Yavuzcan A, Cağlar M, Ustün Y, Dilbaz S, Ozdemir I, Yıldız E, Ozkara A, Kumru S. Evaluation of mean platelet volume, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in advanced stage endometriosis with endometrioma. J Turk Ger Gynecol Assoc. 2013 1;14(4):210-5.
• 13. Wang D, Yang JX, Cao DY, et al. Preoperative neutrophil–lymphocyte and platelet–lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarci¬noma. Onco Targets Ther. 2013;6:211–216.
• 14. Topdagi Yilmaz EP, Topdagi YE, Al RA, Kumtepe Y. The relationship between C-reactive protein, carbohydrate antigen 125, and hematological parameters to endometriotic nodule localization in pelvis. J Chin Med Assoc. 2020 Jun;83(6):577-581. doi: 10.1097/JCMA.0000000000000307. PMID: 32502120.
• 15. Celikbilek M, Dogan S, Ozbakır O, et al. Neutrophil–lymphocyte ratio as a predictor of disease severity in ulcerative colitis. J Clin Lab Anal. 2013;27(1):72–76.
• 16. Aygün F, Efe D. Association of neutrophil/lymphocyte ratio with obstructive coronary artery disease and coronary artery calcium score detected by multislice computed tomography in type 2 diabetes mellitus patients. Patient Prefer Adherence. 2015;9:1023–1031.
• 17. Caglayan EK, Engin-Ustun Y, Gocmen AY, et al. Is there any relation¬ship between serum sirtuin-1 level and neutrophil–lymphocyte ratio in hyperemesis gravidarum? J Perinat Med. Epub 2015 Sep 1.
• 18. Kurtoglu E, Kokcu A, Celik H, Tosun M, Malatyalioglu E. May ratio of neutrophil to lymphocyte be useful in predicting the risk of developing preeclampsia? A pilot study. J Matern Fetal Med. 2014;28(1):97–99.
• 19. Pantham P, Aye IL, Powell TL. Inflammation in maternal obesity and gestational diabetes mellitus. Placenta. 2015;36(7):709–715.
• 20. Pivari F, Mingione A, Brasacchio C, et al. Curcumin and type 2 diabetes mellitus: prevention and treatment. Nutrients. 2019;11(8):1837. 106 W. LIU ET AL.
• 21. Mertoglu C, Gunay M. Neutrophil-lymphocyte ratio and plateletlymphocyte ratio as useful predictive markers of prediabetes and diabetes mellitus. Diabetes Metab Syndr. 2017;11(Suppl 1):S127–S131.
• 22. Lim AK and Tesch GH. Inflammation in diabetic nephropathy. Mediators Inflamm 2012; 2012: 146154.
• 23. Pattanathaiyanon P, Phaloprakarn C, Tangjitgamol S. Comparison of gestational diabetes mellitus rates in women with increased and normal white blood cell counts in early pregnancy. J Obstet Gynaecol Res 2014;40:976-82.
• 24. 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.
• 25. Wolf M, Sauk J, Shah A, et al. Inflammation and glucose intolerance: a prospective study of gestational diabetes mellitus. Diabetes Care. 2004;27(1):21–27.
• 26. 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 Apr 26;12:657-65. doi: 10.2147/TCRM.S104247. PMID: 27217758; PMCID: PMC4853164.
• 27. Sahbaz A, Cicekler H, Aynioglu O, Isik H, Ozmen U.Comparison of the predictive value of plateletcrit withvarious other blood parameters in gestational diabetes development. J Obstet Gynaecol 2016;36:589-93.
• 28. Friis CM, Roland P, Marie C, et al. Adiposity-related inflammation: effects of pregnancy. Obesity. 2013;21(1):E124–E130.
• 29. Liu, W., Lou, X., Zhang, Z., Chai, Y., & Yu, Q. (2021). Association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume with the risk of gestational diabetes mellitus. Gynecological Endocrinology, 37(2), 105-107.
• 30. Ulu S, Bucak A, Ulu MS, et al. Neutrophil–lymphocyte ratio as a new predictive and prognostic factor at the hearing loss of diabetic patients. Eur Arch Otorhinolaryngol. 2014;271(10):2681–2686.
• 31. Wang, J. R., Chen, Z., Yang, K., Yang, H. J., Tao, W. Y., Li, Y. P., ... & Yang, Y. (2020). Association between neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and diabetic retinopathy among diabetic patients without a related family history. Diabetology & metabolic syndrome, 12(1), 1-10.
• 32. Sharif-Askari, F. S., Sharif-Askari, N. S., Guella, A., Alabdullah, A., Al Sheleh, H. B., AlRawi, A. M. H., ... & Hamoudi, R. (2020). Blood Neutrophil-to-Lymphocyte Ratio and Urine IL-8 Levels Predict the Type of Bacterial Urinary Tract Infection in Type 2 Diabetes Mellitus Patients. Infection and Drug Resistance, 13, 1961.
• 33. Wang D, Yang JX, Cao DY, et al. Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma. Onco Targets Ther. 2013;6:211–216.
• 34. Mathur K, Kurbanova N, Qayyum R. Platelet-lymphocyte ratio (PLR) and all-cause mortality in general population: insights from national health and nutrition education survey. Platelets. 2019;30(8): 1036–1041.
• 35. Fashami, M. A., Hajian, S., Afrakhteh, M., & Khoob, M. K. (2020). Is there an association between platelet and blood inflammatory indices and the risk of gestational diabetes mellitus?. Obstetrics & gynecology science, 63(2), 133-140.
• 36. Onalan, E., Gozel, N., & Donder, E. (2019). Can hematological parameters in type 2 diabetes predict microvascular complication development?. Pakistan journal of medical sciences, 35(6), 1511.