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

Öz

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.

Anahtar Kelimeler

• 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

Öz

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.

Anahtar Kelimeler

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

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