Maternal obezitede olumsuz obstetrik ve neonatal sonuçların tahmininde ilk trimester inflamatuar belirteçlerinin rolü

Abstract

Amaç: Obez gebelerde ilk trimester serum inflamatuvar markerlarını sağlıklı gebeler ile karşılaştırmak ve bu markerların gebelik ile neonatal sonuçları öngörmesini incelemek Metod: Bu çalışma, prospektif bir gözlemsel çalışma olup çalışma grubuna 46 obez gebe ile kontrol grubu ise sağlıklı 60 gebeden oluşturulmuştur. Katılımcıların demografik özellikleri, obstetrik ve neonatal sonuçları değerlendirilmiş olup nötrofil-lenfosit oranı (NLR), ile sistemik inflamasyon indeks (SII: NLR*platelet sayısı), sistemik inflamasyon response indeks (SIRI: NLR*monosit sayısı), sistemik inflamasyon agregat indeksi (AISI: NLR* platelet sayısı * monosit sayısı), PLR (platelet-lenfosit oranı) hesaplanmıştır. Yenidoğan yoğun bakım ihtiyacı (NICU) ve kötü obstetrik sonuçlaro öngörmeyi değerlendirmek için Alıcı İşletim Karakteristiği (ROC) eğrileri oluşturuldu ve eğri altındaki alan değerleri standart yöntemler kullanılarak hesaplandı. Bulgular: Her iki grubunda demografik özellikleri benzerdi. Çalışma grubunda acil sezaryan, kötü obstetrik sonuç ve NICU ihtiyacı fazlaydı. Obez grupta inflamatuvar marker olan beyaz kan hücre sayımı ile nötrofil ve monosit, platelet sayımı yüksek bulundu. Ayrıca maternal obez grupta SII, SIRI, AISI, NLR istatistiksel anlamlı yüksekti. Ayrıca, PLR ise çalışma grubunda kontrol grubuna göre bulundu. ROC analizinde, obez gebelerde kötü obstetrik sonuçları öngörme kapasitesinin SII ve AISI için istatistiksel olarak anlamlı olduğu görüldü. Sonuç: Maternal obezitede neonatal ve obstetrik sonuçları öngörmede SII, SIRI, AISI, PLR ve NLR yardımcı olabilir.

Keywords

• Obezite
• gebelik
• sistemik inflamasyon indeks
• sistemik inflamasyon agregat indeksi

Role of first trimester inflammatory markers in predicting adverse obstetric and neonatal outcomes in maternal obesity

Abstract

Aims: To compare first trimester serum inflammatory markers in obese pregnant women with healthy pregnant women and to investigate the predictive value of these markers for pregnancy and neonatal outcomes Methods: This prospective observational study included 46 pregnant women with maternal obesity and 60 healthy pregnant women without obesity. The demographic characteristics, obstetric and neonatal outcomes of the participants were evaluated, and the neutrophil-lymphocyte ratio (NLR), systemic inflammation index (SII: NLR*platelet), systemic inflammation response index (SIRI: NLR*monocyte), aggregate index of systemic inflammation (AISI: NLR*platelet count*monocyte), and PLR (platelet-lymphocyte ratio) were calculated. To evaluate the predictive value for neonatal intensive care unit (NICU) admission and adverse obstetric outcomes, receiver operating characteristic curves were generated and the area under the curve values were calculated. Results: The demographic characteristics of both groups were similar. In the study group, adverse obstetric outcomes, and NICU requirement were increased. In the maternal obese group, inflammatory markers such as SII, SIRI, AISI, and NLR were significantly elevated. PLR was also increased in the study group. In ROC analysis, it was found that the levels of inflammatory markers to predict adverse obstetric and neonatal outcomes in obese pregnant women were statistically significant. Conclusion: SII, SIRI, AISI, PLR, and NLR may be helpful in predicting neonatal and obstetric outcomes in maternal obesity.

Keywords

• Obesity
• pregnancy
• systemic inflammation index
• aggregate index of systemic inflammation

Supporting Institution

None

Ethical Statement

Ethical approval was obtained from the Ethics Committee of the Ministry of Health Ankara Bilkent City Hospital (TABED 2-24-642). This study complies with the Declaration of Helsinki. Written and oral informed consent was obtained from all participants.

Thanks

The authors would like to thank all healthcare professionals who are dedicated to combating obesity and maternal-fetal health disorders, and to protecting the well-being of mothers and infants. This study received no financial support. The data supporting the findings of this study are available from the corresponding author (BAA) upon reasonable request.

References

1. World Health Organization (WHO) Accessed 7 May 2025 Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
2. Denizli M, Capitano ML, Kua KL. Maternal obesity and the impact of associated early-life inflammation on long-term health of offspring. Front Cell Infect Microbiol. 2022;12:940937. doi:10.3389/fcimb.2022.940937
3. Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ. 2017;356:j1. doi:10.1136/bmj.j1
4. Marchi J, Berg M, Dencker A, Olander EK, Begley C. Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obes Rev. 2015;16(8):621-638. doi:10.1111/obr.12288
5. Castaneda C, Marsden K, Maxwell T, et al. Prevalence of maternal obesity at delivery and association with maternal and neonatal outcomes. J Matern Fetal Neonatal Med. 2022;35(25):8544-8551. doi:10.1080/14767058.2021.1988563
6. Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14.
7. Xia Y, Xia C, Wu L, Li Z, Li H, Zhang J. Systemic Immune Inflammation Index (SII), System Inflammation Response Index (SIRI) and risk of all-cause mortality and cardiovascular mortality: a 20-year follow-up cohort study of 42,875 US adults. J Clin Med. 2023;12(3)doi:10.3390/jcm 12031128
8. Zinellu A, Collu C, Nasser M, et al. The Aggregate Index of Systemic Inflammation (AISI): a novel prognostic biomarker in idiopathic pulmonary fibrosis. J Clin Med. 2021;10(18)doi:10.3390/jcm10184134

9. Ozkavak OO, Tanacan A, Serbetci H, et al. Association of first-trimester combined inflammatory markers (NLR, SII, SIRI, and AISI) with poor obstetric outcomes in pregnancies with ulcerative colitis. Am J Reprod Immunol. 2025;93(2):e70055. doi:10.1111/aji.70055
10. Marseglia L, Manti S, D’Angelo G, et al. Oxidative stress in obesity: a critical component in human diseases. Int J Mol Sci. 2015;16(1):378-400.
11. Zhang CXW, Candia AA, Sferruzzi-Perri AN. Placental inflammation, oxidative stress, and fetal outcomes in maternal obesity. Trends Endocrinol Metab. 2024;35(7):638-647. doi:10.1016/j.tem.2024.02.002
12. Shook LL, Kislal S, Edlow AG. Fetal brain and placental programming in maternal obesity: a review of human and animal model studies. Prenat Diagn. 2020;40(9):1126-1137. doi:10.1002/pd.5724
13. Vaughan OR, Rosario FJ, Chan J, et al. Maternal obesity causes fetal cardiac hypertrophy and alters adult offspring myocardial metabolism in mice. J Physiol. 2022;600(13):3169-3191. doi:10.1113/jp282462
14. Loh HH, Taipin H, Said A. Maternal obesity and risk of adverse obstetric outcomes in Malaysia. Ann Acad Med Singap. 2021;50(3):285-288. doi:10.47102/annals-acadmedsg.202054
15. Cardona-Benavides I, Mora-González P, Pineda A, Puertas A, Manzanares Galán S. Maternal obesity and the risk of fetal acidosis at birth. J Matern Fetal Neonatal Med. 2022;35(4):765-769. doi:10.1080/14767058.2020.1731795
16. Liu L, Ma Y, Wang N, Lin W, Liu Y, Wen D. Maternal body-mass index and risk of neonatal adverse outcomes in China: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2019;19(1):105. doi:10.1186/s12884-019-2249-z
17. Zhang Y, Lu M, Yi Y, et al. Influence of maternal body mass index on pregnancy complications and outcomes: a systematic review and meta-analysis. Front Endocrinol (Lausanne.) 2024;15:1280692. doi:10.3389/fendo.2024.1280692
18. Zhou Y, Wang Y, Wu T, Zhang A, Li Y. Association between obesity and systemic immune inflammation index, systemic inflammation response index among US adults: a population-based analysis. Lipids Health Dis. 2024;23(1):245. doi:10.1186/s12944-024-02240-8
19. Liao Y, Zhou K, Lin B, Deng S, Weng B, Pan L. Associations between Systemic Immune-Inflammatory Index and visceral adipose tissue area: results of a national survey. Front Nutr. 2024;11:1517186. doi:10.3389/fnut.2024.1517186
20. Gayret OB, Erol M, Buke O, Ozel A, Tenekecigil A, Altuntaş MJIJP. Systemic Inflammation Response Index and Immune-Inflammation Index as predictors of metabolic syndrome in obese children and adolescents: a prospective cross-sectional study. Iran J Pediatr. 2025; 35(2):e148712.
21. Yildiz EG, Tanacan A, Okutucu G, Bastemur AG, Ipek G, Sahin D. Can System Inflammation Response Index or Systemic Immune Inflammation Index predict gestational diabetes mellitus in the first trimester? A prospective observational study. Int J Gynaecol Obstet 2024;166(2):837-843. doi:10.1002/ijgo.15442
22. Karatas E, Tanacan A, Ozkavak OO, et al. Predictive value of first-trimester Aggregate Index of Systemic Inflammation (AISI) and other inflammatory indices for gestational diabetes mellitus and associated obstetric outcomes. Am J Reprod Immunol. 2025;93(4):e70069. doi:10. 1111/aji.70069
23. Lin Y, Fang J, Ni R, et al. Dynamic change of novel systemic inflammation markers to predict maternal-neonatal prognosis after cervical cerclage. J Inflamm Res. 2023;16:1745-1756. doi:10.2147/jir.S410211
24. Thomas MR, Storey RF. The role of platelets in inflammation. Thromb Haemost. 2015;114(3):449-458. doi:10.1160/th14-12-1067
25. Franco AT, Corken A, Ware J. Platelets at the interface of thrombosis, inflammation, and cancer. Blood. 2015;126(5):582-588. doi:10.1182/blood-2014-08-531582
26. Furuncuoğlu Y, Tulgar S, Dogan AN, Cakar S, Tulgar YK, Cakiroglu B. How obesity affects the neutrophil/lymphocyte and platelet/lymphocyte ratio, Systemic Immune-Inflammatory Index and platelet indices: a retrospective study. Eur Rev Med Pharmacol Sci. 2016;20(7):1300-1306.
27. Derhem B, Karahan İ. Early inflammation related to pediatric obesity. J Pediatr Inf 2023;17(1):9-13. doi:10.5578/ced.20239902
28. Luo L, Chen L, Song J, Ma X, Wang X. Association between Systemic Immune-Inflammatory Index and Systemic Inflammatory Response Index with body-mass index in children and adolescents: a population-based study based on the National Health and Nutrition Examination Survey 2017-2020. Front Endocrinol (Lausanne). 2024;15:1426404. doi:10.3389/fendo.2024.1426404
29. Sahin R, Tanacan A, Serbetci H, et al. First-trimester neutrophil-to-lymphocyte ratio (NLR), Systemic Immune-Inflammation Index (SII), and Systemic Immune-Response Index (SIRI) as predictors of composite adverse outcomes in pregnant women with Familial Mediterranean fever. Z Geburtshilfe Neonatol. 2024;228(2):156-160. doi:10. 1055/a-2125-0973
30. Sahin R, Tanacan A, Serbetci H, et al. The role of first-trimester NLR (neutrophil to lymphocyte ratio), Systemic Immune-Inflammation Index (SII), and, Systemic Immune-Response Index (SIRI) in the prediction of composite adverse outcomes in pregnant women with systemic lupus erythematosus. J Reprod Immunol.Aug 2023;158:103978. doi:10.1016/j.jri.2023.103978
31. Zheng L, Ge R, Weng X, Lin L. Predictive value of serum immune-inflammatory markers for adverse pregnancy outcomes in pregnant women with thrombophilia: a retrospective cohort study. J Inflamm Res. 2024;17:6083-6091. doi:10.2147/jir.S481508
32. Sahin R, Tanacan A, Serbetci H, et al. The Association of Systemic Immune-Inflammation Index (SII), Systemic Immune-Response Index (SIRI), and neutrophil-to-lymphocyte ratio (NLR) with cesarean scar pregnancy (CSP). J Reprod Immunol. 2024;164:104275. doi:10.1016/j.jri.2024.104275