The Systemic Immune-Inflammation Index and its Connection with Maternal Age in Naturally Conceived Pregnancies: A Single-Center Cohort Study

Abstract

Aim: Maternal age is associated with perinatal outcomes, which include preeclampsia, low birth weight, preterm birth, neonatal mortality, increased cesarean rates, and maternal mortality. This study aimed to investigate the effects of maternal age on hematological parameters and systemic immune-inflammatory indices in pregnant women. Material and Methods: A retrospective analysis of 400 pregnant women was conducted, divided into four age groups. Hematological parameters, systemic immune-inflammatory indices, and clinical outcomes were compared across these groups. Results: The mean neutrophil count and monocyte count increased with maternal age, significantly highest in the 40-49 age group (p<0.001, p=0.003). Age-associated inflammation was reflected by increased NLR, MLR, PLR, and SII in the advanced age groups (p<0.001). Positive correlations were found between age, BMI (r=0.301, p<0.001), and MLR (r=0.122, p=0.015). The prevalence of chronic diseases, drug usage, and complications such as preeclampsia and gestational diabetes also significantly increased with age (p<0.001). Conclusion: This analysis reveals age-related alterations in immune-inflammatory indices and clinical outcomes in pregnancy and provides insights for better management and monitoring of different age groups during pregnancy, particularly those at advanced maternal age.

Keywords

• Maternal age
• systemic immune-inflammatory indices
• pregnancy outcomes

Kaynakça

1. Guarga Montori M, Álvarez Martínez A, Luna Álvarez C, et al. Advanced maternal age and adverse pregnancy outcomes: a cohort study. Taiwan J Obstet Gynecol. 2021;60:119-24.
2. Saccone G, Gragnano E, Ilardi B, et al. Maternal and perinatal complications according to maternal age: a systematic review and meta-analysis. Int J Gynaecol Obstet. 2022;159:43-55.
3. Correa-de-Araujo R, Yoon SSS. Clinical outcomes in high-risk pregnancies due to advanced maternal age. J Womens Health (Larchmt). 2021;30:160-7.
4. Glick I, Kadish E, Rottenstreich M. Management of pregnancy in women of advanced maternal age: improving outcomes for mother and baby. Int J Womens Health. 2021;13:751-9.
5. Emokpae MA, Brown SI. Effects of lifestyle factors on fertility: practical recommendations for modification. Reprod Fertil. 2021;2:R13-26.
6. Soysal C, Sarı H, Işıkalan MM, et al. Role of the systemic immune-inflammation index in threatened abortion patients and predicting of abortion. J Obstet Gynaecol Res. 2023;49:1723-8.
7. Gokmen O, Gokmen A. Evaluation of neutrophil-lymphocyte ratios, mean platelet volumes, and platelet-lymphocyte ratios in pterygium. Beyoglu Eye J. 2019;4:163-7.
8. Dadouli K, Janho MB, Hatziefthimiou A, et al. Neutrophil-to-lymphocyte, monocyte-to-lymphocyte, platelet-to-lymphocyte ratio and systemic immune-inflammatory index in different states of bipolar disorder. Brain Sci. 2022;12:1034.

9. Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20:6212-22.
10. Wang J, Zhou D, Dai Z, Li X. Association between systemic immune-inflammation index and diabetic depression. Clin Interv Aging. 2021;16:97-105.
11. Niessen K, Werner-Bierwisch T, Metzing S, Sayn-Wittgenstein FZ. Motherhood at the age of 35 and over: the risk of advanced maternal age as perceived by women - a literature study. Z Geburtshilfe Neonatol. 2017;221:111-21.
12. Walzik D, Joisten N, Zacher J, Zimmer P. Transferring clinically established immune inflammation markers into exercise physiology: focus on neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index. Eur J Appl Physiol. 2021;121:1803-14.
13. Wijeratne T, Sales C, Wijeratne C, et al. Systematic review of existing stroke guidelines: case for a change. Biomed Res Int. 2022;2022:5514793.
14. Xue J, Ma D, Jiang J, Liu Y. Diagnostic and prognostic value of immune/inflammation biomarkers for venous thromboembolism: is it reliable for clinical practice?. J Inflamm Res. 2021;14:5059-77.
15. Maziashvili G, Juliana K, Siva Subramania Pillai Kanimozhi V, et al. The Use of systemic inflammatory markers from routine blood tests in predicting preeclampsia and the impact of age on marker levels. Cureus. 2023;15:e35836.
16. Orgul G, Agbal T, Celen S, Caglar AT. Neuroprotective magnesium sulfate administration increases maternal neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index. Arch Gynecol Obstet. 2021;303:1433-7.
17. Franceschi C, Campisi J. Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. J Gerontol A Biol Sci Med Sci. 2014;69:S4-9.
18. Pawelec G, Goldeck D, Derhovanessian E. Inflammation, ageing and chronic disease. Curr Opin Immunol. 2014;29:23-8.
19. Karimi A, Shobeiri P, Kulasinghe A, Rezaei N. Novel systemic inflammation markers to predict COVID-19 prognosis. Front Immunol. 2021;12:741061.
20. Kosidło JW, Wolszczak-Biedrzycka B, Matowicka-Karna J, et al. Clinical significance and diagnostic utility of NLR, LMR, PLR and SII in the course of COVID-19: a literature review. J Inflamm Res. 2023;16:539-62.
21. Lam P, Mein BJ, Benzie RJ, et al. Maternal diabetes independent of BMI is associated with altered accretion of adipose tissue in large for gestational age fetuses. PLoS One. 2022;17:e0268972.
22. Class QA. Obesity and the increasing odds of cesarean delivery. J Psychosom Obstet Gynaecol. 2022;43:244-50.
23. Iacovou C, Maric T, Bourke M, et al. Gestational weight gain in pregnancies following bariatric surgery. Obes Surg. 2023;33:1004-11.