The Effect of Inflammatory Markers in the Hemogram Parameters of Pregnant Women with Thyroid Disease on Obstetric and Neonatal Outcomes

Yıl 2023, Cilt: 25 Sayı: 3, 231 - 235, 30.12.2023

Funda Demirel , Ünal Turkay

https://doi.org/10.18678/dtfd.1251833

Öz

Aim: This study aimed to determine the differences in hemogram parameters, especially in inflammatory markers and perinatal and neonatal outcomes of pregnant women with thyroid disease, and to examine the effects of these differences on pregnancy outcomes.
Material and Methods: The data of 80 pregnant women diagnosed with thyroid disease according to the American Thyroid Association (ATA) criteria at the first admission between 2016 and 2019 and 100 pregnant women whose thyroid hormone levels were within the normal reference range were retrospectively analyzed. Obstetric outcomes such as type and time of delivery, and the presence of additional disease during pregnancy, and neonatal outcomes such as weight, gender, and Apgar score at birth were compared. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), white blood cell (WBC) count, and hemoglobin (Hb) and mean platelet volume (MPV) values, which are accepted as inflammation markers, were also compared between groups.
Results: There was no significant difference between hypothyroid and hyperthyroid pregnant women in terms of Hb (p=0.319) and PLR (p=0.341) values. Third-trimester WBC (p=0.015) values were higher and MPV (p=0.007) values were lower in the hypothyroid pregnant women compared to the control group. The highest NLR (p=0.005) value was observed in the hypothyroid group. Comorbidities were found to be 27.4% (n=20) in the hypothyroid group, 14.3% (n=1) in the hyperthyroid group, and 1.0% (n=1) in the control group (p<0.001).
Conclusion: Pregnant women with thyroid disease may have differences in hemogram parameters, especially in inflammatory markers, and these differences may affect pregnancy outcomes.

Anahtar Kelimeler

Thyroid disease, NLR, PLR, perinatal and neonatal outcomes, pregnancy

Tiroid Hastalığı olan Gebelerin Hemogram Parametrelerinde İnflamatuar Belirteçlerin Obstetrik ve Neonatal Sonuçlara Etkisi

Öz

Amaç: Bu çalışmanın amacı, tiroid hastalığı olan gebelerin hemogram parametrelerinde, özellikle inflamatuar belirteçlerde ve perinatal ve neonatal sonuçlardaki farklılıkları belirlemek ve bu farklılıkların gebelik sonuçları üzerindeki etkisini incelemektir.
Gereç ve Yöntemler: 2016 ve 2019 yılları arasında ilk başvurusunda Amerikan Tiroid Derneği (American Thyroid Association, ATA) kriterlerine göre tiroid hastalığı tanısı alan 80 gebe kadın ile tiroid hormon düzeyleri normal referans aralığında olan 100 gebe kadının verileri geriye dönük olarak analiz edildi. Doğum tipi ve zamanı ve gebelikte ek hastalık varlığı gibi obstetrik sonuçlar ile doğumda kilo, cinsiyet ve Apgar skoru gibi neonatal sonuçlar karşılaştırıldı. Yine, nötrofil/lenfosit oranı (neutrophil-to-lymphocyte ratio, NLR), trombosit/lenfosit oranı (platelet-to-lymphocyte ratio, PLR), beyaz kan hücresi (white blood cell, WBC) sayısı ve inflamasyon belirteçleri olarak kabul edilen hemoglobin (Hb) ve ortalama trombosit hacmi (mean platelet volume, MPV) değerleri de gruplar arasında karşılaştırıldı.
Bulgular: Hipotiroidili ve hipertiroidili gebeler arasında Hb (p=0,319) ve PLR (p=0,341) değerleri açısından anlamlı bir farklılık yoktu. Hipotiroidili gebelerde kontrol grubuna göre 3. trimester WBC (p=0,015) değerleri daha yüksek ve MPV (p=0,007) değerleri daha düşüktü. En yüksek NLR (p=0,005) değeri hipotiroid grubunda gözlendi. Ek hastalık hipotiroid grubunda %27,4 (n=20), hipertiroid grubunda %14,3 (n=1) ve kontrol grubunda %1,0 (n=1) olarak saptandı (p<0,001).
Sonuç: Tiroid hastalığı olan gebelerin hemogram parametrelerinde özellikle inflamatuar belirteçlerde farklılıklar olabilir ve bu farklılıklar gebelik sonuçlarını etkileyebilir.

Anahtar Kelimeler

Tiroid hastalığı, NLR, PLR, perinatal ve neonatal sonuçlar, gebelik

Kaynakça

• Yamamoto T, Amino N, Tanizawa O, Doi K, Ichihara K, Azukizawa M, et al. Longitudinal study of serum thyroid hormones, chorionic gonadotropin and thyrotrophin during and after normal pregnancy. Clin Endocrinol (Oxf). 1979;10/5):459-68.
• Brent GA. The debate over thyroid-function screening in pregnancy. N Engl J Med. 2012;366(6):562-3.
• Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev. 1997;18(3):404-33.
• Su PY, Huang K, Hao JH, Xu YQ, Yan SQ, Li T, et al. Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development: a prospective population-based cohort study in China. J Clin Endocrinol Metab. 2011;96(10):3234-41.
• Medenica S, Nedeljkovic O, Radojevic N, Stojkovic M, Trbojevic B, Pajovic B. Thyroid dysfunction and thyroid autoimmunity in euthyroid women in achieving fertility. Eur Rev Med Pharmacol Sci. 2015;19(6):977-87.
• Casey BM, Leveno KJ. Thyroid disease in pregnancy. Obstet Gynecol. 2006;108(5):1283-92.
• Li Y, Shan Z, Teng W, Yu X, Li Y, Fan C, et al. Abnormalities of maternal thyroid function during pregnancy affect neuropsychological development of their children at 25-30 months. Clin Endocrinol (Oxf). 2010;72(6):825-9.
• Yim CH. Update on the management of thyroid disease during pregnancy. Endocrinol Metab (Seoul). 2016;31(3):386-91.
• Klein RZ, Haddow JE, Faix JD, Brown RS, Hermos RJ, Pulkinnen A, et al. Prevalence of thyroid deficiency in pregnant women. Clin Endocrinol (Oxf). 1991;35(1):41-6.
• Abalovich M, Gutierrez S, Alcaraz G, Maccalini G, Garcia A, Levalle O. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid. 2002;12(1):63-8.
• Cooper DS, Laurberg P. Hyperthyroidism in pregnancy. Lancet Diabetes Endocrinol. 2013;1(3):238-49.
• Kriplani A, Buckshee K, Bhargava VL, Takkor D, Ammini AC. Maternal and perinatal outcome in thyrotoxicosis complicating pregnancy. Eur J Obstet Gynecol Reprod Biol. 1994;54(3):159-63.
• Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017;27(3):315-89.
• Bashir H, Bhat MH, Farooq R, Majid S, Shoib S, Hamid R, et al. Comparison of hematological parameters in untreated and treated subclinical hypothyroidism and primary hypothyroidism patients. Med J Islam Repub Iran. 2012;26(4):172-8.
• Dorgaleh A, Mahmoodi M, Vavmaghani B, Kiani Node F, Saeeidi Kia O, Alizadeh SH, et al. Effect of thyroid dysfunctions on blood cell count and red blood cell indice. Iran J Ped Hematol Oncol. 2013;3(2):73-7.
• Kawa MP, Grymula K, Paczkowska E, Baskiewicz-Masiuk M, Dabkowska E, Koziolek M, et al. Clinical relevance of thyroid dysfunction in human haematopoiesis: biochemical and molecular studies. Eur J Endocrinol. 2010;162(2):295-305.
• Ozel A, Alici Davutoglu E, Yurtkal A, Madazli R. How do platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio change in women with preterm premature rupture of membranes, and threaten preterm labour? J Obstet Gynaecol. 2020;40(2):195-9.
• Hrubaru I, Motoc A, Moise ML, Miutescu B, Citu IM, Pingilati RA, et al. The predictive role of maternal biological markers and inflammatory scores NLR, PLR, MLR, SII, and SIRI for the risk of preterm delivery. J Clin Med. 2022;11(23):6982.
• Yayla Abide Ç, Vural F, Kılıççı Ç, Bostancı Ergen E, Yenidede İ, Eser A, et al. Can we predict severity of intrahepatic cholestasis of pregnancy using inflammatory markers? Turk J Obstet Gynecol. 2017;14(3):160-5.
• Oztas E, Erkenekli K, Ozler S, Ersoy AO, Kurt M, Oztas E, et al. Can routine laboratory parameters predict adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy? J Perinat Med. 2015;43(6):667-74.
• Liu W, Lou X, Zhang Z, Chai Y, Yu Q. Association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume with the risk of gestational diabetes mellitus. Gynecol Endocrinol. 2021;37(2):105-7.
• Pace NP, Vassallo J. Association between neutrophil-lymphocyte ratio and gestational diabetes-a systematic review and meta-analysis. J Endocr Soc. 2021;5(7):bvab051.