Early predictors of small‐for‐gestational‐age neonates using non‐invasive, low‐cost, and readily available hematological markers

Abstract

Objective: To evaluate whether neutrophil-to-lymphocyte ratio (NLR), a well-established inflammatory marker, can be used as an early predictor for small-for-gestationalage (SGA) neonates and other adverse pregnancy outcomes. Methods: A case-control study compared first-trimester hematological biomarkers in pregnancies of patients with and without SGA (n=149, n=151, respectively). Demographic, clinical, and obstetrical characteristics and first-trimester complete blood count were retrieved. Woman with singleton pregnancies who delivered at Soroka University Medical Center between January 2015 and December 2016 were included. Patients with known maternal infections, relevant medications, hematological conditions, and chronic diseases that may alter the blood count, those with multiple pregnancies, and those with congenital or chromosomal abnormalities were excluded. After univariate analysis, a linear regression model was constructed to assess the association between hematological indices and SGA. Receiver operating curves were constructed to evaluate the sensitivity and specificity of NLR. Results: First-trimester NLR values of the SGA group were significantly higher compared to controls (3.03 ± 1.68 vs 2.63 ± 1.2, P=0.016). Significantly higher levels of NLR were noted among the severely (<3%) SGA neonates (3.12 ± 1.62 vs 2.62 ± 1.2; P=0.034). Conclusion: NLR may be an early, clinically useful marker in the prediction of SGA. As blood samples are routinely collected, correct implication of this result may serve as a valuable non-invasive, low-cost, readily available predicting tool.

Association between white blood cell count and adverse pregnancy outcomes: a retrospective cohort study from a tertiary hospital in China

“…Only caesarean section was associated with WBC count in the first and second trimesters, and macrosomia was associated with WBC count in the second trimester, although the OR values were approximately 1 (range, 1.02–1.04). We also tested the relationship between WBC and stillbirth but found no significant correlation attributing to an extremely low incidence of stillbirth which was consistent with the previous studies 7–10…”

“…We also tested the relationship between WBC and stillbirth but found no significant correlation attributing to an extremely low incidence of stillbirth which was consistent with the previous studies. [7][8][9][10] In the continuous analyses, the ORs for the increase in average WBC by 1 SD were significant for gestational hypertension, pre-eclampsia, GDM, preterm birth and low birth weight. However, there were no statistically significant associations between maternal average WBC count and caesarean section, macrosomia and fetal distress.…”

“…6 In addition, some studies using small sample sizes showed an association between the neutrophil/lymphocyte ratio (rather than WBC) in the first trimester and birth weight and pre-eclampsia. [7][8][9][10] However, previous studies on the association between WBC and pregnancy or pregnancy outcomes used small sample sizes, or the end points observed for pregnancy outcomes were relatively unitary. Furthermore, observations on the relationship between WBC and pregnancy outcome focused on the first trimester and lacked data for the second and third trimesters.…”

“…In 2020, Diabetes published a study on the association between peripheral blood WBC count in the first trimester and GDM, which suggested an association between elevated neutrophil count (rather than WBC count) and GDM 6. In addition, some studies using small sample sizes showed an association between the neutrophil/lymphocyte ratio (rather than WBC) in the first trimester and birth weight and pre-eclampsia 7–10…”

Data-Driven Modeling of Pregnancy-Related Complications

“…Well-established measures of health such as hematology panels and urinalyses continue to provide useful information when assessing maternal and fetal health. For instance, higher neutrophil counts and neutrophil-to-lymphocyte ratiosboth inflammatory markershave been associated with the development of GDM and decreased fetal growth [43]. Additionally, proteinuria and bacteriuria, determined through urinalysis and urine culture, respectively, are important predictors of lifethreatening complications like preeclampsia [44,45].…”