Abstract
Objective: To assess whether changes in platelet indices, detectable by simple complete blood count (CBC), during pregnancy could be used as markers for prediction of development of preeclampsia (PE). Methods: A total of 2813 pregnant women who received regular antenatal care until delivery were included. Participants were divided into 3 groups: normotensive pregnant women (n = 2621), women with PE without severe features (n = 169), and women with PE with severe features (n = 23). Blood samples were collected during antenatal visits and/or during the period of in-patient hospital stay, and changes in platelet indices were compared among the three groups. Results: Platelet count (PC) was decreasing while mean platelet volume (MPV) and platelet distribution width (PDW) were increasing as PE progressed. Receiver operating characteristics (ROC) curve analysis showed that PDW had the largest area under curve (AUC) [0.980 (95% CI: 0.964 - 1.000)], making it the best marker for predicting development of PE. Also, PDW showed the most statistically significant correlation with mean arterial pressure (MAP) (r = 0.902, p = 0.000), making it the best marker for predicting severity of hypertension. Conclusion: This study provides evidence that PC decreases while MPV and PDW increase as pregnancy advances, and these changes are more pronounced in PE than normotensive pregnancy. These changes predate development of PE by 2 - 8 weeks and are proportional to the progress of this disorder. The selected platelet indices, especially PDW, have the potential to be utilized as markers for not only prediction of PE development but also severity of hypertension.
Highlights
Preeclampsia (PE) is a pregnancy-specific multisystem disorder characterized by abnormal vascular response to placentation which is associated with increased systemic vascular resistance, enhanced platelet aggregation, activation of the coagulation system, and endothelial cell dysfunction with resultant reduced organ perfusion [1] [2]
This change was more pronounced in PE without severe features than normotensive pregnancy and in PE with severe features than PE without severe features (p = 0.00)
mean platelet volume (MPV) and platelet distribution width (PDW) in participants in all groups showed continuous increase over the course of pregnancy starting from 24 - 28 weeks gestation onwards
Summary
Preeclampsia (PE) is a pregnancy-specific multisystem disorder characterized by abnormal vascular response to placentation which is associated with increased systemic vascular resistance, enhanced platelet aggregation, activation of the coagulation system, and endothelial cell dysfunction with resultant reduced organ perfusion [1] [2]. Because PE can progress rapidly, it requires prompt intervention that may include observation in a tertiary care setting and termination of pregnancy, either by inducing labor or by Cesarean section, which is the only known cure for this condition [5]-[8]. As it affects multiple organs, no single, specific and cost-effective marker to predict PE has yet been proposed [9]. Several models have been suggested but are found to be not clinically relevant [10]-[12]
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