Abstract
Spontaneous preterm birth is the basic problem of perinatal mortality in Bulgaria. Pregnancy is characterized by physiological leukocytosis - determined by twice increased neutrophils levels, unchanged monocyte levels, and a reduction in the levels of lymphocytes, eosinophils, and basophils. The leukocytosis is particularly pronounced in the last trimester, due to physiological stress during pregnancy, and it is a result of the increased inflammatory response, a consequence of selective immune tolerance, immunosuppression, and fetus-immunomodulation.
 The objective of this study was to investigate and to appreciate maternal leukocytosis as potential diagnostic markers in spontaneously declared preterm birth and term birth declared cases.
 Methods: The case–control study was performed in UMBAL-City Hospital, Stara Zagora during 2017–2020. The study involved 200 patients, split into two groups: G1- the healthy pregnant women, n1=100 with а registered singleton pregnancy, at gestational age 37-39+6, gave birth on the term (TB); G2- the PTB patients, n2=100, confirmed clinically by cardiotocography for gestation >32 weeks. The highly sensitive Leuko-TIC-ELISA-WBC (upper limit of the normal number of Leuc during pregnancy - 15x109 per L) test was used for investigation. Blood samples were taken by puncture of the v.cubitalis in an anticoagulant at the time of hospitalization and examined within 1 hrs. Patients with systemic chronic illness and infections were excluded from the study.
 The results showed statistically significant Leuc reduction in SPTB patients (14.31±2.66×109/L, p>0.03), compared to the increased (14.67±3.21×109/L) (in normal-15x109L) Leuc values in the TB group.In conclusion, the results of the Leuc value confirm the presence of a systemic leukocytosis/oxidative inflammatory reaction at the time of declaring SPTB and TB.
Highlights
Pregnancy is characterized by physiological leukocytosis (Kaur et al, 2014) - mainly dependent on neutrophils - circulating phagocytes, whose levels double
The results showed statistically significant Leuc reduction in SPTB patients (14.31±2.66×109/L, p>0.03), compared to the increased (14.67±3.21×109/L) Leuc values in the TB group.In conclusion, the results of the Leuc value confirm the presence of a systemic leukocytosis/oxidative inflammatory reaction at the time of declaring SPTB and TB
The role of leukocytes as a potential early diagnostic marker for spontaneous preterm birth (sPTB) has been discussed in the current prospective case-control study
Summary
Pregnancy is characterized by physiological leukocytosis (Kaur et al, 2014) - mainly dependent on neutrophils - circulating phagocytes, whose levels double. Kaur et al, (2014) found that other circulating phagocytes (monocytes, lymphocytes, eosinophils, and basophils) retain or suffer a significant decrease in their levels compared to the period before pregnancy. Studies by Kaur et al (2014) and Akinlaja (2016) commented that leukocytosis is due to physiological stress during pregnancy itself. It is the result of an enhanced inflammatory response due to selective immune tolerance, immunosuppression, and immunomodulation of the fetus. A study by Dhariwal et al (2016) demonstrated a reduction in lymphocyte levels as the gestational weeks progressed
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