Download PDF
CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(05): 458-466
DOI: 10.1055/s-0042-1743101
Original Article
Obstetrics

Hematological Parameters to Predict the Severity of Hyperemesis Gravidarum and Ketonuria

Parâmetros hematológicos para prever a gravidade da hiperêmese gravídica e da cetonúria
Mehmet Musa Aslan 
1   Department of Obstetrics and Gynecology, Sakarya Training and Research Hospital, School of Medicine, Sakarya University, Sakarya, Turkey
,
Mustafa Taner Yeler 
2   Department of Biochemistry, Muş State Hospital, Muş, Turkey
,
İsmail Bıyık 
3   Department of Obstetrics and Gynecology, Kütahya Health Sciences University, Kütahya, Turkey
,
Hilal Uslu Yuvacı 
4   Sakarya University, School of Medicine, Sakarya Training and Research Hospital, Department of Obstetrics and Gynecology, Sakarya, Turkey
,
Arif Serhan Cevrioğlu 
4   Sakarya University, School of Medicine, Sakarya Training and Research Hospital, Department of Obstetrics and Gynecology, Sakarya, Turkey
,
Selcuk Özden 
4   Sakarya University, School of Medicine, Sakarya Training and Research Hospital, Department of Obstetrics and Gynecology, Sakarya, Turkey
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective Hyperemesis gravidarum (HG) is a pregnancy complication that can progress with persistent nausea and vomiting. The aim of the present study is to evaluate the relationship between hematological parameters and HG.

Method A total of 532 pregnant women with HG who were admitted to the Department of Obstetrics and Gynecology between March 2019 and February 2021, and 534 healthy pregnant women with characteristics similar to those of the case group were included in the study. The hematological parameters of both groups were compared. In addition, the hematological parametersof patients with HG according to the severity of ketonuria were compared.

Results The mean age of the HG group (n = 532) was 26.3 ±  4.1 years, and that of the control group (n = 534) was 25.9 ±  4.8 years. Among patients with HG, 46% (n = 249) had ketone (+), 33% (n = 174), ketone (++), and 21% (n = 109), ketone (++ + ). The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were higher in the HG group than in the control group: 3.8 (2.8–5.8)/3.2 (2.6–4.0); p < 0.001; and 135.2 ±  30.4/108.9 ±  62.2; p < 0.001 respectively. The neutrophil count, NLR, and PLR were higher in the group with ketone (++ + ) than in the groups with ketone (+) or ketone (++): 7.6 ±  1.9/5.5 ±  2.4; p < 0.001; 3.8(2.8–4.6)/2.9(2.3–3.6); p < 0.001; and 149.9 ±  48.0/135.9 ±  65.7; p < 0.001 respectively. The mean corpuscular hemoglobin (MCH) level, the NLR, and the PLR were identified as independent predictors of the presence of HG and the level of ketone positivity in HG patients.

Conclusion The NLR and PLR were high in patients with HG, suggesting the its inflammatory activity. They may be important markers associated with the presence and severity of HG.

Resumo

Objetivo A hiperêmese gravídica (HG) é uma complicação da gravidez que pode evoluir com náuseas e vômitos persistentes. O objetivo deste estudo é avaliar a relação entre os parâmetros hematológicos e a HG.

Método Foram incluídas neste estudo 532 gestantes com HG internadas no Departamento de Obstetrícia e Ginecologia entre março de 2019 e fevereiro de 2021, e 534 gestantes saudáveis com características semelhantes às do grupo de caso. Os parâmetros hematológicos foram comparados entre gestantes com e sem HG. Além disso, os parâmetros hematológicos foram comparados entre as pacientes com HG de acordo com a gravidade da cetonúria.

Resultados A média de idade do grupo GH (n = 532) foi de 26,3 ±  4,1 anos, e a do grupo de controle (n = 534) foi de 25,9 ±  4,8 anos. Entre as pacientes com HG, 46% (n = 249) tinham cetona(+), 33% (n = 174), cetona(++), e 21% (n = 109), cetona(+ + +). A razão de neutrófilos para linfócitos (RNL) e a razão de plaquetas para linfócitos (RPL) foram maiores no grupo HG do que no grupo de controle: 3,8 (2,8–5,8)/3,2 (2,6–4,0); p < 0,001; e 135,2 ±  30,4/108,9 ±  62,2; p < 0,001, respectivamente). A contagem de neutrófilos, a RNL e a RPL foram maiores no grupo com cetona(++ + ) do que nos grupos com cetona(+) e cetona(++): 7,6 ±  1,9/5,5 ±  2,4; p < 0,001; 3,8 (2,8–4,6)/2,9 (2,3–3,6); p < 0,001; e 149,9 ±  48,0/135,9 ±  65,7; p < 0,001, respectivamente. O nível médio de hemoglobina corpuscular (MHC), a RNL e a RPL foram identificados como preditores independentes da presença de HG e do nível de positividade de cetona em pacientes com HG.

Conclusão A RNL e RPL estavam elevadas em pacientes com HG, o que sugere a sua atividade inflamatória. Elas podem ser marcadores importantes associados à presença e à gravidade da HG.

Keywords

hyperemesis gravidarum - ketonuria - hematological parameters

Palavras-chave

hiperêmese gravídica - cetonúria - parâmetros hematológicos

Contributors

All authors contributed to the writing of the article, relevant revision of the intellectual content, and approved the final version submitted for publication.




Publication History

Received: 22 July 2021

Accepted: 19 October 2021

Article published online:
11 April 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Lacroix R, Eason E, Melzack R. Nausea and vomiting during pregnancy: A prospective study of its frequency, intensity, and patterns of change. Am J Obstet Gynecol 2000; 182 (04) 931-937
    CrossrefPubMedSearch in Google Scholar
  • 2 Godsey RK, Newman RB. Hyperemesis gravidarum. A comparison of single and multiple admissions. J Reprod Med 1991; 36 (04) 287-290
    PubMedSearch in Google Scholar
  • 3 Eliakim R, Abulafia O, Sherer DM. Hyperemesis gravidarum: a current review. Am J Perinatol 2000; 17 (04) 207-218
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG. Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005; 11 (05) 527-539
    CrossrefPubMedSearch in Google Scholar
  • 5 Ismail SK, Kenny L. Review on hyperemesis gravidarum. Best Pract Res Clin Gastroenterol 2007; 21 (05) 755-769
    CrossrefPubMedSearch in Google Scholar
  • 6 Golberg D, Szilagyi A, Graves L. Hyperemesis gravidarum and Helicobacter pylori infection: a systematic review. Obstet Gynecol 2007; 110 (03) 695-703
    CrossrefPubMedSearch in Google Scholar
  • 7 Ng QX, Venkatanarayanan N, De Deyn MLZQ, Ho CYX, Mo Y, Yeo WS. A meta-analysis of the association between Helicobacter pylori (H. pylori) infection and hyperemesis gravidarum. Helicobacter 2018; 23 (01) e12455
    CrossrefPubMedSearch in Google Scholar
  • 8 Jafarzadeh A, Hassanshahi GH, Nemati M. Serum levels of high-sensitivity C-reactive protein (hs-CRP)in Helicobacter pylori-infected peptic ulcer patients and its association with bacterial CagA virulence factor. Dig Dis Sci 2009; 54 (12) 2612-2616
    CrossrefPubMedSearch in Google Scholar
  • 9 Niemeijer MN, Grooten IJ, Vos N, Bais JM, van der Post JA, Mol BW. et al. Diagnostic markers for hyperemesis gravidarum: a systematic review and metaanalysis. Am J Obstet Gynecol 2014; 211 (02) 150.e1-150.e15
    CrossrefPubMedSearch in Google Scholar
  • 10 Bhat T, Teli S, Rijal J, Bhat H, Raza M, Khoueiry G. et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther 2013; 11 (01) 55-59
    CrossrefPubMedSearch in Google Scholar
  • 11 Yildirim M, Turkyilmaz E, Avsar AF. Preoperative neutrophil-to-lymphocyte ratio has a better predictive capacity in diagnosing tubo-ovarian abscess. Gynecol Obstet Invest 2015; 80 (04) 234-239
    CrossrefPubMedSearch in Google Scholar
  • 12 Templeton AJ, McNamara MG, Šeruga B, Vera-Badillo FE, Aneja P, Ocaña A. et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst 2014; 106 (06) dju124
    CrossrefPubMedSearch in Google Scholar
  • 13 Ioannidou P, Papanikolaou D, Mikos T, Mastorakos G, Goulis DG. Predictive factors of Hyperemesis Gravidarum: A systematic review. Eur J Obstet Gynecol Reprod Biol 2019; 238: 178-187
    CrossrefPubMedSearch in Google Scholar
  • 14 Austin K, Wilson K, Saha S. Hyperemesis Gravidarum. Nutr Clin Pract 2019; 34 (02) 226-241
    CrossrefPubMedSearch in Google Scholar
  • 15 London V, Grube S, Sherer DM, Abulafia O. Hyperemesis gravidarum: a review of recent literature. Pharmacology 2017; 100 (3-4): 161-171
    CrossrefPubMedSearch in Google Scholar
  • 16 McCarthy FP, Lutomski JE, Greene RA. Hyperemesis gravidarum: current perspectives. Int J Womens Health 2014; 6: 719-725
    CrossrefPubMedSearch in Google Scholar
  • 17 Zahorec R. Ratio of neutrophil to lymphocyte counts–rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001; 102 (01) 5-14
    PubMedSearch in Google Scholar
  • 18 Wang D, Yang JX, Cao DY, Wan XR, Feng FZ, Huang HF. et al. Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma. OncoTargets Ther 2013; 6: 211-216
    CrossrefPubMedSearch in Google Scholar
  • 19 Kurt RK, Güler A, Silfeler DB, Ozçil MD, Karateke A, Hakverdi AU. Relation of inflammatory markers with both presence and severity of hyperemesis gravidarum. Ginekol Pol 2014; 85 (08) 589-593
    CrossrefPubMedSearch in Google Scholar
  • 20 Tayfur C, Burcu DC, Gulten O, Betul D, Tugberk G, Onur O. et al. Association between platelet to lymphocyte ratio, plateletcrit and the presence and severity of hyperemesis gravidarum. J Obstet Gynaecol Res 2017; 43 (03) 498-504
    CrossrefPubMedSearch in Google Scholar
  • 21 Beyazit F, Öztürk FH, Pek E, Ünsal MA. Evaluation of the hematologic system as a marker of subclinical inflammation in hyperemesis gravidarum: a case control study. Ginekol Pol 2017; 88 (06) 315-319
    CrossrefPubMedSearch in Google Scholar
  • 22 Yildirim M, Cendek BD, Desdicioglu R, Avşar AF. The existence of continuous systemic inflammation in pregnant women with hyperemesis gravidarum. Cyprus J Med Sci. 2016; 1: 46-50
    CrossrefPubMedSearch in Google Scholar
  • 23 Çintesun E, Akar S, Gul A, Çintesun FN, Sahin G, Ezveci H. et al. Subclinical inflammation markers in hyperemesis gravidarum and ketonuria: A case-control study. J Lab Physicians 2019; 11 (02) 149-153
    Thieme ConnectPubMedSearch in Google Scholar
  • 24 Sari N, Ede H, Engin-Ustun Y, Göçmen AY, Çağlayan EK. Hyperemesis gravidarum is associated with increased maternal serum ischemia-modified albumin. J Perinat Med 2017; 45 (04) 421-425
    CrossrefPubMedSearch in Google Scholar
  • 25 Bath PM, Butterworth RJ. Platelet size: measurement, physiology and vascular disease. Blood Coagul Fibrinolysis 1996; 7 (02) 157-161
    CrossrefPubMedSearch in Google Scholar
  • 26 Derbent AU, Yanik FF, Simavli S, Atasoy L, Urün E, Kuşçu UE. et al. First trimester maternal serum PAPP-A and free β-HCG levels in hyperemesis gravidarum. Prenat Diagn 2011; 31 (05) 450-453
    CrossrefPubMedSearch in Google Scholar
  • 27 Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy 2021; 122 (07) 474-488
    CrossrefPubMedSearch in Google Scholar
  • 28 Jiang S, He F, Gao R. et al. Neutrophil and Neutrophil-to-Lymphocyte Ratio as Clinically Predictive Risk Markers for Recurrent Pregnancy Loss. Reprod Sci 2021; 28 (04) 1101-1111
    CrossrefPubMedSearch in Google Scholar