Exp Clin Endocrinol Diabetes 2014; 122(01): 39-43
DOI: 10.1055/s-0033-1361087
Article
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Benefits of the Neutrophil-to-Lymphocyte Ratio for the Prediction of Gestational Diabetes Mellitus in Pregnant Women

H. Yilmaz
1   Turgut Ozal University, School of Medicine, Internal Medicine, Ankara, Turkey
,
H. T. Celik
2   Turgut Ozal University, School of Medicine, Biochemistry, Ankara, Turkey
,
M. Namuslu
2   Turgut Ozal University, School of Medicine, Biochemistry, Ankara, Turkey
,
O. Inan
1   Turgut Ozal University, School of Medicine, Internal Medicine, Ankara, Turkey
,
Y. Onaran
3   Turgut Ozal University, School of Medicine, Obstetrics and Gynecology, Ankara, Turkey
,
F. Karakurt
4   Necmettin Erbakan University, School of Medicine Konya, Turkey
,
A. Ayyildiz
5   Agn State Hospital, Biochemistry, Agn, Turkey
,
M. A. Bilgic
1   Turgut Ozal University, School of Medicine, Internal Medicine, Ankara, Turkey
,
N. Bavbek
1   Turgut Ozal University, School of Medicine, Internal Medicine, Ankara, Turkey
,
A. Akcay
1   Turgut Ozal University, School of Medicine, Internal Medicine, Ankara, Turkey
› Author Affiliations
Further Information

Publication History

received 24 July 2013
first decision 12 September 2013

accepted 29 October 2013

Publication Date:
24 January 2014 (online)

Abstract

Aims:

There is growing consensus in the literature that inflammation plays a central role in the pathophysiology of obesity, Type 2 Diabetes Mellitus (T2DM), Gestational Diabetes Mellitus (GDM) and cardiovascular complications. Measuring the neutrophil-to-lymphocyte ratio (NLR) provides a simple inexpensive method for the assessment of inflammatory status. We investigated the predictive value of pre-procedural (before the oral glucose tolerance test (OGTT)) NLR on the development of GDM in pregnancy.

Methods:

42 women with GDM and 68 women without GDM were included in the study. Complete Blood Count and biochemical tests were followed by a diagnostic 4-point 100-g-OGTT within 2 weeks. GDM was diagnosed by the Carpenter and Coustan criteria. The NLR was calculated from the data.

Results:

The mean NLR level was significantly higher in GDM women (3.00±0.83 vs. 2.26±0.43 p<0.001, respectively). In ROC analysis, NLR>2.93 had 76.2% sensitivity and 94.1% specificity in predicting GDM. Logistic regression analysis showed that elevated NLR (OR: 5.512, 95% CI: 1.352–22.475, p=0.017) was an independent variable for predicting GDM in pregnancy.

Conclusions:

An elevated NLR level is a powerful and independent predictor of GDM. The results of this study suggested that inflammation plays a central role in the pathogenesis of GDM.

 
  • References

  • 1 Metzger BE, Buchanan TA, Coustan DR et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 2007; 30: S251-S260
  • 2 Hunt KJ, Schuller KL. The increasing prevalence of diabetes in pregnancy. Obstet Gynecol Clin North Am 2007; 34: 173-199
  • 3 Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002; 25: 1862-1868
  • 4 Yogev Y, Visser GHA. Obesity, gestational diabetes and pregnancy outcome. Semin Fetal Neonatal Med 2009; 14: 77-84
  • 5 Pradhan AD, Manson JE, Rifai N et al. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA 2001; 286: 327-334
  • 6 Richardson AC, Carpenter MW. Inflammatory mediators in gestational diabetes mellitus. Obstet Gynecol Clin North Am 2007; 34: 213-244
  • 7 Hotamisligil GS. Inflammation and metabolic disorders. Nature 2006; 444: 860-867
  • 8 de Jager CP, van Wijk PT, Mathoera RB et al. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care 2010; 14: R192
  • 9 Park JJ, Jang HJ, Oh IY et al. Prognostic value of neutrophil to lymphocyte ratio in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2013; 111: 636-642
  • 10 Dan J, Zhang Y, Peng Z et al. Postoperative Neutrophil-to-Lymphocyte Ratio Change Predicts Survival of Patients with Small Hepatocellular Carcinoma Undergoing Radiofrequency Ablation. PLoS One 2013; 8: e58184
  • 11 Pichler M, Hutterer GC, Stoeckigt C et al. Validation of the pre-treatment neutrophil-lymphocyte ratio as a prognostic factor in a large European cohort of renal cell carcinoma patients. Br J Cancer 2013; 108: 901-907
  • 12 Buyukkaya E, Karakas MF, Karakas E et al. Correlation of Neutrophil to Lymphocyte Ratio With the Presence and Severity of Metabolic Syndrome. Clin Appl Thromb Hemost Sep 18 2012;
  • 13 Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982; 144: 768-773
  • 14 Di Cianni G, Miccoli R, Volpe L et al. Intermediate metabolism in normal pregnancy and in gestational diabetes. Diabetes Metab Res Rev 2003; 19: 259-270
  • 15 Asemi Z, Samimi M, Tabassi Z et al. A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance, inflammation, and oxidative stress in gestational diabetes. Nutrition 2013; 29: 619-624
  • 16 Festa A, D’Agostino Jr R, Howard G et al. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000; 102: 42-47
  • 17 Perry IJ, Wannamethee SG, Shaper AG. Prospective study of serum gamma-glutamyltransferase and risk of NIDDM. Diabetes Care 1998; 21: 732-737
  • 18 Tan PC, Mubarak S, Omar SZ. Gamma-glutamyltransferase level in pregnancy is an independent risk factor for gestational diabetes mellitus. J Obstet Gynaecol Res 2008; 34: 512-517
  • 19 Alanbay I, Coksuer H, Ercan M et al. Can serum gamma-glutamyltransferase levels be useful at diagnosing gestational diabetes mellitus?. Gynecol Endocrinol 2012; 28: 208-211
  • 20 Lee DH, Silventoinen K, Jacobs Jr DR et al. gamma-Glutamyltransferase, obesity, and the risk of type 2 diabetes: observational cohort study among 20,158 middle-aged men and women. J Clin Endocrinol Metab 2004; 89: 5410-5414
  • 21 Coutinho Tde A, Turner ST, Peyser PA et al. Associations of serum uric acid with markers of inflammation, metabolic syndrome, and subclinical coronary atherosclerosis. Am J Hypertens 2007; 20: 83-89
  • 22 Gungor ES, Danisman N, Mollamahmutoglu L. Relationship between serum uric acid, creatinine, albumin and gestational diabetes mellitus. Clin Chem Lab Med 2006; 44: 974-977
  • 23 Laughon SK, Catov J, Provins T et al. Elevated first-trimester uric acid concentrations are associated with the development of gestational diabetes. Am J Obstet Gynecol 2009; 201 (402) e1-e5