• Users Online: 77
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2012  |  Volume : 24  |  Issue : 2  |  Page : 32-36

Mean platelet volume as a risk factor in pregnant diabetic women


1 Department of Internal Medicine, Sohag University, Sohag, Egypt
2 Minia University, Minia, Egypt
3 Department of Obstetric and Gynecology, Zagazig University, Zagazig, Egypt
4 Department of Hematology & Clinical Pathology, Ain-Shams University, Cairo, Egypt

Date of Submission01-Feb-2012
Date of Acceptance05-May-2012
Date of Web Publication16-Jul-2014

Correspondence Address:
Essam S. Badawy
MD, Department of Internal Medicine, Minia University, P.O. Box 61661, 7th, Ahmed Orabi St., Minia City, Minia
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.7123/01.EJIM.0000419581.67334.75

Rights and Permissions
  Abstract 

Background

Diabetes is an established risk factor for cardiovascular disease (CVD); therefore, the subset of women with gestational diabetes mellitus (GDM) who develop type 2 diabetes mellitus is at an increased risk for developing CVD in the future.

Objectives

To assess the platelet count and mean platelet volume (MPV) of pregnant women with GDM and gestational impaired glucose tolerance (GIGT) to determine whether GDM and GIGT are risk factors for future development of CVD.

Patients and methods

A 50 g oral glucose load (OGL) was administered to all participants (400 pregnant women), and routine hematologic parameters and MPV were studied at 24–28 gestational weeks using a Beckman/Coulter MAXM Hematology Analyzer. When a plasma glucose level of at least 140 mg/dl was measured after administering OGL, a 100 g 3-h oral glucose tolerance test was performed. Of these women, 296 (74%) had normal oral glucose tolerance, 48 (12%) had GIGT, and 65 (14%) had GDM. The mean platelet counts were higher in the normal OGL group than in the GIGT group, and higher in the GIGT group than in the GDM group, with no statistically significant differences among the three groups. However, MPV was significantly higher in the GDM group than in the normal glucose level group (P<0.05). Also, women with high MPV values had lower platelet counts.

Results

A significant difference was observed for MPV values between the GDM and normal OGL groups.

Conclusion

Presence of a high MPV in cases of GDM could indicate an increased risk for current and future thrombotic complications.

Keywords: cardiovascular risk factors, diabetes mellitus, gestational diabetes mellitus, gestational impaired glucose tolerance, mean platelet volume, pregnancy, thrombotic complications


How to cite this article:
Abel-Rahman SM, Badawy ES, Amer AA, Fekry D. Mean platelet volume as a risk factor in pregnant diabetic women. Egypt J Intern Med 2012;24:32-6

How to cite this URL:
Abel-Rahman SM, Badawy ES, Amer AA, Fekry D. Mean platelet volume as a risk factor in pregnant diabetic women. Egypt J Intern Med [serial online] 2012 [cited 2019 Jul 20];24:32-6. Available from: http://www.esim.eg.net/text.asp?2012/24/2/32/136011


  Introduction Top


Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy, and it affects 1.2–14.3% of pregnant women 1. Gestational impaired glucose tolerance (GIGT) is a glycemic disorder and is considered a prediabetic state 2. Considering the GDM consequences on increased perinatal and maternal morbidity and mortality, in addition to long-term complications, its accurate identification and treatment is of utmost importance 3,4. More than 50% of GDM women will develop type 2 diabetes mellitus (DM) in the future, and women with a history of GIGT also have an increased risk for developing diabetes 5. Diabetes is an established risk factor for cardiovascular disease (CVD); therefore, the subset of women with GDM who develop type 2 DM is at an increased risk for developing CVD in the future 6. Altered platelet morphology and function have been reported in patients with metabolic syndrome, stroke, and DM 7–10. Mean platelet volume (MPV) is a new and independent risk factor for myocardial infarction (MI), cerebral infarction, and transient ischemic attacks 7–11. MPV is an important, simple, effortless, and cost-effective measure that should be used for predicting the possibility of impending acute events such as MI and cerebrovascular events 2, 11, 12. Patients with large platelet counts can be identified easily during routine hematological examination and could possibly benefit from preventive treatment 13.

In this study, we aimed to assess the platelet count and MPV values of pregnant women with GDM and GIGT to ascertain whether GDM and GIGT are risk factors for future development of cardiovascular disorders.


  Materials and methods Top


This research was conducted in Bakhsh Hospital-Makkah (Saudi Arabia), in the Departments of Obstetrics & Gynaecology and Internal Medicine, between January 2009 and December 2011. Patients with anemia, hemoglobinopathy, chronic inflammatory bowel disease, renal failure, cyanotic congenital heart disease, pre-existing DM, other chronic diseases, and pre-eclampsia were excluded from the study. Informed consent was obtained from all selected patients.

A 50 g oral glucose load (OGL) was administered at 24–28 gestational weeks to all participants. When plasma glucose of at least 140 mg/dl was measured 2 h after the OGL, a 100 g 3-h oral glucose tolerance test (OGTT) was performed. A fasting peripheral venous blood sample was obtained from all participants at the same time as the OGTT. GDM was diagnosed when two or more abnormal plasma glucose levels were obtained during the OGTT according to the NDDG criteria (≥105 mg/dl fasting, ≥190 mg/dl at 1 h, ≥165 mg/dl at 2 h, or ≥145 mg/dl at 3 h) 14. Only one abnormal value was considered for GIGT. For all cases the following hematological parameters were evaluated: hemoglobin, hematocrit, red blood cell and platelet counts, MPV, red cell distribution width, and platelet distribution width. Samples were taken by means of antecubital vein puncture into tubes containing tripotassium EDTA. All samples were analyzed on a Beckman/Coulter MAXM Hematology Analyzer (Beckman Coulter, California, USA) 1–2 h after collection to minimize changes in platelet size. MPV reference range was determined as 7.8–11 fl. Data were analyzed with SPSS software version 13.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Mean±SD was calculated for age and MPV for all these groups separately. Differences between the mean age and MPV values between groups and within groups were calculated by analysis of variance. P-values and 95% confidence intervals were also calculated. A P-value 0.05 or less was considered statistically significant. The relationships between two continuous variables, platelet count, and MPV were assessed by linear regression analysis. All tests were two-sided with a 0.05 significance level.


  Results Top


A total of 400 pregnant women fulfilling the selection criteria were selected and divided into three groups according to the OGL and OGTT result: 296 (74%) women with a normal OGL, 48 (12%) with GIGT, and 56 (14%) with GDM. Mean age, gravity, parity, and gestational age were similar, as shown in [Table 1]. The mean OGL results were 115.9, 148.7, and 171.3 mg/dl for the nondiabetic, GIGT, and GDM groups, respectively. There were significant differences between the three groups with respect to the OGL test results (P<0.002 for GDM vs. GIGT and GDM vs. normal OGL, GDM vs. GIGT and GIGT vs. normal OGL).
Table 1: Demographic characteristics. Hematological and biochemical results of the group

Click here to view


With regard to the hematological parameters, red blood cell count, hemoglobin, hematocrit, red cell distribution width, and platelet distribution width values were similar among the three groups [Table 1]. The mean platelet counts were higher in the normal OGL group than in the GIGT group and higher in the GIGT group than in the GDM group, with no statistically significant differences among the three groups. With regard to the mean MPV values there was a significant difference between the GDM group and the group with normal OGL (P<0.05) [Table 1]. In linear regression analysis, an inverse relationship between platelet count and MPV levels was observed (P<0.001, r=0.105). Patients with high MPV values had lower platelet counts [Table 1].


  Discussion Top


GDM leads to significant health problems in mothers later in life. Women with a history of GDM have a 20–50% risk of developing type 2 DM within 5 years of pregnancy 15,16. Although the risk for type 2 DM is well established among women with GDM, there have been few studies on this issue in women with lower degrees of glucose intolerance during pregnancy 14,17–20. Research by Carr et al. 21 on this subject showed that women with a history of GIGT have an increased risk for developing diabetes. A recent study by Vambergue et al. 22 reported that GIGT was independently associated with glucose intolerance at 6.75 years postpartum, and cases with GIGT had a 4.57-fold increased risk compared with normal pregnant women.

Diabetes is an established risk factor for CVD; therefore, the subset of women with GDM who develop type 2 DM is at an increased risk for developing CVD in the future 6. It is uncertain, however, whether normoglycemic women with a history of GDM or GIGT who do not develop type 2 DM later are also at increased risk for future CVD. Women with a history of GDM, although normoglycemic after pregnancy, have an increased risk for insulin resistance and decreased endothelium-dependent vasodilatation 23,24. Such data suggest that GDM may represent the transient unmasking of a latent metabolic syndrome that may become clinically apparent later in life as CVD. Vascular dysfunction is another independent risk factor for CVD and women with prior GDM may have impaired vascular function 25,26. In their study, Anastasiou et al. 24 concluded that women with a history of GDM have impaired endothelium function as assessed by flow-mediated dilatation. Another study on this issue 26 showed that women with prior GDM have impaired acetylcholine-induced skin vasodilatation after the postpartum period (2–4 years), as assessed by laser Doppler flow, when compared with normal controls. The changed balance between prostacyclin and thromboxane observed in vessels of diabetic patients might serve as an explanation for the vascular modifications mentioned above 27. This imbalance between prostacyclin and thromboxane is responsible for the hypercoagulability in diabetic women and could result in fetal loss – one of the most important complications of GDM. Hypercoagulability and vascular dysfunction cause microthrombosis in placental bed vessels and placental infarctions. Consequently, this generates an impairment in the fetomaternal circulatory system, which results in low placental perfusion and finally in fetal loss 28.

Platelets play an important role in the integrity of normal homeostasis, and MPV is the indicator for their function 29. Large platelets contain more dense granules, are more potent than smaller ones, and are hence more thrombogenic 30,31. An increase in MPV has been documented in patients with metabolic syndrome, stroke, and DM 31. Increased MPV is now emerging as an independent risk factor for thromboembolism and MI 10, 32, 33. Bozkurt et al. 34 demonstrated that the MPV in their GDM group was significantly higher than the MPV of healthy pregnant women, but no statistically significant difference was observed in the platelet count between the women in the GDM group and normal pregnant women. In addition, an inverse relationship was observed between platelet number and MPV. Our study showed results similar to those of Bozkurt et al. 34 and Kosus et al. 35. GDM cases had a lower platelet count and a higher MPV. There was no difference between groups in terms of platelet count, but the MPV of our GDM group was significantly higher than that of the healthy group. An inverse relationship between platelet count and MPV levels was also observed [Figure 1]. This knowledge may be important for the prevention of thrombotic complications related to increased MPV in patients with GDM that can result in impairment in the fetomaternal circulatory system. Anticoagulant therapy such as low-dose aspirin may improve pregnancy outcome by blocking the action of cyclooxygenase synthesis and preventing thrombosis of the placental vasculature.
Figure 1: Correlation between platelet count and mean platelet volume.

Click here to view


In one study, De Pablos 36 showed that patients with GIGT had a higher prevalence of certain cardiovascular risk factors compared with patients with normal glucose tolerance in the white population. In our study MPV was found to be increased in the GIGT group. Although this increase was not statistically significant, it may be an early sign of risk for future CVD.


  Conclusion Top


Glucose intolerance during pregnancy may be an early sign of metabolic disease later in life. Pregnancy helps women to assess their metabolic state. Because pregnancy itself contains excessive metabolic changes, women who tolerate these changes successfully can be considered as having a lower CVD risk in the future if no other risk factors are present. Women with GDM would be expected to be at higher risk for future CVD. Our results suggest that GDM may serve as a marker of increased risk for future CVD. Another important finding in our study was the presence of higher MPV in GIGT women than in normal women. This means that GIGT may be a risk factor for CVD also. However, future studies with a larger series and long-term follow-up of such cases are needed to confirm this evidence. Such evidence might lead women to take preventive measures now and in the future, such as lifestyle changes or prophylactic pharmacological interventions.[36]

 
  References Top

1.Newton KM, Kim C, Knopp RH. American diabetes association: gestational diabetes mellitus. Diabetes Care. 2003;27:88–90  Back to cited text no. 1
    
2.Bock G, Dalla Man C, Campioni M, et al. Pathogenesis of pre-diabetes: mechanism of fasting and postprandial hyperglycemia in people with impaired fasting glucose and/or impaired glucose tolerance. Diabetes. 2006;55:3536–3549  Back to cited text no. 2
    
3.Evans MJ. Diabetes and pregnancy: a review of pathology. Br J Diab Vasc Dis. 2009;9:201–206  Back to cited text no. 3
    
4.Lindsay RS. Gestational diabetes: causes and consequences. Br J Diab Vasc Dis. 2009;9:27–31  Back to cited text no. 4
    
5.Gabbe SG, Graves CR. Management of diabetes mellitus complicating pregnancy. Obstet Gynecol. 2003;102:857–868  Back to cited text no. 5
    
6.Daviglus ML, Stamler J, Pirzada A, et al. Favorable cardiovascular risk profile in young women and long term risk of cardiovascular and all cause mortality. JAMA. 2004;292:1588–1592  Back to cited text no. 6
    
7.Khandeker MM, Khurana AS, et al. Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: an Indian scenario. J Clin Pathol. 2006;59:146–149  Back to cited text no. 7
    
8.Kilicli-Camur N, Demirtunc R, et al. Could mean platelet volume to be a predictive marker of acute myocardial infarction? Med Sci Monit. 2005;11:387–392  Back to cited text no. 8
    
9.Chu SG, Becker RC, Berger PB, et al. Mean platelet volume as a predictor of cardiovascular risk: a systemic review and meta-analysis. J Thrombos Hemost. 2010;8:148–156  Back to cited text no. 9
    
10.Nadar SK, Lip GY, Blann AD. Platelet morphology , soluble P selectin and platelet P selectin in acute ischemic stroke. The West Birmingham Stroke Project. Thromb Hemost. 2004;92:1342–1348  Back to cited text no. 10
    
11.O’Malley T, Langhorne P, Stewart C, et al. Platelet size in stroke patients. Stroke. 1995;26:995–999  Back to cited text no. 11
    
12.Sharpe PC, Trinick T. Mean platelet volume in diabetic patients. Q J Med. 1993;86:739–742  Back to cited text no. 12
    
13.Khuwaja AK, Rafique G, et al. Macrovascular complications and their associated factors among persons with type 2 diabetes mellitus in Karachi, Pakistan: a multicenter study. J Pak Med Assoc. 2004;54:60–66  Back to cited text no. 13
    
14.Lobner K, Knopff A, et al. Predictors of postpartum diabetes in women with gestational diabetes mellitus. Diabetes. 2006;55:792–797  Back to cited text no. 14
    
15.Metzger BE, Cho NH, Roston SM, et al. Pre-pregnancy weight and antepartum insulin secretion predict glucose tolerance 5 years after gestational diabetes mellitus. Diabetes Care. 1993;16:1598–1605  Back to cited text no. 15
    
16.Kaufmann RC, Schleyhahn FT, et al. Gestational diabetes diagnostic criteria: long-term maternal follow up. Am J Obstet Gynecol. 1995;172:621–625  Back to cited text no. 16
    
17.Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systemic review. Diabetes Care. 2002;25:1862–1868  Back to cited text no. 17
    
18.Lee AJ, Hiscock RJ, Wein P, et al. Gestational diabetes mellitus: clinical predictor and long term risk of developing type 2 diabetes. Diabetes Care. 2007;30:878–883  Back to cited text no. 18
    
19.Lauenborg J, Hansen T, Jensen DM, et al. Increasing incidence of diabetes after gestational diabetes: long-term follow up in a Danish population. Diabetes Care. 2004;27:1194–1199  Back to cited text no. 19
    
20.Weijers RN, Bekedam DJ. Relationship between gestational diabetes mellitus and type 2 diabetes: evidence of mitochondrial dysfunction. Clin Chem. 2007;53:377–383  Back to cited text no. 20
    
21.Carr DB, Newton KM, et al. Modestly elevated glucose level during pregnancy are associated with a higher risk of future diabetes among women without gestational diabetes mellitus. Diabetes Care. 2008;31:1037–1039  Back to cited text no. 21
    
22.Vambergue A, Dognin C, Boulogne A, et al. Increasing incidence of abnormal glucose tolerance in women with prior abnormal glucose tolerance during pregnancy: DIAGEST 2 study. Diabet Med. 2008;25:58–64  Back to cited text no. 22
    
23.Kousta E, Lawrence NJ, et al. Insulin resistance and B-cell dysfunction in normoglycemic European women with a history of gestational diabetes. Clin Endocrinol. 2003;50:289–297  Back to cited text no. 23
    
24.Anastasiou E, Lekakis JP, et al. Impaired endothelium dependent vasodilatation in women with previous gestational diabetes mellitus. Diabetes Care. 1998;21:2111–2115  Back to cited text no. 24
    
25.Weber T, Auer J, et al. Arterial stiffness, wave reflections, and the risk of coronary artery disease. Circulation. 2004;109:184–189  Back to cited text no. 25
    
26.Hu J, Norman M, et al. Increased large arterial stiffness and impaired acetylcholine induced skin vasodilatation in women with previous gestational diabetes mellitus. Br J Obstet Gynecol. 1998;105:1279–1287  Back to cited text no. 26
    
27.Saldeen P, Olofsson P, et al. Structural, functional and circulatory placental changes associated with impaired glucose metabolism. Eur J Obstet Gynecol Reprod Biol. 2002;105:136–142  Back to cited text no. 27
    
28.Alonso A, Soto I, et al. Acquired and inherited thrombophilia in women with unexplained fetal losses. Am J Obstet Gynecol. 2002;187:1337–1342  Back to cited text no. 28
    
29.Jakubowski JA, Thompson CB, et al. Arachidonic acid metabolism by platelets of different size. Br J Hematol. 1983;53:503–511  Back to cited text no. 29
    
30.Chamberlain KG, Tong M, et al. The relationship of human platelet density to platelet age: platelet population labeling by monoamine oxidase inhibition. Blood. 1989;73:1218–1225  Back to cited text no. 30
    
31.Pereira J, Cretney C, Aster RH. Variation of class 1 HLA antigen expression among platelet density cohorts: a possible index of platelet age? Blood. 1988;71:516–519  Back to cited text no. 31
    
32.Tavil Y, Sen N, et al. Mean platelet volume in patients with metabolic syndrome and its relationship with coronary artery disease. Thromb Res. 2007;120:245–250  Back to cited text no. 32
    
33.Boos CJ, Lip GY. Assessment of mean platelet volume in coronary artery disease: what does it mean? Thromb Res. 2007;120:11–13  Back to cited text no. 33
    
34.Bozkurt N, Yilmaz E, Biri A, et al. The mean platelet volume in gestational diabetes. J Thromb Thrombolysis. 2006;22:51–54  Back to cited text no. 34
    
35.Kosus A, Kosus N, Duran M, et al. Assessment of mean platelet volume of pregnant women with gestational diabetes mellitus and impaired glucose tolerance as a marker of future cardiovascular disease risk. Br J Diab and Vasc Dis. 2011;7:29–33  Back to cited text no. 35
    
36.De Pablos-Velasco PL, Martinez Marin FJ, et al. Prevalence and determinants of diabetes mellitus and glucose intolerance in a Canarian Caucasian population: comparison of the 1997 ADA and the 1985 WHO criteria: the Guia study. Diabet Med. 2001;18:235–241  Back to cited text no. 36
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and me...
Results
Discussion
Conclusion
Introduction
Materials and me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed843    
    Printed20    
    Emailed0    
    PDF Downloaded111    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]