RESUMO
Background: Maternal serum biomarkers assist in identifying various maternal and foetal complications. In this manner, the present study was conducted to assess the birth of high-risk infants using ß-hCG level and neutrophil lymphocyte ratio and their correlation with the development of low birth weight and poor APGAR score. Methods:A tertiary hospital-based prospective observation study was conducted among primi gravida attending the Department of Obstetrics & Gynaecology of Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. Written informed consent was obtained from prim gravida who met the eligibility criteria. Basic details on socio-demographics and selective blood investigations, i.e., ß-hCG and neutrophil-to-lymphocyte ratio (NLR), were examined and followed-up until postdelivery to assess the neonatal outcome. Data was analysed using SPSS version 21.0 with appropriate statistical methods. Sample size: The contamination rate was calculated by dividing the total number of contaminated blood cultures by the total number of cultures multiplied by 100. Results:The mean (±SD) age of participants (N=440) was 23.7 (±1.6). Overall, the mean (±SD) of birth weight and APGAR score at five minutes were 2.6 (±0.6), and 8.8 (±1.2), respectively, within the normal limits. Maternal values of NLR and ß-hCG (IU/mL) were negatively correlated to neonatal outcomes, i.e., low birth weight and poor APGAR score. The mean values of NLR were significantly high in neonates with poor outcomes (LBW, poor APGAR). The sensitivity and specificity of ß-hCG as a predictor for poor APGAR score was 83% and 66% at 16-18 weeks (AUC -0.82, cut-off 22721) and 83%, and 90%, respectively at 32-34 weeks (AUC-0.79, cut-off 14825). The sensitivity and specificity of NLR as a predictor for poor APGAR score were 78% and 61% at 16-18 weeks (AUC-0.76, cut-off 4.5), and 89% and 53%, respectively at 32-34 weeks (AUC-0.74, cut-off 4.5). Conclusion:High levels of maternal NLR and ß-hCG resulted in low birth weight neonates and poor APGAR score. The negative impact of these biomarkers should be further explored on a larger scale basis. Ascertaining this would lead to reduction in poor fetal outcomes.
RESUMO
Early detection and prediction of preeclampsia (PE) may avert serious materno-fetal complications. This prospective nested study was conducted to evaluate the role of serum beta human chorionic gonadotropin (hCG) and the neutrophil-lymphocyte ratio (NLR) in predicting the development and severity of PE. Four hundred and forty primigravidas, between 16 to 18 weeks of gestation, were recruited in the study. Serum beta-hCG and NLR were measured at the time of recruitment and they were followed and monitored for the development of PE and severe PE. Out of these 440 women, 64 (14%) developed PE; of which 25 (39%) developed severe PE. The mean values of NLR and serum beta hCG were significantly higher in patients developing PE and severe PE. NLR, with a cutoff value of 5.6, predicted the development of PE with 73.4% sensitivity and 88.6% specificity and severe PE with sensitivity 93.3% and specificity 86.6% respectively. The sensitivity and specificity of serum beta hCG in predicting the development of PE was 75% each for a cutoff value of 25,415 IU/mL whereas these values were 86.7%, and 79.1% respectively, for a cut-off value of 29,654 IU/mL for predicting the development of severe PE. These findings suggest that NLR and serum beta hCG can be used as excellent biomarkers in predicting both the development of PE and its severity. Multicentric studies involving subjects of multiple ethnicities should be done for establishing its utility as a routine screening test.
