La Verde Marco, Molitierno Rossella, Marrapodi Maria Maddalena, Fordellone Mario, Laganà Antonio Simone, Palma Marica, Petillo Antonella, Riemma Gaetano, Vastarella Maria Giovanna, De Franciscis Pasquale
Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.
Department of Woman, Child and General and Specialized Surgery, Pediatric Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.
Gynecol Obstet Invest. 2025 Apr 28:1-11. doi: 10.1159/000545591.
Several studies explored the role of maternal systemic inflammation indices during pregnancy. Different conditions, such as gestational hypertension, preeclampsia, and gestational diabetes, are associated with abnormal systemic inflammation indices. However, there is a lack of research on the impact of systemic inflammation indices on fetal growth in physiological pregnancies. The objective of this study was to explore the potential associations between birth weight, length, and head circumference with a group of systemic inflammatory indices, namely, platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR), the mean platelet volume-to-lymphocyte ratio (MPVLR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI).
Full-term, physiological pregnancies admitted to a tertiary center from November 2019 until February 2021 were included in a prospective observational study. We excluded pregnancies affected by gestational or pregestational diabetes, chronic hypertension, gestational hypertension, pre-eclampsia/eclampsia, fetal growth restriction, preterm delivery or premature rupture of membranes, multiple pregnancies, and malformed fetuses. Sociodemographic characteristics, clinical data, and complete blood count were recorded.
Continuous variables were reported as either the means and standard deviation or median and interquartile ranges according to their distribution, as assessed by the Shapiro-Wilk normality test. Categorical variables were reported as percentages. To measure the linear association between continuous variables, the Pearson correlation test was used if variables had a normal distribution. Otherwise, Spearman's rank correlation test was calculated. To obtain an inflammatory latent score, a principal component analysis (PCA) was performed on NLR, PLR, MPVLR, MLR, SII, and SIRI.
Overall, 264 pregnant women came to our observation before the delivery. After the exclusion criteria, 199 pregnant were included. The Spearman's rank correlation test showed a high correlation among the indices. Then, a PCA was performed to a composite indicator of inflammatory score. The first principal component was selected, with a proportion of explained variance equal to 73.11%. The contributions of variables suggested excluding from the score the MLR index. From the linear regression models, results denoted that the inflammatory score negatively affects the birth weight (β = -42.60, 95% CI -76.91, -8.28) and the head circumference (β = -0.14, 95% CI -0.24, -0.04); however, the effect of the score on the birth length is not statistically significant at 5% (β = -0.12, 95% CI -0.27, 0.02).
This research's main limitation is the lack of data about the indirect inflammatory markers during the first and second trimesters of pregnancy. In addition, no neonatal outcomes were scheduled, such as NICU hospitalization for the different neonatal pathologies.
The results of our study revealed a negative direct correlation between the composite indicator of inflammatory score and the birth weight and fetal head circumference. This novel finding prompts further evaluation of the role of indirect inflammatory markers on fetal growth and neonatal outcomes and highlights the need for additional research to clarify the complex relationship between inflammation and pregnancy.
多项研究探讨了孕期母体全身炎症指标的作用。不同情况，如妊娠期高血压、子痫前期和妊娠期糖尿病，都与全身炎症指标异常有关。然而，关于生理妊娠中全身炎症指标对胎儿生长的影响，目前缺乏相关研究。本研究的目的是探讨出生体重、身长和头围与一组全身炎症指标之间的潜在关联，这些指标包括血小板-淋巴细胞比值（PLR）、中性粒细胞-淋巴细胞比值（NLR）、平均血小板体积与淋巴细胞比值（MPVLR）、单核细胞-淋巴细胞比值（MLR）、全身免疫炎症指数（SII）和全身炎症反应指数（SIRI）。
纳入2019年11月至2021年2月在一家三级中心入院的足月生理妊娠病例，进行前瞻性观察研究。我们排除了受妊娠期或孕前糖尿病、慢性高血压、妊娠期高血压、子痫前期/子痫、胎儿生长受限、早产或胎膜早破、多胎妊娠和胎儿畸形影响的妊娠。记录社会人口学特征、临床数据和全血细胞计数。
连续变量根据其分布情况，经Shapiro-Wilk正态性检验评估后，以均值和标准差或中位数和四分位数间距的形式报告。分类变量以百分比形式报告。为测量连续变量之间的线性关联，若变量呈正态分布，则使用Pearson相关检验；否则，计算Spearman秩相关检验。为获得炎症潜在评分，对NLR、PLR、MPVLR、MLR、SII和SIRI进行主成分分析（PCA）。
总体而言，264名孕妇在分娩前来我院接受观察。经过排除标准后，纳入199名孕妇。Spearman秩相关检验显示各指标之间存在高度相关性。然后，进行PCA以得出炎症评分的综合指标。选择第一个主成分，其解释方差比例为73.11%。变量的贡献表明应从评分中排除MLR指数。从线性回归模型来看，结果表明炎症评分对出生体重（β = -42.60，95%CI -76.91，-8.28）和头围（β = -0.14，95%CI -0.24，-0.04）有负面影响；然而，该评分对出生身长的影响在5%水平上无统计学意义（β = -0.12，95%CI -0.27，0.02）。
本研究的主要局限性在于缺乏妊娠第一和第二孕期间接炎症标志物的数据。此外，未安排新生儿结局观察，如不同新生儿疾病入住新生儿重症监护病房的情况。
我们的研究结果显示炎症评分综合指标与出生体重和胎儿头围之间存在负向直接相关性。这一新发现促使进一步评估间接炎症标志物对胎儿生长和新生儿结局的作用，并强调需要更多研究来阐明炎症与妊娠之间的复杂关系。
