Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Obstet Gynecol. May 11, 2023; 12(3): 17-27
Published online May 11, 2023. doi: 10.5317/wjog.v12.i3.17
Clinical implication of platelet to lymphocyte ratio in early onset preeclampsia: A single-center experience
Wisam Akram, Zina Abdullah Hussein, Mazin Hameed Humadi, Wassan Nori
Wisam Akram, Zina Abdullah Hussein, Wassan Nori, Obstetrics and Gynecology, Mustansiriyah University, Baghdad 10052, Iraq
Mazin Hameed Humadi, Department of Inspection, Ministry of Health, Baghdad 10052, Iraq
Author contributions: Akram W contributed to conception and statistical analysis; Abdullah Hussein Z and Hameed Humadi M contributed to data collection and scientific editing; Nori W wrote, edited, and drafted the final version; all authors read and approved the final version.
Institutional review board statement: The study was reviewed and approved by the ethical committee of Mustansiriyah University (No. 160).
Informed consent statement: All participants gave informed consent after we explained the study aims and methods prior to enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: The data that support this study are available upon reasonable request to the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wassan Nori, PhD, Academic Editor, Academic Research, Senior Researcher, Obstetrics and Gynecology, Mustansiriyah University, Al Amin Street, Al Saydyia, No. 38 House, Baghdad 10052, Iraq. dr.wassan76@uomustansiriyah.edu.iq
Received: January 26, 2023
Peer-review started: January 26, 2023
First decision: February 8, 2023
Revised: February 8, 2023
Accepted: April 4, 2023
Article in press: April 4, 2023
Published online: May 11, 2023

Preeclampsia (PE) is a pregnancy syndrome of undetermined etiology; inflammation was one of the proposed theories for its development.


To examine the platelet to lymphocyte ratio (PLR), an inflammatory biomarker, as a marker to predict poor maternal-neonatal outcomes in early-onset PE (EoPE).


A cross-sectional study enrolled 60 pregnant women with EoPE (at 32-30 wk of gestation) at a university hospital. Demographic criteria and hematological indices were collected, including platelet counts and indices (mean platelet volume and platelet distribution width), PLR, and the Doppler study, which calculated estimated fetal weight (EFW), amniotic fluid index (AFI), resistance index (RI), and pulsatility index (PI). Participants were followed until delivery, where maternal outcomes were recorded, including; delivery mode and reason for cesarean section, and neonatal outcomes, including fetal growth restriction (FGR), meconium-stained liquid, the 5-min Apgar score, and admission to the intensive care unit.


There was a trend of insignificant increases in cesarean sections. Sixty-one-point two percent (37/60) fetuses were admitted to the neonatal care unit; 70.0% of admitted fetuses were meconium-stained liquor, and 56.7% of them had FGR. PLR was positively correlated with AFI and EFW as r = 0.98, 0.97, P < 0.001; PLR showed negative correlations with PI and RI as r = -0.99, -0.98, P < 0.001. The Apgar score and the number of days admitted to the intensive care unit had a positive and negative correlation (0.69, -0.98), P < 0.0001, respectively. Receiver operating characteristic calculated a PLR cutoff value (7.49) that distinguished FGR at 100% sensitivity and 80% specificity.


Strong, meaningful relationships between PLR and FGR parameters and a poor neonatal outcome with a significant P value make it a recommendable biomarker for screening EoPE-related complications. Further studies are suggested to see the impact on maternal-neonatal health.

Keywords: Preeclampsia, Early onset, Maternal complication, Adverse perinatal outcome, Apgar score

Core Tip: Women with preeclampsia (PE) suffer increased morbidity and mortality; their offspring endure higher risks in the early neonatal period and later life. Despite extensive research into PE, the only definitive treatment is to terminate the pregnancy. Many seek efficient prediction methods that may reduce expected risk. Platelet to lymphocyte ratio (PLR), an inflammatory biomarker, was studied in PE; however, little is known about its role in early-onset PE, a subtype with serious consequences for fetal and maternal health. Herein, we examine the role of PLR, which showed a strong, meaningful relationship between fetal growth restriction and poor neonatal outcome, making PLR a recommendable screening parameter.