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Evaluating mean platelet volume and platelet distribution width as predictors of early-onset pre-eclampsia: a
Patience Ijeoma Udeh1, Ayokunle Moses Olumodeji2, Taiwo Olufunmilayo Kuye-Kuku1,3
1Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Lagos, Nigeria.
Insights
Mean platelet volume (MPV) and platelet distribution width (PDW) measured early in pregnancy can reliably predict severe early-onset pre-eclampsia. These readily available blood tests offer a promising tool for early detection, especially in resource-limited settings.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Perinatal Medicine
Background:
- Pre-eclampsia is a significant cause of maternal and fetal morbidity.
- Current predictors are not universally accessible, particularly in resource-limited regions.
- Platelets play a key role in pre-eclampsia pathophysiology, but reliable early markers are needed.
Purpose of the Study:
- To investigate mean platelet volume (MPV) and platelet distribution width (PDW) as predictors of early-onset pre-eclampsia.
- To assess the utility of these platelet indices in a Nigerian cohort.
- To determine if MPV and PDW can serve as accessible screening tools.
Main Methods:
- Prospective cohort study of 648 pregnant women recruited between 14-18 weeks gestation.
- Measurement of platelet count (PC), MPV, and PDW from venous blood.
- Monitoring for early-onset pre-eclampsia until 34 weeks gestation; ROC curve analysis for predictive values.
Main Results:
- Early-onset pre-eclampsia occurred in 5.9% of participants.
- Women who developed pre-eclampsia had significantly higher MPV and PDW, and lower PC at recruitment.
- MPV and PDW demonstrated high sensitivity and specificity for predicting severe early-onset pre-eclampsia (AUCs > 0.996).
Conclusions:
- MPV and PDW measured between 14-18 weeks gestation are reliable predictors of severe early-onset pre-eclampsia.
- These platelet indices offer a feasible and accessible screening method.
- This finding is particularly relevant for improving prenatal care in resource-limited settings.
Background:
Platelets are pivotal players in the pathophysiology of pre-eclampsia, with observed lower counts in affected individuals compared to normotensive counterparts. Despite advancements, the elusive cause of pre-eclampsia persists, motivating intense global efforts to identify reliable predictors. The currently recommended predictors of pre-eclampsia are not readily available in many resource-limited regions like Nigeria. This cohort study explores the potential of mean platelet volume (MPV) and platelet distribution width (PDW) as predictive markers of early-onset pre-eclampsia. Both platelet indices are components of the full blood count, a widely available routine test in pregnancy.
Methods:
In this prospective cohort study, 648 healthy pregnant women attending antenatal care at Lagos State University Teaching Hospital and General Hospital Ifako-Ijaiye, Lagos, were recruited between 14-18weeks gestational age. Platelet count (PC), MPV and PDW were measured from their venous blood at recruitment. Participants were monitored until 34weeks of gestation, focusing on the occurrence of early-onset preeclampsia as the outcome of interest. Individuals with chronic medical conditions were excluded from the study. Data analysis involved t-test, Chi-Square and Mann-Whitney U tests, with statistical significance set at a confidence level of 95% and p < 0.05. Sensitivity, specificity, and predictive values were determined using receiver operating characteristics (ROC) curves.
Results:
The incidence of early-onset pre-eclampsia in the study was 5.9%. Women who later developed pre-eclampsia had higher median MPV and PDW at 14-18weeks (10.8 fl. and 24.8 fl.) compared to normotensive women (8.1 fl. and 13.3 fl.)(p < 0.001). The median PC was lower in pre-eclamptics (190 × 103/µl) compared to normotensives(264 × 103/µl)(p < 0.001). Using Youden's test, cut-off values identified: PC < 211.5 × 103/µl, MPV > 9.4 fl., and PDW > 21.3 fl., predicted early-onset pre-eclampsia with 96.6% sensitivity and 65.6% specificity for PC; 79.3% sensitivity and 97.7% specificity for PDW; and 82.8% sensitivity and 96.1% specificity for MPV. Cut-offs of PC < 185 × 103/µl, MPV > 10.7 fl., and PDW > 28.3 fl., predicted severe early-onset pre-eclampsia with 100.0% sensitivity and 90.9% specificity for PC, 100.0% sensitivity and 99.4% specificity for MPV, and 100.0% sensitivity and 99.8% specificity for PDW, with corresponding area under the ROC curves of 0.983, 0.996, and 0.998, respectively.
Conclusion:
The evaluation of MPV and PDW between 14 and 18 weeks of gestation appears to be a reliable predictor of severe early-onset pre-eclampsia.
