Predictive Value of Neutrophil to Lymphocyte Ratio in Early Detection of Gestational Diabetes Mellitus Among Pregnant Women in First Trimester of Pregnancy

Abstract

Background & Objective: A substantial number of pregnant women develop gestational diabetes mellitus

(GDM). Various biomarkers are being used to diagnose gestational diabetes mellitus. Early detection of

GDM can done by using inflammatory markers like neutrophil-to-lymphocyte ratio (NLR) and the platelet-

to-lymphocyte ratio (PLR) that are rapid, inexpensive and easy to use in different clinical setting. The

objective of this study was to evaluate diagnostic accuracy of raised neutrophil to lymphocyte ratio for

detection of gestational diabetes mellitus taking OGTT as gold standard.

Methods: This was a cross-sectional study held in Department of Obstetrics and Gynecology CMH Lahore

from November, 2018 –May, 2020. After approval from hospital ethical review committee and taking an

informed consent, 473 pregnant women enrolled in first trimester between age 18-35 years, fulfilling the

inclusion criteria were included whereas known diabetics, patients with cardiovascular disorders, previous

history of GDM were excluded. Blood samples in sterilized manner were drawn and sent to hospital

laboratory for analysis of NLR. Then they were screened during 24-28 weeks of gestation for diagnosis of

gestational diabetes mellitus on OGGT. The females were labelled for positive NLR and GDM as per

operational definition. Diagnostic accuracy of NLR was calculated for development of gestational diabetes

mellitus.

Results: Mean age of females was 26.72 ± 4.90 years and mean gestational age was 15.50 ± 1.67 weeks.

94(19.9%) females who had raised neutrophil to lymphocyte ratio while 397(80.1%) females had normal

neutrophil to lymphocyte ratio and there were 90(19%) females who had gestational diabetes mellitus while

rests of 383(81%) did not have gestational diabetes mellitus. The sensitivity, specificity, positive predictive

value, negative predictive value and overall diagnostic accuracy of NRL was 95.56%, 97.91%, 91.49%,

98.94% and 97.46%, respectively.

Conclusion: The study concluded that raised neutrophil to lymphocyte ratio is significantly high among

gestational diabetes mellitus and NLR has a high diagnostic accuracy for predicting gestational diabetes

mellitus.