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Platelet distribution width and the risk of unexplained recurrent pregnancy loss: a meta-analysis

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Abstract

Objective

Changes of platelet distribution width (PDW) have been observed in women with unexplained recurrent pregnancy loss (URPL). However, relevant previous studies showed inconsistent results. We performed a meta-analysis to comprehensively evaluate the association between PDW and URPL.

Methods

Observational studies reporting the difference of PDW between women with and without URPL were retrieved by searching PubMed, Embase, Web of Science, Wanfang, and CNKI. A random-effect model was used to pool the results by incorporating potential heterogeneity.

Results

Eleven case-control studies with 1847 women with URPL and 2475 healthy women were included. Age was matched for all studies between cases and controls. Pooled results showed women with URPL had significantly increased level of PDW (mean difference [MD]: 1.54%, 95% CI: 1.04 to 2.03, p < 0.05; I2 =77%). Subgroup analysis showed consistent result for URPL defined as ≥ 2 (MD: 1.45%, p = 0.003) and ≥ 3 (MD: 1.61%, p < 0.001) failed clinical pregnancies, and in studies compared to women with normal pregnancy (MD: 2.02%, p < 0.001) and non-pregnant healthy women (MD: 1.34%, p < 0.001). Results of the meta-analysis also showed that increment of PDW was associated with higher odds of URPL (per 1 unit, odds ratio: 1.26, 95% CI: 1.17 to 1.35, p < 0.001; I2 = 0%).

Conclusions

Women with URPL had significantly increased levels of PDW compared to healthy women without URPL, which suggest that higher PDW may predict the risk of URPL.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

RPL :

recurrent pregnancy loss

URPL :

unexplained recurrent pregnancy loss

NOS :

Newcastle-Ottawa Scale

PDW :

platelet distribution width

References

  1. Dimitriadis E, Menkhorst E, Saito S, Kutteh WH, Brosens JJ. Recurrent pregnancy loss. Nat Rev Dis Primers. 2020;6(1):98. https://doi.org/10.1038/s41572-020-00228-z.

    Article  PubMed  Google Scholar 

  2. Shahine L, Lathi R. Recurrent pregnancy loss: evaluation and treatment. Obstet Gynecol Clin North Am. 2015;42(1):117–34. https://doi.org/10.1016/j.ogc.2014.10.002.

    Article  PubMed  Google Scholar 

  3. Hong Li Y, Marren A. Recurrent pregnancy loss: a summary of international evidence-based guidelines and practice. Aust J Gen Pract. 2018;47(7):432–6. https://doi.org/10.31128/AJGP-01-18-4459.

    Article  PubMed  Google Scholar 

  4. Mashiach S. Recurrent pregnancy loss: causes, controversies, and treatment. Isr Med Assoc J. 2021;23(1):64–5.

    PubMed  Google Scholar 

  5. Saravelos SH, Regan L. Unexplained recurrent pregnancy loss. Obstet Gynecol Clin North Am. 2014;41(1):157–66. https://doi.org/10.1016/j.ogc.2013.10.008.

    Article  PubMed  Google Scholar 

  6. Youssef A, van der Hoorn MLP, Dongen M, Visser J, Bloemenkamp K, van Lith J, et al. External validation of a frequently used prediction model for ongoing pregnancy in couples with unexplained recurrent pregnancy loss. Hum Reprod. 2022;37(3):393–9. https://doi.org/10.1093/humrep/deab2646454846.

    Article  CAS  PubMed  Google Scholar 

  7. Zullino S, Clemenza S, Mecacci F, Petraglia F. Low molecular weight heparins (LMWH) and implications along pregnancy: a focus on the placenta. Reprod Sci. 2022;29(5):1414–23. https://doi.org/10.1007/s43032-021-00678-0.

    Article  CAS  PubMed  Google Scholar 

  8. Kwak-Kim J, Yang KM, Gilman-Sachs A. Recurrent pregnancy loss: a disease of inflammation and coagulation. J Obstet Gynaecol Res. 2009;35(4):609–22. https://doi.org/10.1111/j.1447-0756.2009.01079.xJOG1079.

    Article  CAS  PubMed  Google Scholar 

  9. Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia. 2010;14(1):28–32.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Leader A, Pereg D, Lishner M. Are platelet volume indices of clinical use? A multidisciplinary review. Ann Med. 2012;44(8):805–16. https://doi.org/10.3109/07853890.2011.653391.

    Article  PubMed  Google Scholar 

  11. Izzi B, Gialluisi A, Gianfagna F, Orlandi S, De Curtis A, Magnacca S, et al. Platelet distribution width is associated with P-selectin dependent platelet function: results from the Moli-family cohort study. Cells. 2021;10(10):2737. https://doi.org/10.3390/cells10102737.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Borkataky S, Jain R, Gupta R, Singh S, Krishan G, Gupta K, et al. Role of platelet volume indices in the differential diagnosis of thrombocytopenia: a simple and inexpensive method. Hematology. 2009;14(3):182–6. https://doi.org/10.1179/102453309X426182.

    Article  PubMed  Google Scholar 

  13. Lee E, Kim M, Jeon K, Lee J, Lee JS, Kim HS, et al. Mean platelet volume and platelet distribution width indicate that platelets remain small for most of heir lifespans in patients with essential thrombocythemia. Clin Lab. 2019;65(4) https://doi.org/10.7754/Clin.Lab.2018.180938.

  14. Luzzatto G, de Franchis G, Fabris F, Gerunda GE, Girolami A. Increased proportion of giant platelets and platelet distribution width are better indicators of altered platelet homeostasis than mean platelet volume in liver cirrhosis. Folia Haematol Int Mag Klin Morphol Blutforsch. 1988;115(5):719–26.

    CAS  PubMed  Google Scholar 

  15. Ntaios G, Papadopoulos A, Chatzinikolaou A, Saouli Z, Karalazou P, Kaiafa G, et al. Increased values of mean platelet volume and platelet size deviation width may provide a safe positive diagnosis of idiopathic thrombocytopenic purpura. Acta Haematol. 2008;119(3):173–7. https://doi.org/10.1159/000135658.

    Article  PubMed  Google Scholar 

  16. Ural U, Bayoglu Tekin Y, Balik G, Kir Sahin F, Colak S. Could platelet distribution width be a predictive marker for unexplained recurrent miscarriage? Arch Gynecol Obstet. 2014;290(2):233–6. https://doi.org/10.1007/s00404-014-3192-x.

    Article  CAS  Google Scholar 

  17. Dundar O, Pektas MK, Bodur S, Bakir LV, Cetin A. Recurrent pregnancy loss is associated with increased red cell distribution width and platelet distribution width. J Obstet Gynaecol Res. 2015;41(4):551–8. https://doi.org/10.1111/jog.12600.

    Article  PubMed  Google Scholar 

  18. Li Q, Ma CY. Significance of Hcy, folic acid, PLT, MPV, and PDW detection in patients with recurrent spontaneous abortion. Int J Lab Med. 2017;38(5):613–4. https://doi.org/10.3969/j.issn.1673-4130.2017.05.015.

    Article  Google Scholar 

  19. Zhang L, Ma Y, Zhu YN, Shen YF, Li S, Zhu B. Associations between RDW-CV, PDW, and NLR with unexplained recurrent miscarriage. Chin J Clin Lab Sci. 2018;36(6):432–4. https://doi.org/10.13602/j.cnki.jcls.2018.06.09.

    Article  Google Scholar 

  20. Li XJ, Yi H, Huang YL, Liu ZY. Correlation analysis of recurrent abortion with thromboelastogram and platelet parameters. Chin J Clin Obstet Gynecol. 2020;21(6):634–5. https://doi.org/10.13390/j.issn.1672-1861.2020.06.026.

    Article  CAS  Google Scholar 

  21. Wei ZP, Lin Z. Application value of combined detection of EmAb, CAC, and PDW in clinical diagnosis of recurrent miscarriage. J Mol Diagn Ther. 2021;13(6):977–80. https://doi.org/10.19930/j.cnki.jmdt.2021.06.032.

    Article  Google Scholar 

  22. Zhao Y, He XT. Combined diangostic value of platelet distribution width with neutrophil-lymphocyte ratio for patients with recurrent miscarriage. Chin Remed Clin. 2021;21(12):2156–7. https://doi.org/10.11655/zgywylc2021.12.067.

    Article  Google Scholar 

  23. Lu XJ, Liang JM, Shen LL, Bai YQ, Gao JX, Qin LX, et al. Anlysis for the diagnostic value of different detection methods for recurrent miscarriage. Chin J Lab Diagn. 2022;26(4):480–3. https://doi.org/10.3969/j.issn.1007-4287.2022.04.002.

    Article  Google Scholar 

  24. Fonksiyonları T, İncebıyık A, Hacıvelioğlu S, Gencer M, Güngör A, Coşar E. Is there any relationship between platelet functions, red cell distribution width and recurrent pregnancy loss? J Clin Analytical Med. 2015;6(1):149–51. https://doi.org/10.4328/jcam.1879.

    Article  Google Scholar 

  25. Erdem ZS, Cayir Y, Kosan Z, Erdem HB. Is there any relation between recurrent miscarriage and complete blood count values? A case-control study. Konuralp Medical Journal. 2020;12(1):39–43. https://doi.org/10.18521/ktd.518494.

    Article  Google Scholar 

  26. Qian SJ, Li J, Shen XH. Diagnostic value and clinical significance of combined detection of PDW and NLR in patients with recurrent spontaneous abortion. Int J Lab Med. 2020;41(9):1101–4. https://doi.org/10.3969/j.issn.1673-4130.2020.09.019.

    Article  Google Scholar 

  27. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Higgins J, Thomas J, Chandler J, Cumpston M, Li T, Page M, et al. Cochrane handbook for systematic reviews of interventions version 6.2. The Cochrane Collaboration. 2021. www.training.cochrane.org/handbook. Accessed 10 Jan 2023

  29. American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril. 2012;98(5):1103–11. https://doi.org/10.1016/j.fertnstert.2012.06.048.

    Article  Google Scholar 

  30. Liu T, Guo X, Liao Y, Liu Y, Zhu Y, Chen X. Correlation between the presence of antinuclear antibodies and recurrent pregnancy loss: a mini review. Front Endocrinol. 2022;13:873286. https://doi.org/10.3389/fendo.2022.873286.

    Article  Google Scholar 

  31. Scharf RE. Drugs that affect platelet function. Semin Thromb Hemost. 2012;38(8):865–83. https://doi.org/10.1055/s-0032-1328881.

    Article  CAS  PubMed  Google Scholar 

  32. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2010. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 10 Jan 2023

  33. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration. 2011. www.cochranehandbook.org. Accessed 10 Jan 2023

  34. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58. https://doi.org/10.1002/sim.1186.

    Article  PubMed  Google Scholar 

  35. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Bick RL, Hoppensteadt D. Recurrent miscarriage syndrome and infertility due to blood coagulation protein/platelet defects: a review and update. Clin Appl Thromb Hemost. 2005;11(1):1–13. https://doi.org/10.1177/107602960501100101.

    Article  CAS  PubMed  Google Scholar 

  37. Kotani S, Kamada Y, Shimizu K, Sakamoto A, Nakatsuka M, Hiramatsu Y, et al. Increased plasma levels of platelet factor 4 and beta-thromboglobulin in women with recurrent pregnancy loss. Acta Med Okayama. 2020;74(2):115–22. https://doi.org/10.18926/AMO/58269.

    Article  PubMed  Google Scholar 

  38. Flood K, Peace A, Kent E, Tedesco T, Dicker P, Geary M, et al. Platelet reactivity and pregnancy loss. Am J Obstet Gynecol. 2010;203(3):281.e1–5. https://doi.org/10.1016/j.ajog.2010.06.023.

    Article  PubMed  Google Scholar 

  39. Vlachadis N, Tsamadias V, Siori M, Vrachnis N, Economou E. Association of the PECAM-1 (Leu125Val) and P-Selectin (Thr715Pro) gene polymorphisms with unexplained spontaneous miscarriages. Cureus. 2022;14(2):e21859. https://doi.org/10.7759/cureus.21859.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Dendana M, Hizem S, Magddoud K, Messaoudi S, Zammiti W, Nouira M, et al. Common polymorphisms in the P-selectin gene in women with recurrent spontaneous abortions. Gene. 2012;495(1):72–5. https://doi.org/10.1016/j.gene.2011.11.034.

    Article  CAS  PubMed  Google Scholar 

  41. Sansanayudh N, Numthavaj P, Muntham D, Yamwong S, McEvoy M, Attia J, et al. Prognostic effect of mean platelet volume in patients with coronary artery disease. A systematic review and meta-analysis. Thromb Haemost. 2015;114(6):1299–309. https://doi.org/10.1160/TH15-04-0280.

    Article  PubMed  Google Scholar 

  42. Zheng YY, Wang L, Shi Q. Mean platelet volume (MPV) and platelet distribution width (PDW) predict clinical outcome of acute ischemic stroke: a systematic review and meta-analysis. J Clin Neurosci. 2022;101:221–7. https://doi.org/10.1016/j.jocn.2022.05.019.

    Article  PubMed  Google Scholar 

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Funding

This study was supported by the program named “Application of aspirin or low molecular weight heparin in the treatment of unexplained recurrent early pregnancy failure” (2021MSXM173).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, No. 120 Longshan Road, Yubei District, Chongqing, 400010, China

    Yan Shi

  2. Department of Obstetrics and Gynecology, Women and Children‘s Hospital of Chongqing Medical University, No. 120 Longshan Road, Yubei District, Chongqing, 400010, China

    Dongmei Xu

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Contributions

Yan Shi and Dongmei Xu designed the study, performed literature search, study quality assessment, data collection, statistical analysis, and results interpretation. Yan Shi drafted the manuscript. Dongmei Xu critically revised the manuscript. Yan Shi and Dongmei Xu approved the submission of the manuscript.

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Correspondence to Dongmei Xu.

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Shi, Y., Xu, D. Platelet distribution width and the risk of unexplained recurrent pregnancy loss: a meta-analysis. J Assist Reprod Genet 40, 1523–1531 (2023). https://doi.org/10.1007/s10815-023-02819-7

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