Evaluation of the Relationship between Inflammatory Markers and Patients with Hyperemesis Gravidarum

Background: Hyperemesis gravidarum (HG): is a more severe type of nausea and vomiting in pregnancy which is different to NVP and can cause dehydration, weight loss and electrolyte imbalance. The disease mechanism is unknown, but there is some evidence of a systemic inflammatory process. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and C reactive protein (CRP) have been suggested as possible diagnostic and prognostic markers.

Method: A case–control study was carried out at the Maternity and Pediatrics Teaching Hospital in Al Diwaniyah from February to December 2024. Twenty pregnant women with HG and 20 healthy women were enrolled; all pregnant women were <16 weeks' gestation. Demographic, PUQE, and laboratory investigations, such as CBC, coagulation profile, urinalysis, liver and renal function, thyroid function, and inflammatory markers (NLR, PLR, CRP) were gathered. Data were analyzed statistically using SPSS with p value of ≤ 0.05.

Results: There were no significant differences in baseline characteristics between groups (age, BMI, gestational age, gravidity). HG patients showed significantly higher neutrophil and platelet counts, elevated NLR (4.21 vs. 2.89, p = 0.002), PLR (133.45 vs. 115.58, p = 0.008), and CRP (1.04 vs. 0.34 mg/dL, p < 0.001). Severity analysis showed that corresponding to the severity of the disease, there is a correlation between the CRP count and the severity of the disease (p = 0.010) and the platelet count (p = 0.043). ROC analysis revealed that CRP was able to show its diagnostic usefulness with an AUC value of 0.798, specificity of 100%, and an accuracy of 79.8% at a cut-off point of >0.61 mg/dL.

Conclusions HG is accompanied by a strong systemic inflammatory response. Increased CRP and platelets are associated with severity and could be used as low cost and easily available markers for diagnosis and clinical management. To confirm these findings and investigate specific anti inflammatory treatments, larger and multi center studies are recommended.