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Platelet count in preeclampsia: a systematic review and meta-analysis.

G. Woldeamanuel,Kenean Getaneh Tlaye,Ling Wu,L. Poon,Chi Chiu Wang

Published 2023 in American Journal of Obstetrics & Gynecology MFM

ABSTRACT

OBJECTIVE Many studies reported the association between platelets and preeclampsia. However, sample sizes were small, and their findings were inconsistent. Here, we conducted a systematic review and meta-analysis to evaluate the association in pooled samples and in details. DATA SOURCES A systematic literature search was performed using Medline, EMBASE, Science Direct, Web of Science, Cochrane Library, NICHD-DASH, LILACS and Scopus from inception to 22 April 2022. STUDY ELIGIBILITY CRITERIA Observational studies compared platelet count between women with preeclampsia and normotensive pregnant women were included. METHODS The mean differences (MD) with 95% confidence interval (CI) in platelet count were calculated. Heterogeneity was assessed using I2 statistics. Sensitivity and subgroup analyses were conducted. Statistical analysis was performed using RevMan 5.3 and PROMETA 3 software. RESULTS A total of 56 studies comprising 4892 preeclamptic and 9947 normotensive pregnant women were included. Meta-analysis showed that platelet count was significantly lower in women with preeclampsia than normotensive controls (overall: MD -32.83, 95% CI -40.13 to -25.52, p < 0.00001, I2 = 92%; mild preeclampsia: MD -18.65, 95% CI -27.17 to -10.14, p < 0.00001, I2 = 84%; severe preeclampsia: MD -42.61, 95% CI -57.53 to -27.68, p < 0.00001, I2 = 94%). Significantly lower platelet count was also observed in second trimester (MD -28.84, 95% CI -44.59 to -13.08, p = 0.0003, I2 = 93%), third trimester (MD -40.67, 95% CI -52.14 to -29.20, p < 0.00001, I2 = 92%) and measurement before the diagnosis of preeclampsia (MD -18.81, 95% CI -29.98 to -7.64, p = 0.009, I2 = 87%), but not in first trimester (MD -15.14, 95% CI -37.71 to 7.43, p = 0.19, I2 = 71%). Overall, the pooled sensitivity and specificity of platelet count were 0.71 and 0.77, respectively. The area under the curve was 0.80. CONCLUSIONS This meta-analysis confirmed that platelet count was significantly lower in preeclamptic women, irrespective of severity and presence or absence of associated complications; even before the onset of preeclampsia and in the second trimester of pregnancy. Our findings suggest that platelet count may be a potential marker to identify and predict preeclampsia.

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