J Thromb Thrombolysis (2006) 22:51–54
DOI 10.1007/s11239-006-8322-2
The mean platelet volume in gestational diabetes
Nuray Bozkurt · Ercan Yılmaz · Aydan Biri ·
Zeki Taner · Özdemir Himmetoğlu

C Springer Science + Business Media, LLC 2006
Abstract Objective: To compare the platelet count and
mean platelet volume (MPV) values of pregnancies diag-
nosed with gestational diabetes with those of healthy preg-
nancies.
Material—method: Between June 2003 and September
2004, 100 healthy pregnancies and 100 pregnancies with ges-
tational diabetes were studied at Gazi University, Department
of Obstetrics and Gynecology.
Results: While no statistically significant difference was
observed in the platelet count between the two groups, the
MPV of the gestational diabetes group (9.4 ± 1.6 fl) was
evaluated to be significantly higher than the MPV of the
healthy pregnancy group (8.3 ± 1.1 fl). Additionally, when
linear regression analysis was performed an inverse relation-
ship was observed between platelet number and MPV.
Conclusion: There is a need for further research focusing
on the platelet function in the observation and treatment of
gestational diabetes, which can pose the risk of developing
Type 2 diabetes for the mother and has negative consequences
for the fetus.
Keywords Mean platelet volume . Gestational diabetes
Introduction
Gestational Diabetes Mellitus is defined as a carbonhy-
drate metabolism disorder arising during pregnancy and this
N. Bozkurt . E. Yılmaz . A. Biri . Z. Taner . Ö. Himmetoğlu
Department of Gynecology and Obstetrics, Gazi University,
Faculty of Medicine
N. Bozkurt ()
Tirebolu Sokak, 27/18, Yukariayranci, TR-06550, Ankara, Turkey
e-mail: nmbozkurt@yahoo.com
metabolism is negatively affected by the natural course of
pregnancy [1]. The increased concentration of cortisone, pro-
lactin, human placental lactogen and leptin in the circulation
play an important role in the development of insulin resis-
tance [1]. The increased insulin resistance prevents the use of
glucose in peripheral tissues and increases the serum glucose
concentration. 3–5% of all pregnancies are negatively af-
fected by gestational diabetes mellitus [2]. Considering ges-
tational diabetes mellitus’ consequences of increased perina-
tal morbidity and mortality, in addition to a larger frequency
of long-term complications in the mother and fetus, its accu-
rate identification and treatment is of utmost importance [3].
Women diagnosed with GDM represent approximately 90%
of all cases of diabetes complicating pregnancy. More than
50% of these women will develop type 2 diabetes mellitus in
their future life [2].
Placental dysfunction is assumed to be partly account-
able for high frequency of perinatal impediments in dia-
betic women. When compared to normal pregnancy, per-
fused diabetic placentea transfers more arachidonic acid to
prostanoids. This results in a higher TxA2 and lower PGI2
concentration in the perfusates on both the fetal and maternal
side of the circulation. Platelet generated TxA2 have power-
ful vasoconstrictive and platelet activating functions whereas
endothelial cell generated PGI2 possesses vasodilating and
anti-aggregating actions. Furthermore, the hypercoagulable
conditions stimulated by GDM could be correlated to the
variations in TxA2 and/or PGI2 production in this disease
[4]. Diabetes is a systemic disorder which affects the normal
physiological function of all systems, one of which is the
hematopoietic system. The micro and macro vascular patho-
logical platelets produced in the systemic circulation of dia-
betic patients are the elements of the hematopoietic system
causing major pathology. Platelets are the first line of defence
upon loss of vascular integrity. Platelet membrane receptors’
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Table 1 The demographic and
clinical properties of the study
and control groups
Birth weigth
Age
Birth week
Platelet
Mean platelet volume
Wbc
Rbc
interaction with injury related factors such as collagen, mi-
crofibrils and Von Willebrand factor stimulate linkage to not
only other platelets but also to the vessel wall. Moreover,
comprehensive agents such as thromboxane A2 and serotonin
are amalgamated and extruded from the platelet [5]. Mean
platelet volume showing the platelet size is an indicator of
platelet function [6]. In comparison to small platelets, larger
platelets or thrombocytes with a higher MPV value produce
higher amounts of the prothrombotic factor Tromboxane A2
[7].
This study aimed to compare the platelet count and mean
platelet volume (MPV) values of pregnancies having ges-
tational diabetes with those of healthy pregnancies. It also
aimed to examine the change in the number of platelets and
MPV values of patients with gestational diabetes as com-
pared to those of normal pregnancies.
Materials ve methods
The study was conducted at Gazi University, Department of
Obstetrics and Gynecology, between June 2003 and Septem-
ber 2004, and the study group consisted of 100 consecutive
pregnancies with gestational diabetes and 100 healthy preg-
nancies. The findings were accordingly compared for these
two groups.
The patients and controls diagnosed with anemia, hemo
globinopathy, chronic inflammatory disease, pre-existing di-
abetes mellitus, other chronic disease and preeclampsia ex-
cluded from the study. When plasma glucose ≥140 mg/dl
was measured following the 50 gram oral glucose loading test
that was administered at 24–28 gestational weeks, a 100 gr-
3 h oral glucose tolerance test was applied. The patients who
had high values from both tests were considered to have ges-
tational diabetes. Gestational diabetic patients whose blood
glucose could be controlled through a healthy diet and exer-
cise (Class A1) were included in this study.
A fasting peripheral venous blood sample was obtained
from all participants in their last trimester (32–36 weeks).
All blood samples were analyzed by an auto analyzer (Cell-
Dyn 4000, Abbott) for the measurement of platelet volume.
In our clinic, the MPV reference range is determined as
7–11.0 fl.
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J Thromb Thrombolysis (2006) 22:51–54
Gestational diabet (−) Gestational diabet (+) p
3341 ± 418 3535 ± 443 0.002
28 ± 4 31 ± 5 <0.001
39 ± 1.3 38.5 ± 3.3 NS
217560 ± 53807 223240 ± 48584 NS
8.3 ± 1.1 9.4 ± 1.6 <0.001
9848 ± 2657 9840 ± 2715 NS
4.1 ± 0.5 (milyon) 4.1 ± 0.9 (milyon) NS
Statistical analysis
Data were analyzed with the SPSS software version 13.0 for
Windows (SPSS Inc., Chicago, Illinois). Continuous vari-
ables were presented as mean ± SD and categorical vari-
ables as frequency and percentage. Differences in baseline
characteristics between groups were assessed with t tests for
continuous variables and χ 2 tests for binary variables. The
relationship between two continuous variables, platelet size
and mean platelet volume, was assessed by linear regression
analysis. All tests were two-sided with a 0.05 significance
level.
Results
Table 1 illustrates the clinical characteristics and laboratory
test scores of the 100 GDM and 100 normal pregnancies at
Gazi University, Department of Obstetrics and Gynecology.
The two groups showed no significant difference between
the birth week and average platelet count. As expected, the
average birth weight of gestational diabetic patients’ babies
was higher than those of normal pregnancies (3341 ± 418
vs. 3535 ± 443, p = 0.002). Patient in the diabetic group
were on average 3 years old (28 ± 4 vs 31 ± 5, p ≤ 0.001).
The platelet volume of the gestational diabetes group was
significantly higher than that of the healthy pregnancy group
(9.4 ± 1.6 fl vs 8.3 ± 1.1 fl, p < 0.001) (Table 1). Addition-
ally, when linear regression analysis was performed an in-
verse relationship was observed between platelet number and
MPV. Patients with high MPV values had a lower platelet
count (Fig. 1).
Discussion
In this study where gestational diabetic pregnancies were
compared to normal pregnancies, the patients with GDM
were observed to have a higher median platelet volume.
Platelet volume is a marker of platelet activation and func-
tion, and is measured using MPV. In previous studies, MPV
was observed to be higher in non-pregnant diabetics when
compared to the normal population [8–11, 12]. Furthermore,
J Thromb Thrombolysis (2006) 22:51–54
Fig. 1 Patients with high MPV
values had a lower platelet count
(Fig. 1). r = 0.253; P < 0.001
PLT
in impaired fasting glucose cases which are thought to be a
pre-diabetic situation, high MPV was noted. In comparison
to normal sized platelets, trombocytes with high MPV values
are more reactive. Therefore, this situation may lead to an in-
crease in production of TromboxanA2, which are specific to
trombocytes and basically causes vasoconstriction and vein
occlusion, a decrease in prostacylin concentration, and thus,
results in vasoconstriction at vascular vein level [13–15]. It
is argued that an increase in MPV sets the stage for micro
and macro vascular complications in diabetic patients [11].
Increased MPV values are also reported in various cardio-
vascular diseases [6].
MPV values can be an effective marker reflecting blood
glucose level [9]. In a study group of 22 patients with DM,
MPV values were higher, but with the decrease in blood glu-
cose, there was a significant decrease in MPV values [9].
It is suggested that insulin potentates murine megakaryocy-
topoiesis in vitro, in a study; therefore, due to the increased
insulin in insulin resistant cases big platelets may be observed
[16]. In another study, it is claimed that increased aggrega-
tion and multiplication functions occur in diabetic patients’
megakaryocyte stem-cells. It is also observed that Glycopro-
tein IB molecule, a marker of megakaryocyte stem-cell, is
found more in platelets’ cell membrane with high MPV val-
ues in diabetic patients [10]. Our study also indicates that as
the number of platelets decrease, the MPV values increase
when the correlation between the number of platelets and
mean platelet volume is examined. In a study, Type 2 diabet-
ics had high MPV values while the numbers of platelets were
fewer [8]. It is argued that the number of peripheral platelets
may depend on variables such as platelet production rate and
mean platelet survival. Some studies report that platelet sur-
vival in diabetic patients may be shorter [17]. In another study
in which gestational hypertension and gestational diabetics’
53
400000
300000
200000
100000
6 8 10 12 14
MPV
platelet counts and MPV values in the last trimester were
compared to healthy pregnancies, it was identified that the
platelet count of women with gestational hypertension was
lower than the control group whereas their MPV values were
higher. Moreover, gestational diabetic women were found
to have a lower platelet count on the average and a higher
MPV. Nevertheless, this finding was not statistically signif-
icant [18]. So far, this is the only study which measures the
MPV value of patients with gestational diabetes. However,
only 21 subjects were included in this study. We were not
able to track any articles printed in English on this topic.
Diabetes as well as the metabolic syndrome, including in-
sulin resistance, which lie beneath it are hyper-coagulable
conditions. Increased platelet reactivity, enlarged activity of
the coagulation system, and impaired fibrinolysis are typi-
cal and much is understood about them [19]. A study con-
ducted on the placentas of diabetic patients show an increased
incidence of vascular pathological changes. These lesions
are embodied in obliterative endarteritis, fibromuscular scle-
rosis and mural thrombosis which affect the fetoplacental
circulation. The changed balance between prostacyclin and
thromboxane observed in these vessels might serve as an ex-
planation for the vascular modifications mentioned [20]. As
known, one of the most significant risk factors in gestational
diabetic cases is intrauterine fetal loss. As with other ma-
ternal thrombophilia cases, the hypercoagubilite in diabetic
patients could result in fetal loss. This risk factor arises due
to the production of microthrombosis on placental bed ves-
sels and placental infarctions. Consequently, this generates a
conciliation in the fetomaternal circulatory system, that re-
sults in low placental perfusion and finally in the loss of the
fetus [21].
All in all, gestational diabetes mellitus is a systemic and
metabolic disorder which occurs at pregnancy and ends
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postpartum, but has a high possibility of developing into Type
2 diabetes. Patients diagnosed with gestational diabetes need
to be closely observed in their antenatal check ups. Close
observation is a must in order to prevent complications of
diabetic illnesses characterized with hyperglycemia nega-
tively influencing all maternal systems and fetal homeostasis.
Further research may indicate higher MPV values in gesta-
tional diabetic patients whose diabetes cannot be regulated
with a healthy diet, but with insulin (Class A2), who had
preconceptional overt diabetes before falling pregnant and
whose diabetes is difficulty regulated with insulin treatment.
As studies related to platelet functions in gestational diabetes
increase, we strongly believe that there will be improvements
in prenatal and postnatal observation and treatment, and thus
a decrease in the complications for both the fetus and the
mother.
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