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Mercelina-Roumans et al: Platelets in smoking pregnant women 267Eur J Clin Chem Clin Biochem1995; 33:267-269 1995 Walter de Gruyter & Co.Berlin New York

Platelet Count and Platelet Indices at Various Stages of Normal Pregnancyin Smoking and Non-Smoking WomenBy PatriciaE. A. M. Mercelina-Roumans1, Johannes M. H. Ubachs1 and Jan W. J. van Wersch21 Department of Obstetrics and Gynaecology2 Department of HaematologyDe Wever Hospital, Heerlen, The Netherlands

(Received November 11, 1994/February 2, 1995)

Summary: Our objective was to compare the platelet count and platelet indices of smoking and non-smokingwomen at different stages of normal pregnancy.Study design: In 247 non-smoking and 123 smoking healthy pregnant women the platelet count, the mean plateletvolume, the platelet distribution width and the plateletcrit were compared at 0 1 0 , 1 1 2 0 , 2 1 3 0 and 3 1 4 0weeks of pregnancy. Exclusion criteria were a diastolic pressure 90 mmHg, an endocrine disease, a coagulationdisorder, acetylsalicylic acid or phenprocoumon use. A women was considered a smoker if she smoked more than4 cigarettes a day. Non-smokers were defined as women reporting no smoking at all. Blood samples were run onthe Sysmex NE-8000.Results: There was no significant difference between the platelet count in the two groups. In the non-smokinggroup, the platelet count showed a significant decrease with gestational age (287 X 109/1 to 258 X 109/1). This wasnot the case in the smokers group. The mean platelet volume of the smokers was significantly lower than that ofthe non-smokers in the last ten weeks of pregnancy (10.4 fl versus 10.7 fl). The platelet distribution width and theplateletcrit did not change under the influence of cigarette smoking.Conclusion: Smoking during pregnancy does not significantly affect platelet count or platelet indices.

Introduction mal pregnancy regardless of the smoking behaviour ofT , .- , - , , . . j ~ the women, although the combination of platelet andIn recent years there has been a broad interest m defin- , , . . . '. . . ^ , r N , . .,, ~ A , j ~ platelet size indices as mean platelet volume (MPV),mg the mechanisms responsible for the adverse effects , . , . . . . . , / ^ j , - , 1J r . ,. , - ' xr . , " - platelet distribution width (PDW) and plateletcrit (PCT)of cigarette smoking (1-3). Various reports have fo- K . t ., . . . . J _ / . . , \. 'A ^ - f\ r * * u might provide better insight into platelet biology duringcused on the influence of smoking on platelets because r ^ , f , , ,f .,, . ... , o r . pregnancy. The aim of this study was to assess the plate-of a possible association between smoking, analteration f 6 , , , . , . ,r ^ * J ^ ^* u i ^ * . // n\ c f letcountand platelet indices (MPV, PDW and PCT) atof blood platelets and atherosclerosis (4-7). Some of . r_ , v * , . ,A 4 - j - i . r i x i ^ * j various stages ofnormal pregnancy in smoking andnon-these studies showed an increase of platelet turnover and 6 * 6 Ja decrease of platelet survival in smokers (4, 7). The smokinSwomen-increased destruction of platelets, however, was not suf-ficient to reduce the number of circulating platelets. m _ . . . M . _m * 4 . 4 . - x u / A o\ Materials and MethodsPlatelet counts either remained normal (4, 8) or wereincreased (9, 10). Smoking and platelet behaviour dur- Twohundredandforty seven non-smoking and 123 smoking heal-

A ,j j *, , thy pregnant women attending the department of obstetrics formg pregnancy were notaddressed up to now. Most plate- ^of meir pregnancy were included in thestudy. Thelet studies have been confined to platelet counts in nor- platelet count and platelet indices were determined at four differentEur J Clin Chem Clin Bioonem 1995 ; 33 (No 5)

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268 Mercelina-Roumans et al.: Platelets in smoking pregnant women

stages (0-10, 11-20, 21-30, 31-40 weeks) of pregnancy. Notall patients were checked in all four stages.Exclusion criteria were a diastolic pressure ^90 mmHg, an en-docrine disease or a coagu lation disorder. None of the patients usedacetylsalicylic acid or phenprocoumon. The known duration of thegestation was based on the last menstrual period and an ultrasounddetermination between 8 and 14 weeks. The number of cigarettessmoked per day was estimated by the patient, in most cases con-firmed by her partner. A women w as considered a smoker if shesmoked more than 4 cigarettes a day. The group of women whosmoked more than 15 cigarettes a day was too small to subdividethe smokers into an intermediate smoking level group (5-15 ciga-rettes pe r day) and a group of heavy smokers (> 15 cigarettes pe rday). Non-smokers were defined as women reporting no smokingat all. Th e basic characteristics of these patients are given in table 1.Blood samples were drawn between 8.30 an d 9.30 a.m. intoEDTA-K 2 containing tubes (Sarstedt, Germany) and kept at roomtemperature for at most 5 hours before they were run on the Sys-me x NE-8000 (TOA Medical Electronics Corp., Kobe, Japan) Cor-relations were determined by linear regression analysis with themethod of the least squares. The significance of the differences ofthe med ian values of the various groups w as assessed by the Mann-Wliitney-Wilcoxon test.

to 264 X 109/1 in the smokers group however was notsignificant (p = 0.86).The MPV of the smokers was significantly lower thanthe volume of the non-smokers in the last ten weeks ofpregnancy (10.4 versus 10.7; p = 0.02). The MPV in thenon-smoking group did not charge during gestation.This quantity was also more or less stable in the smokinggroup. The PDW of the two groups is compared and didno t change under the influence of smoking. There wasalso no difference in the plateletcrit values. In the non-smoking group the PDW increased significantly fromthe beginning to the end of pregnancy (11.7% to 12.3%;p = 0.03). This was not the case in the smoking group.The PCT in the non-smokers decreased significantlythroughout pregnancy (26.3 1/1 to 24.9 l/l; p = 0.04). ThePCT in the smokers also decreased throughout preg-nancy, but this difference was not significant.

ResultsIn table 2 the comparison of the platelet counts of thesmoking and non-smoking females at four stages ofpregnancy is given. In the non-smoking group, the plate-let count showed a slight but significant decrease withgestational age. The group started with a median plateletcount of 287 X 109/1and ended with a platelet count of258 X 109/1 (p = 0.002). The decrease from 283 X 109/1

DiscussionIn the present study the only difference in platelet countsobserved was a slight but significant decrease with ges-tational age in the non-smoking group. Platelet survivalis known to diminish in late pregnancy (11). This is dueto an accelerated state of coagulation and fibrinolysiswhich increases towards term (12). Haemodilution inpregnancy may be another explanation for the decrease

Tab. 1 Basic characteristics of the pregnant women.Groups of patients

Non-smokers, normal pregnancy (n = 247)Smokers, norm al pregnancy (n = 123)

Ag e(a)median(interquartile range)30(27-33)29(25-32)

Parity

47.9% primi52.1% multi47.8% primi52.2% multi

Cigarettesper daymedian(interquartile range)0

10(5-15)

Tab. 2 Comparison of the platelet counts of the smoking (S) and non-smoking (NS) females at fourstages during normal pregnancy.

Gestational age (weeks)Patient groupsSample sizeMedian (109/1)Lower quartile (109/1)Upper quartile (109/1)p-value of MWW-test

Platelets0-10NS932871)232325l) vs. ')

S46283 )21 5322

:n.s.

11-20NS662642)2303022) vs . :

21-30S292672)23 929 9

'): n. s.

NS1192643)22 63083) vs. " -

S452833)24 7334

;):n.s.

31-40NS1802584).2113024 ) v s . 4 ;

S682644)232312

): n. s.MWW = Mann-Whitney-Wilcoxon-te$\.

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Mercelina-Roumans et al.: Platelets in smoking pregnant women 269

of platelets (13). It is remarkable that this decrease ofplatelets does not occur in the smoking group.Most platelet studies in normal pregnancy have beenconfined to platelet counts, but the platelet count aloneis not conclusive. Platelet size indices provide more in-formation about platelet biology. The MPV is an indica-tion of the amount of young platelets. Fay et al. (14)studied platelet count and indices in blood samples from2066 healthy women with an uncomplicated pregnancy.The MPV remained stable until 35 weeks gestation androse dramatically thereafter. Ahmed et al. (15) studiedthe MPV in healthy pregnants. This quantity remainedconstant between the first trimester and the end of nor-mal pregnancy. In patients who became pre-eclamptic, apersistent increase in MPV was found. Hutt et al. (16)found that the MPV increased 2 3 weeks before thedevelopment of pre-eclampsia.In our study the MPV was significantly lower in the lastten weeks of pregnancy in the smoking than in the non-smoking group. The MPV of the non-smokers remained

almost constant from the beginning to the end of preg-nancy.Less has been published regarding PDW and PCT inpregnancy. In the present study these indices remainedmore or less constant in both smoking and non-smokingwomen throughout pregnancy. This is an accordancewith earlier results of our group (17), in which plateletindices were studied in normal pregnancy.In several studies the effect of the smoking constituentsnicotine and carbon monoxide on platelet aggregation innon-pregnants has been evaluated in vivo and in vitro( 1 8 2 1 ) . They generally showed evidence of plateletactivation. Smokers had an enhanced aggregation ofplatelets, although the platelet count did not differ fromnon-smokers. The present study indicates that smokingduring pregnancy does not affect platelet count andplatelet indices in a clinically relevant way.However, the effect of the combination of smoking andpregnancy on platelet aggregation still has to be as-sessed.

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young adult: effects of cigarette smoking, strong family historyand medical therapy. Circulation 1981; 63:546-51.8. Ring T, Kristensen SD, Jensen PN , Mounts-Andersen T, Mad-sen H, Dyerberg J. Cigarette smoking shortens the bleedingtime. Thromb Re s 1983;32:531-6.9. Murchison LE, Fyfe T. Effects of cigarette smoking on serum-lipids, blood-glucose and platelet adhesiveness. Lancet 1966;1:182-4.10. Erikssen J, Hellern A, Stonriosken H. Chronic effect of smok-ing on platelet count and "platelet adhesiveness" in presumablyhealthy middle-aged men. Thromb Haem 1977; 38:606-11.11. Wallenburg HCS, van Kessel PH. Platelet lifespan in normalpregnancy as determined by a non-radio-isotopic technique. BrJ Obstet Gynaecol 1978;85:33-6.12. McK ay DG. Chronic intravascular coagulation in normal preg-nancy and pre-eclampsia. Contrib Nephrol 1981; 25:108-11.13. Letsky E A. Coagulation problems during pregnancy. In: Hyt-ten F, Chamberlain G, editors. Clinical physiology in obstet-

rics. Chapter 2. The haematological system. Edinb urgh: Scien-tific Publications, 1991:46.14. Fay RA, Hughes AO, Farron NT. Platelets in pregnancy: hy -perdestruction in pregnancy. Obstet Gynecol 1983; 61:238-40 .15. Ahmed Y, van Iddehinge B, Paul C, Sullivan MHF, Elder MG.Retrospective analysis of platelet num bers an d volumes in nor-mal pregnancy and in pre-eclampsia. Br J Obstet Gynaecol1993; 100:216-20.16 . Hutt R, Ogunniyi SO , Sullivan M H, Elder M G. Increasedplatelet vo lume an d aggregation precede the onset of pre-eclampsia. Obstet Gynecol 1994; 83:146-9.17. Van Wersch JWJ, van Hof AC, Ubachs JMH. The use of animpedance particle counter for the measurement of plateletcount, platelet indices an d platelet function during pregnancy.Sysmex Int J 1992; 2:44-9.18. Berglund U, Wallenburg L, von Schenck H. Platelet functionan d plasma fibrinogen an d their relation to gender, smokinghabits, obesity and beta-blocker treatment in young survivorsof myocardial infaction. Thromb Haemostas 1988; 60:214.19. Dotevall A , Rutti J. Platelet reactivity, fibrinogen and smoking.Eur J Haematol 1987; 38:55-9.20. Laszlo E, Kaldi N. Kovacs L. Alterations in plasma proteinsan d platelet functions with ageing an d cigarette smoking inhealthy men. Thromb Haemostas 1983; 49:150.21. Belch JJF,McArdle BM, Burns P, Lowe GDO,Forbes CD.Th e effects of acute smoking on platelet behaviour, fibrinolysisand haemorheology in habitual smokers. Thromb Haemostas1984; 51:6-8.

Dr. J. W. J. van WerschDepartment of HaematologyDe Wever HospitalP.O. Box 4446NL-6401 CX HeerlenThe N etherlands

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