Mean corpuscular volume; A non-invasive index in the evaluation of gestational hypertension and disease severity in patients with preeclampsia

Document Type : Original Article


1 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran.

2 Resident, Department of Obstetrics and Gynecology, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran.

3 Medical student, Student Research Committee, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran.

4 Assistant Professor, Department of Immunology, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran.


Introduction: Preeclampsia is a disorder of pregnancy characterized by high blood pressure. Regarding vascular and red blood cell (RBC) damages in preeclampsia patients, the present study was performed with aim to investigate the relationship between the level of RBC indicators with the incidence and severity of preeclampsia.
Methods: This case-control study was conducted within one year (July 2021 to July 2022) on 22 pregnant women with mild preeclampsia, 38 pregnant women with severe preeclampsia, and 38 healthy pregnant women who referred to Amiral Momenin Hospital in Zabol city. Evaluation of the number of red blood cells and the amount of hemoglobin, hematocrit, MCV, MCH, and MCHC was obtained by analyzing 2 ml of blood containing anticoagulant. Data analysis was done using SPSS statistical software (version 26) and independent t-test, chi-square, Pearson, and logistic regression analysis. P<0.05 was considered statistically significant.
Results: Among the basic variables, having a history of preeclampsia (P=0.005), body mass index (P=0.030), systolic blood pressure (P<0.001) and diastolic blood pressure (P<0.001) had significant differences between the three studied groups. Among the RBC indices, MCV was significantly different between the studied groups (P=0.043). Hemoglobin (r= -0.248, P=0.034), MCV (r= -0.335, P=0.004), and MCH (r= -0.315, P=0.007) had a significant correlation with systolic blood pressure. Hemoglobin [OR (95% CI)= 0.545 (0.335, 0.912), P=0.021], hematocrit [OR (95% CI)= 0.789, (0.644, 0.967), P=0.022], and MCV [OR (95% CI)= 0.891 (0.808, 0.983), P=0.022] were related to the severity of preeclampsia.
Conclusion: Considering the significant reduction of MCV index in the preeclampsia group and the correlation of this decrease with the increase of systolic blood pressure and the severity of preeclampsia, it is suggested that this non-invasive index be measured during pregnancy for screening of preeclampsia.


  1. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. The Lancet 2005; 365(9461):785-99.
  2. Lotfalizadeh M, Khoshsima M. Relationship between maternal age and season with preeclampsia in the patients admitted in gynecology ward of Imam-Reza hospital during 3 years (2001-2004). Iran J Obstet Gynecol Infertil 2016; 19(8):1-5.
  3. Berg CJ, MacKay AP, Qin C, Callaghan WM. Overview of maternal morbidity during hospitalization for labor and delivery in the United States: 1993–1997 and 2001–2005. Obstetrics & Gynecology 2009; 113(5):1075-81.
  4. Xiao R, Sorensen TK, Williams WA, Luthy DA. Influence of pre-eclampsia on fetal growth. The Journal of Maternal-Fetal & Neonatal Medicine 2003; 13(3):157-62.
  5. Powe CE, Levine RJ, Karumanchi SA. Preeclampsia, a disease of the maternal endothelium: the role of antiangiogenic factors and implications for later cardiovascular disease. Circulation 2011; 123(24):2856-69.
  6. Heilmann L, Rath W, Pollow K. Hemorheological changes in women with severe preeclampsia. Clinical hemorheology and microcirculation 2004; 31(1):49-58.
  7. Valdés G. Preeclampsia and cardiovascular disease: interconnected paths that enable detection of the subclinical stages of obstetric and cardiovascular diseases. Integrated Blood Pressure Control 2017: 17-23.
  8. Kurt RK, Aras Z, Silfeler DB, Kunt C, Islimye M, Kosar O. Relationship of red cell distribution width with the presence and severity of preeclampsia. Clinical and Applied Thrombosis/Hemostasis 2015; 21(2):128-31.
  9. Elgari MM, Khabour OF, Alhag SM. Correlations between changes in hematological indices of mothers with preeclampsia and umbilical cord blood of newborns. Clinical and Experimental Hypertension 2019; 41(1):58-61.
  10. Jhee JH, Lee S, Park Y, Lee SE, Kim YA, Kang SW, et al. Prediction model development of late-onset preeclampsia using machine learning-based methods. PLoS One 2019; 14(8):e0221202.
  11. Snell KI, Allotey J, Smuk M, Hooper R, Chan C, Ahmed A, et al. External validation of prognostic models predicting pre-eclampsia: individual participant data meta-analysis. BMC medicine 2020; 18(1):1-18.
  12. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122(5):1122-1131.
  13. Ahn H, Park J, Gilman‐Sachs A, Kwak‐Kim J. Immunologic characteristics of preeclampsia, a comprehensive review. American journal of reproductive immunology 2011;65(4):377-94.
  14. Piazze J, Gioia S, Maranghi L, Anceschi M. Mean platelet and red blood cell volume measurements to estimate the severity of hypertension in pregnancy. J Perinat Med 2006; 34(3):246-7.
  15. Kim MA, Han GH, Kwon JY, Kim YH. Clinical significance of platelet‐to‐lymphocyte ratio in women with preeclampsia. American Journal of Reproductive Immunology 2018; 80(1):e12973.
  16. Vahidroodsari F, Ayati SE, Ebrahimi M, Esmaily H, Shahabian MA. The effect of prepregnancy body mass index on the development of gestational hypertension and preeclampsia. Journal of Babol University of Medical Sciences 2009; 11(4):49-53.
  17. Oishi M, Tanaka K, Ishihara K, Iino K, Ito A, Yokoyama Y. Current status of long-term follow-up system for women with a history of hypertensive disorders of pregnancy: the HDP-PPAP study (HDP-Postpartum in Aomori prefecture study). The Journal of Maternal-Fetal & Neonatal Medicine 2023; 36(1):2183757.
  18. Gezer C, Ekin A, Ertas IE, Ozeren M, Solmaz U, Mat E, et al. High first-trimester neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios are indicators for early diagnosis of preeclampsia. Ginekologia polska 2016; 87(6):431-5.
  19. Dai DM, Cao J, Yang HM, Sun HM, Su Y, Chen YY, et al. Hematocrit and plasma albumin levels difference may be a potential biomarker to discriminate preeclampsia and eclampsia in patients with hypertensive disorders of pregnancy. Clinica Chimica Acta 2017; 464:218-22.
  20. Siddiqui IA, Jaleel A, Kadri HM, Saeed WA, Tamimi W. Iron status parameters in preeclamptic women. Archives of gynecology and obstetrics 2011; 284:587-91.
  21. Makuyana D, Mahomed K, Shukusho FD, Majoko F. Liver and kidney function tests in normal and pre-eclamptic gestation--a comparison with non-gestational reference values. The Central African journal of medicine 2002; 48(5-6):55-9.
  22. Hershkovitz R, Ohel I, Sheizaf B, Nathan I, Erez O, Sheiner E, et al. Erythropoietin concentration among patients with and without preeclampsia. Archives of gynecology and obstetrics 2005; 273:140-3.
  23. Nasiri M, Faghihzadeh S, Majd HA, Zayeri F, Kariman N, Ardebili NS. Longitudinal discriminant analysis of hemoglobin level for predicting preeclampsia. Iranian Red Crescent Medical Journal 2015; 17(3).
  24. Şanlıkan F, Tufan F, Göçmen A, Kabadayı C, Şengül E. The evaluation of homocysteine level in patients with preeclampsia. Ginekologia Polska 2015; 86(4).
  25. Mtali YS, Lyimo MA, Luzzatto L, Massawe SN. Hypertensive disorders of pregnancy are associated with an inflammatory state: evidence from hematological findings and cytokine levels. BMC pregnancy and childbirth 2019; 19:1-9.
  26. Morceau F, Dicato M, Diederich M. Pro-inflammatory cytokine-mediated anemia: regarding molecular mechanisms of erythropoiesis. Mediators of inflammation. 2009; 2009.