Reference Intervals of Hematological Parameters Among Healthy Pregnant Women in Eastern Sudan: A Prospective Longitudinal Cohort Study.

Authors

Ishag Adam, Nahla B Mohamed, Hagir H T Ahmed, Enshrah M Elamin, Gamal K Adam

Published in

International journal of women's health. Volume 18. Pages 648322. Epub Oct 07, 2026.

Abstract

Pregnancy induces maternal hematological adaptations. Because these shifts are influenced by environmental, nutritional, and ethno-geographic variations, relying on international adult reference intervals (RIs) may increase the risk of diagnostic misclassification. Given the scarcity of context-specific reference intervals in Sudan, this study aimed to establish the localized, trimester-specific complete blood count (CBC) RIs for healthy pregnant women in Eastern Sudan.
This hospital-based longitudinal cohort study included apparently healthy pregnant women during their first trimester and followed up till the third trimester at Gadarif Maternity Hospital. CBC parameters were analyzed using a Sysmex KX-21 automated analyzer. Following CLSI guidelines, trimester-specific 95% RIs were determined non-parametrically by calculating the central 2.5^th and 97.5^th percentiles. Cross-trimester variations were analyzed using the Friedman test.
Of the 120 included, total white blood cell (WBC) counts increased significantly from the first trimester median of 7.6 ×10⁹/L (95% RI: 4.0-11.8 ×10⁹/L) to a second trimester peak of 8.5×10⁹/L (95% RI: 4.7-13.110⁹/L; p < 0.001). Conversely, red blood cell (RBC) counts decreased across gestation (p < 0.001). Hemoglobin and hematocrit levels reached the lowest observed median in the second trimester (10.7 g/dL, 95% RI: 9.1-12.8; 34.7%, 95% RI: 30.2-39.5%), followed by a modest but significant third-trimester recovery (p = 0.008 and p = 0.006). Both MCV and MCH exhibited progressive, significant cross-trimester increases (p < 0.001), while MCHC remained uniform (p = 0.373). Platelet counts demonstrated a linear decline to a third-trimester nadir of 230.5×10⁹/L (95% RI: 128.4-356.9×10⁹/L; p < 0.001), while platelet distribution width (PDW) expanded progressively (p < 0.001).
This study showed that CBC parameters vary significantly across trimesters and differ from international baselines. The second-trimester hemoglobin lower boundary of 9.1g/dL and late-pregnancy gestational thrombocytopenia need further validation in larger and more diverse populations before routine clinical use.

PMID:
42861127
Bibliographic data and abstract were imported from PubMed on 12 Oct 2026.

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