Research Article | DOI: https://doi.org/10.31579/2639-4162/380
1Department of Hematology and Blood Transfusion Science, Faculty of Medical Laboratory Science, Imo State University, Owerri, Nigeria.
2Department of Hematology and Blood Transfusion Science, Faculty of Medical Laboratory Science, Federal University Otuoke, Bayelsa State, Nigeria.
*Corresponding Author: Aloy-Amadi Oluchi, Department of Hematology and Blood Transfusion Science, Faculty of Medical Laboratory Science, Federal University Otuoke, Bayelsa State, Nigeria.
Citation: Ugwuegbu D. Favour, Aloy A. Oluchi and Lenox-Prince TO., (2026), Red Cell Indices, Fibrinogen and Alanine Aminotransferase in Pregnant Women with Gestational Diabetes in Owerri Nigeria, J. General Medicine and Clinical Practice, 9(10); DOI:10.31579/2639-4162/380
Copyright: © 2026, Aloy-Amadi Oluchi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 14 September 2026 | Accepted: 29 September 2026 | Published: 07 October 2026
Keywords: gestational diabetes mellitus; red cell indices; fibrinogen; alanine aminotransferase; pregnancy; nigeria
Background: Gestational diabetes mellitus (GDM) is accompanied by metabolic, inflammatory, haematological, coagulation and hepatic changes that may influence pregnancy outcomes. Objective: To compare red cell indices, fibrinogen and alanine aminotransferase (ALT) between pregnant women with GDM and normoglycemic pregnant controls in Owerri, Nigeria, and to examine variation by age and trimester and correlations with ALT.
Objective: To compare red cell indices, fibrinogen and alanine aminotransferase (ALT) between pregnant women with GDM and normoglycemic pregnant controls in Owerri, Nigeria, and to examine variation by age and trimester and correlations with ALT.
Methods: This hospital-based comparative cross-sectional study enrolled 60 pregnant women aged 20–45 years: 30 with GDM and 30 age-matched controls. Mean cell volume (MCV), mean cell haemoglobin (MCH), mean cell haemoglobin concentration (MCHC) and red cell distribution width (RDW) were derived from manually measured red blood cell count, haemoglobin and packed cell volume. Fibrinogen was assayed by the Clauss method and ALT by an enzymatic colorimetric method. Group means were compared and Pearson correlations calculated at p < .05. Results: MCV and MCH were lower in the GDM group than controls (76.30 ± 7.44 versus 81.20 ± 5.93 fL, p = .007; 27.00 ± 2.95 versus 30.03 ± 2.68 pg, p < .0001). Fibrinogen and ALT were higher in GDM (456.83 ± 111.21 versus 223.77 ± 66.33 mg/dL and 27.03 ± 13.05 versus 16.47 ± 8.36 U/L; both p < .0001). MCHC and RDW did not differ significantly. Within GDM, MCV, MCH and MCHC varied by age; MCH and MCHC varied by trimester. ALT correlated positively with MCV (r 38, p = .041) and MCH (r = .40, p = .029), but not with MCHC, RDW or fibrinogen. Conclusion: GDM in this cohort was associated with lower erythrocyte size and haemoglobin content, higher fibrinogen and higher ALT. These exploratory findings support integrated haematological, coagulation and hepatic assessment, but require confirmation in larger longitudinal studies with rigorously documented pre-analytical procedures.
Gestational diabetes mellitus is hyperglycaemia first recognized during pregnancy that does not clearly meet criteria for overt diabetes. It is not a single uniform disorder: women may enter pregnancy with limited beta-cell reserve, develop disproportionate pregnancy-induced insulin resistance, or have previously unrecognised dysglycaemia. Contemporary diagnostic systems therefore distinguish overt diabetes detected in pregnancy from GDM, while acknowledging that thresholds and screening strategies differ among professional bodies. This distinction matters because classification determines the timing and intensity of treatment, postpartum surveillance and counselling about future cardiometabolic risk. [1-4]
The burden of GDM is considerable and continues to rise alongside obesity, delayed childbearing, urbanization and reduced physical activity. Global estimates depend strongly on the diagnostic criteria and population studied, but millions of pregnancies are affected annually. African estimates are heterogeneous because screening is inconsistent, laboratory access is uneven and many women first present late for antenatal care. In Nigeria, differences in regional demographics and testing practices complicate direct comparison, yet available evidence consistently shows that GDM is an important and under-recognized maternal health problem. [8,9,26]
Pregnancy is physiologically insulin resistant, particularly in the second and third trimesters. Placental hormones, adipokines and inflammatory mediators reduce maternal insulin sensitivity so that glucose and other nutrients remain available to the fetus. Most women compensate through increased pancreatic beta-cell mass and insulin secretion. GDM develops when this compensatory response is insufficient for the degree of insulin resistance. Maternal adiposity, excessive gestational weight gain, genetic susceptibility, advanced age, previous GDM, family history of diabetes and some ethnic backgrounds increase risk. [4,5,7,29]
The clinical importance of GDM extends beyond elevated glucose. Maternal hyperglycaemia is related continuously to fetal overgrowth, neonatal hypoglycaemia, operative delivery, hypertensive disorders and other adverse outcomes, even below older diagnostic cut-offs. Treatment reduces several important complications, but risk is not abolished, particularly when diagnosis or glycemic control is delayed. After pregnancy, women with previous GDM have a substantially increased likelihood of developing type 2 diabetes, while exposed offspring face higher risks of adiposity and disordered glucose metabolism. [27,28,30]
Normal pregnancy also alters haematological measurements. Plasma volume expands more than red cell mass, producing physiological hemodilution. Iron demand rises because of maternal erythropoiesis, placental needs, fetal growth and blood loss at delivery. MCV, MCH and MCHC help characterize erythrocyte size and hemoglobinization, while RDW describes variation in cell volume. Interpretation in pregnancy must therefore consider gestational age, iron status, inflammation, haemoglobinopathy and supplementation rather than assuming that a change is caused by dysglycaemia alone. ¹⁰⁻¹⁵
GDM may influence erythrocytes through several pathways. Chronic or recurrent hyperglycemia can increase non-enzymatic glycation of membrane proteins, oxidative stress and osmotic disturbance. Low-grade inflammation may alter iron trafficking through hepcidin and reduce iron availability for erythropoiesis, while dietary patterns or supplementation may modify measured indices in the opposite direction. These competing influences help explain why studies have reported inconsistent changes in MCV, MCH, MCHC and RDW. A local comparison is useful because nutritional exposures, malaria, haemoglobin variants and antenatal practices vary between populations. [5,11,13-15,21]
Pregnancy is additionally a hypercoagulable state. Concentrations of several procoagulant factors, including fibrinogen, rise while fibrinolytic activity is altered. These adaptations reduce haemorrhage at delivery but contribute to increased venous thromboembolism risk. GDM may amplify this balance through inflammation, endothelial dysfunction, obesity and insulin resistance. Fibrinogen is both a coagulation substrate and an acute-phase protein; raised concentrations can therefore represent overlapping hemostatic and inflammatory processes rather than a GDM-specific abnormality. [16-18]
Alanine aminotransferase is concentrated predominantly in hepatocytes and is widely used as a marker of hepatocellular injury, although values may remain within the conventional laboratory interval despite meaningful metabolic variation. Insulin resistance promotes hepatic lipid accumulation and altered glucose handling, providing a biologically plausible link between ALT and GDM. Prior investigations have associated higher aminotransferase activities or ratios with GDM, but ALT is influenced by obesity, medications, viral hepatitis and pre-existing liver disease. It should therefore be interpreted as a contextual marker, not as a diagnostic test for GDM. [19,20]
Few studies in south-eastern Nigeria have examined erythrocyte indices, functional fibrinogen and ALT together in the same pregnant participants. Studying the three domains can provide a broader picture of oxygen-carrying characteristics, coagulation potential and hepatic metabolic stress. It may also reveal whether ALT changes track red-cell characteristics or fibrinogen within GDM, although a cross-sectional design cannot establish directionality or mechanism. [4,16,19]
This study compared MCV, MCH, MCHC, RDW, fibrinogen and ALT between women with GDM and apparently healthy pregnant controls attending a specialist hospital in Owerri. It further assessed variation among age categories and trimesters within the GDM group and examined correlations of ALT with the other measured variables. We hypothesised that GDM would be associated with altered red cell indices and higher fibrinogen and ALT. [1,4,17,19]
1.1 Literature context
Diagnostic approaches to GDM shape both prevalence estimates and the clinical meaning of a study group. The one-step 75-g OGTT recommended by the IADPSG measures fasting, 1-hour and 2-hour plasma glucose, with one abnormal value sufficient for diagnosis. Other systems use a preliminary glucose challenge followed by a longer OGTT. WHO guidance also distinguishes diabetes mellitus in pregnancy from GDM because marked fasting or 2-hour hyperglycaemia may reflect previously undiagnosed diabetes. A manuscript must therefore report the exact test, glucose load, sampling times and thresholds rather than use the term GDM without operational detail. [2,3,7]
Timing is equally important. Routine testing is usually undertaken at 24–28 weeks because placental insulin resistance becomes more pronounced as pregnancy advances. Hyperglycaemia detected in the first trimester may represent overt pre-existing diabetes, early GDM in a high-risk woman or a transient finding requiring confirmation, depending on the criterion applied. Including all trimesters can be scientifically valuable, but only when classification rules are explicit. This consideration is especially relevant to the present dataset because ten GDM participants were assigned to each trimester. [1-3,5]
The consequences of maternal hyperglycaemia occur along a continuum. In the HAPO study, increasing maternal glucose below thresholds for overt diabetes was associated with birth weight above the 90th percentile, primary caesarean delivery, neonatal hypoglycaemia and cord-blood C-peptide. This evidence informed lower diagnostic thresholds intended to capture clinically meaningful risk. However, a diagnosis also carries costs, anxiety and additional monitoring. Biomarker studies should therefore clarify whether a proposed measure predicts outcomes independently, improves on glucose testing or merely accompanies the metabolic state. [24,27]
Maternal physiology supplies the background against which every laboratory result must be judged. Plasma volume begins to expand early and can increase substantially by late pregnancy, while red cell mass rises less, particularly when iron supply is inadequate. The resulting hemodilution reduces haemoglobin and hematocrit without necessarily indicating disease. Renal, hepatic and endocrine systems also adapt. Reference intervals obtained from non-pregnant adults may consequently misclassify healthy pregnant women, and trimester-specific intervals are preferable where analytically validated. [10-12]
MCV represents the average erythrocyte volume and is useful for morphological classification of anemia. MCH expresses the mean haemoglobin mass per cell, while MCHC expresses haemoglobin concentration relative to cell volume. These indices are interdependent calculations rather than wholly independent biological measurements. A fall in both MCV and MCH is typical of iron-restricted haemoglobin synthesis, but it may also occur in thalassemia traits and some chronic inflammatory states. Interpretation is strongest when combined with haemoglobin, reticulocytes, blood-film morphology, ferritin and transferrin saturation. [11-13,23]
RDW adds information about the dispersion of erythrocyte size. It can rise early in iron deficiency as successive cohorts of smaller cells enter circulation, and it may remain normal when a uniformly microcytic inherited phenotype is present. RDW has also been studied as an inflammatory and prognostic marker, but values are method dependent. RDW-CV and RDW-SD are not interchangeable, and manual calculation without a full cell-volume histogram is unusual. Studies should identify the exact metric, instrument or derivation and quality-control procedures so that results can be compared meaningfully. [14,15]
Iron biology and glucose metabolism may intersect in complex ways. Inflammation increases hepatic hepcidin, which limits intestinal iron absorption and traps iron within macrophages. Conversely, high iron stores have sometimes been associated with insulin resistance and GDM risk, perhaps through oxidative stress, although association does not establish causality. Pregnancy increases iron demand, and supplementation practices vary. A lower MCV in women with GDM could therefore reflect deficiency, inflammation, inherited microcytosis or treatment patterns; ferritin alone would also need interpretation alongside inflammation. [5,11,21]
Fibrinogen has structural and signaling roles. Thrombin converts soluble fibrinogen to fibrin, while activated factor XIII stabilizes the clot. Fibrinogen also affects platelet aggregation, blood viscosity and inflammatory interactions. During uncomplicated pregnancy, its progressive increase contributes to a state prepared for rapid hemostasis after placental separation. In GDM, insulin resistance, adipose inflammation and endothelial activation could produce additional elevation, yet this pathway overlaps strongly with obesity and hypertensive disease. A valid comparison therefore benefits from gestational-age matching and adjustment for adiposity and inflammation. [16-18]
Assay quality is particularly important when an observed fibrinogen difference is large. In the Clauss method, excess thrombin is added to diluted citrated plasma, making clotting time mainly dependent on functional fibrinogen concentration. Underfilled citrate tubes change the blood-to-anticoagulant ratio; delayed processing, heparin contamination, turbidity and some fibrin-degradation products may interfere. Serum is unsuitable because clotting consumes fibrinogen. Clear documentation of tube type, fill volume, centrifugation, storage, calibration and internal quality control is therefore part of the scientific result, not a minor technical detail. [16,22]
ALT catalysis transfer of an amino group from alanine to alpha-ketoglutarate and is measured through coupled enzymatic reactions in many contemporary assays. Although more liver-associated than aspartate aminotransferase, ALT is not disease specific. Mild increases may accompany steatitis liver disease, medications, viral infection, muscle injury and metabolic dysfunction. Pregnancy itself does not ordinarily produce the large physiological ALT rise seen with alkaline phosphatase. Consequently, a higher group mean in GDM is potentially informative, but clinical interpretation requires the full liver profile and relevant history. [19,20]
The liver is central to glucose and iron regulation. Insulin normally suppresses hepatic glucose output; hepatic insulin resistance permits continued gluconeogenesis despite hyperinsulinaemia. The liver also produces hepcidin, transferrin, fibrinogen and many acute-phase proteins. This shared hepatic origin offers a conceptual basis for examining ALT, red-cell indices and fibrinogen together. Yet shared regulation can be obscured by pregnancy physiology and confounding, and a simple correlation cannot establish a pathway. Mechanistic interpretation needs longitudinal measurements and mediation analyses rather than isolated cross-sectional coefficients. [5,20,21]
Laboratory markers are most valuable when they improve a clinical decision. For GDM, the immediate decisions concern glucose monitoring, nutrition therapy, physical activity, medication when required and fetal surveillance. MCV and MCH can identify a parallel need to investigate anemia; fibrinogen may characterize hemostatic activation; and ALT may identify women needing hepatic assessment. Their roles are complementary rather than replacements for glucose testing. Demonstrating independent prediction of pre-eclampsia, fetal overgrowth, neonatal morbidity or later diabetes would be necessary before advocating a new biomarker panel. [1,4,6,27,30]
2.1 Study Area
The study was conducted at the antenatal clinic of Imo State Specialist Hospital, Umuganda, Owerri West Local Government Area, Imo State, Nigeria. The hospital is a public secondary healthcare facility that provides round-the-clock medical and antenatal services to residents of Owerri and neighboring communities.
2.2 Study Design and Population
This hospital-based comparative cross-sectional study was conducted between September and October 2024. The study population comprised 60 pregnant women aged 20–45 years. Thirty pregnant women diagnosed with gestational diabetes mellitus constituted the study group, while 30 age-matched, apparently healthy pregnant women without gestational diabetes mellitus served as controls. Eligible women attending the antenatal clinic during the study period were consecutively recruited. The purpose and procedures of the study were explained to each participant, after which written informed consent was obtained. Participants who consented completed a structured questionnaire designed to obtain relevant demographic and clinical information.
2.3 Sample Collection and Processing
Seven milliliters of venous blood was collected aseptically from the antecubital vein of each participant using a sterile needle and syringe. The blood was appropriately distributed into ethylenediaminetetraacetic acid(2mls), sodium citrate(2mls) and plain sample containers [3].
The blood collected into the EDTA container was gently mixed to prevent clot formation and used for the determination of red blood cell count, haemoglobin concentration and packed cell volume. Red blood cell count was determined manually using a hemocytometer, while haemoglobin concentration and packed cell volume were measured using standard manual laboratory procedures. Mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration and red cell distribution width were subsequently calculated from the red blood cell count, haemoglobin concentration and packed cell volume.
The citrated blood sample was centrifuged to obtain plasma for fibrinogen determination using the Clauss method. Blood collected into the plain container was allowed to clot and then centrifuged at 3,000 revolutions per minute for five minutes. The separated serum was transferred into a properly labelled sample container and used for the determination of alanine aminotransferase by an enzymatic colorimetric method. Samples that could not be analyzed immediately were stored under appropriate conditions until analysis.
2.4 Ethical Considerations
Ethical approval for the study was obtained from the appropriate ethics authority of Imo State Specialist Hospital, Umuganda, following the submission and review of the research protocol. Administrative permission was also obtained from the hospital management and the officers responsible for the antenatal clinic. The purpose, procedures, potential benefits and minimal risks of the study were clearly explained to the participants. Participation was voluntary, and written informed consent was obtained before questionnaire administration and blood collection. Participants were informed that they could withdraw from the study at any time without affecting the medical care they received. Personal information and laboratory results were treated confidentially and used strictly for research purposes.
2.5 Statistical Analysis
Data were entered and analyzed using IBM SPSS Statistics version 21.0. Continuous variables were expressed as mean and standard deviation. The independent-samples Student’s t test was used to compare mean values between pregnant women with gestational diabetes mellitus and the control group. One-way analysis of variance was used for comparisons involving more than two groups, while Pearson’s correlation analysis was used to determine relationships between selected continuous variables. Statistical significance was set at p < .05.
Sixty participants were analyzed, comprising 30 women with GDM and 30 age-matched pregnant controls. The available summary dataset contained the six prespecified outcomes but did not include individual-level demographic, anthropometric, glucose-control, iron-status or medication variables. Results are therefore presented as unadjusted comparisons. The five tables below reproduce the numerical values reported in the source project without alteration.[4,25]
| Parameter | GDM patients (n = 30) | Control (n = 30) | t value | p value |
| MCV (fL) | 76.30 ± 7.44 | 81.20 ± 5.93 | −2.82 | .007* |
| MCH (pg) | 27.00 ± 2.95 | 30.03 ± 2.68 | −4.17 | < .0001* |
| MCHC (g/dL) | 35.10 ± 1.84 | 35.90 ± 1.49 | −1.85 | .070 |
| RDW (%) | 38.37 ± 4.21 | 40.20 ± 4.11 | −1.71 | .094 |
Table 1: Red Cell Indices in GDM and Control Groups (mean ± SD)
Note. *p < .05. MCV = mean cell volume; MCH = mean cell haemoglobin; MCHC = mean cell haemoglobin concentration; RDW = red cell distribution width; SD = standard deviation.
MCV was significantly lower in the GDM group than in controls (76.30 ± 7.44 versus 81.20 ± 5.93 fL; t = −2.82, p = .007). MCH was also lower in GDM (27.00 ± 2.95 versus 30.03 ± 2.68 pg; t = −4.17, p < .0001). MCHC and RDW were numerically lower in GDM, but neither comparison reached the prespecified significance level (p = .070 and p = .094, respectively; Table 1). [11,13-15]
| Parameter | GDM patients (n = 30) | Control (n = 30) | t value | p value |
| Fibrinogen (mg/dL) | 456.83 ± 111.21 | 223.77 ± 66.33 | 9.86 | < .0001* |
| ALT (U/L) | 27.03 ± 13.05 | 16.47 ± 8.36 | 3.73 | < .0001* |
Table 2: Fibrinogen and ALT in GDM and Control Groups (mean ± SD)
Note. *p < .05. ALT = alanine aminotransferase; SD = standard deviation.
Fibrinogen was substantially higher among women with GDM than controls (456.83 ± 111.21 versus 223.77 ± 66.33 mg/dL; t = 9.86, p < .0001). ALT was likewise higher in GDM (27.03 ± 13.05 versus 16.47 ± 8.36 U/L; t = 3.73, p < .0001; Table 2). Although the mean ALT in the GDM group remained within the project’s stated conventional interval, its distribution was wider, and the group difference indicates relative hepatic metabolic variation rather than proof of hepatocellular disease. [16,19,20]
| Parameter | 20–29 years (n = 10) | 30–39 years (n = 10) | 40–45 years (n = 10) | F value | p value |
| MCV (fL) | 74.90 ± 8.90 | 73.20 ± 7.04 | 80.80 ± 3.77 | 3.34 | .050* |
| MCH (pg) | 25.90 ± 3.45 | 26.00 ± 2.49 | 29.10 ± 1.60 | 4.81 | .016* |
| MCHC (g/dL) | 34.00 ± 1.70 | 35.40 ± 1.43 | 35.90 ± 1.97 | 3.30 | .050* |
| RDW (%) | 38.20 ± 3.49 | 37.50 ± 5.23 | 39.40 ± 3.95 | 0.50 | .611 |
| Fibrinogen (mg/dL) | 419.20 ± 94.96 | 441.80 ± 96.93 | 509.50 ± 128.59 | 1.90 | .170 |
| ALT (U/L) | 27.70 ± 15.97 | 21.80 ± 9.10 | 31.60 ± 12.53 | 1.48 | .246 |
Table 3: Study Variables in GDM by Age Group (mean ± SD)
Note. *p < .05. Abbreviations as in Tables 1 and 2.
Within the GDM group, MCV, MCH and MCHC differed across the three age categories (p = .050, .016 and .050). The highest means occurred among participants aged 40–45 years. RDW, fibrinogen and ALT did not differ significantly by age. Each age cell contained ten women, and no documented post-hoc comparisons identified which pairs differed; the omnibus findings should therefore be regarded as exploratory (Table 3). [4,25]
| Parameter | First trimester (n = 10) | Second trimester (n = 10) | Third trimester (n = 10) | F value | p value |
| MCV (fL) | 74.20 ± 4.92 | 75.10 ± 10.09 | 79.60 ± 5.80 | 1.57 | .226 |
| MCH (pg) | 25.40 ± 1.43 | 26.60 ± 3.92 | 29.00 ± 1.76 | 4.91 | .015* |
| MCHC (g/dL) | 33.90 ± 1.66 | 35.00 ± 1.63 | 36.40 ± 1.43 | 6.30 | .006* |
| RDW (%) | 38.10 ± 5.17 | 37.40 ± 2.50 | 39.60 ± 4.62 | 0.70 | .507 |
| Fibrinogen (mg/dL) | 419.80 ± 118.16 | 449.30 ± 100.72 | 501.40 ± 109.33 | 1.42 | .259 |
| ALT (U/L) | 23.10 ± 10.68 | 29.00 ± 16.07 | 29.00 ± 12.27 | 0.67 | .522 |
Table 4: Study Variables in GDM by Trimester (mean ± SD)
Note. *p < .05. Abbreviations as in Tables 1 and 2.
Across trimesters, MCH increased from 25.40 ± 1.43 pg in the first trimester to 29.00 ± 1.76 pg in the third trimester (p = .015), while MCHC increased from 33.90 ± 1.66 to 36.40 ± 1.43 g/dL (p = .006). MCV, RDW, fibrinogen and ALT did not show statistically significant trimester differences. The inclusion of first-trimester participants highlights the need to verify whether hyperglycaemia represented early-detected GDM or pre-existing/overt diabetes (Table 4). [1-3,10,11]
| Variable | n | r value | p value |
| MCV | 30 | .38 | .041* |
| MCH | 30 | .40 | .029* |
| MCHC | 30 | .20 | .303 |
| RDW | 30 | −.14 | .448 |
| Fibrinogen | 30 | −.01 | .966 |
Table 5: Pearson Correlations of ALT with Selected Variables in GDM
Note. *p < .05. ALT was the reference variable. Abbreviations as in Tables 1 and 2.
ALT correlated positively with MCV (r = .38, p = .041) and MCH (r = .40, p = .029). Correlations with MCHC (r = .20), RDW (r = −.14) and fibrinogen (r = −.01) were not statistically significant. These coefficients are unadjusted and were estimated in only 30 women; they do not demonstrate that hepatic changes caused erythrocyte changes (Table 5). [19-21,25]
This study found a combined pattern of lower MCV and MCH and higher fibrinogen and ALT among pregnant women classified as having GDM compared with age-matched normoglycaemic pregnant controls. MCHC and RDW did not differ significantly. Within GDM, selected red-cell indices varied across age and trimester categories, and ALT showed modest positive correlations with MCV and MCH. Taken together, the observations suggest that GDM in this clinical cohort coexisted with changes spanning erythrocyte characteristics, coagulation and hepatic metabolism, but the design cannot determine whether hyperglycaemia was the direct cause.[4-7,16,19]
The lower MCV in GDM corresponds to an average microcytic pattern. In pregnancy, the most common explanation would be iron-restricted erythropoiesis, but MCV is neither sensitive nor specific enough to establish iron deficiency. Ferritin, transferrin saturation, C-reactive protein, reticulocyte indices and haemoglobin genotype were not measured. Inflammation can increase hepcidin and reduce circulating iron despite preserved or increased storage iron, whereas routine iron supplementation can raise iron availability. Thalassemia traits and other haemoglobinopathies can also lower MCV. The result should therefore prompt an etiological assessment rather than being interpreted as a characteristic lesion of GDM. [11-13,21]
MCH was also lower in GDM, indicating less haemoglobin per erythrocyte. Because MCH is mathematically related to haemoglobin concentration and red cell count and commonly falls with MCV, the two findings are internally coherent. The preservation of MCHC suggests that haemoglobin concentration within the smaller cells was comparatively maintained. This pattern may occur in early iron restriction or other microcytic states, but confirmation requires iron and haemoglobinopathy testing. Glycaemia may contribute indirectly through inflammation, renal or hepatic regulation and nutritional patterns, yet the present data cannot separate those pathways. [13,21,23]
The absence of a significant RDW difference deserves careful interpretation. RDW reflects heterogeneity of erythrocyte size and often rises when newly produced iron-restricted cells circulate alongside older normocytic cells. However, it is affected by analyzer methodology, reference population and biological variation. The source study’s RDW means near 38–40% are far above values usually generated by automated hematology systems, raising the possibility that the reported calculation is not directly comparable with routine RDW-CV. Preserving the table is important, but verification of formula, units and raw data is essential before making clinical claims from this endpoint. [14,15]
The marked fibrinogen difference is biologically plausible. Pregnancy itself increases fibrinogen as part of preparation for hemostasis at delivery. GDM may further raise it through systemic inflammation, increased hepatic acute-phase synthesis, endothelial activation and accompanying adiposity. Earlier work has described altered hemostatic and cytokine profiles in GDM, supporting the possibility of a more prothrombotic phenotype. Nevertheless, fibrinogen is nonspecific and can increase with infection, tissue injury and obesity. Without body mass index, inflammatory markers and obstetric complications, residual confounding remains substantial. [16,17]
The GDM mean of 456.83 mg/dL exceeded the project’s stated non-pregnant-oriented interval, but pregnancy-specific interpretation is necessary. Fibrinogen normally rises with gestational age, and published pregnancy reference data show wide trimester-dependent distributions. The control mean of 223.77 mg/dL appears relatively low for later pregnancy, which makes confirmation of trimester matching and specimen handling particularly important. The groups were described as age matched, not explicitly trimester matched. Differences in gestational-age composition could therefore account for part of the observed contrast even though trimester comparisons within GDM were nonsignificant. [10,16]
Pre-analytical documentation is a central concern for fibrinogen. A functional Clauss assay is conventionally performed on platelet-poor citrated plasma, with anticoagulant ratio, fill volume, transport time and centrifugation affecting validity. The source report documented EDTA and plain tubes but did not mention citrate. Serum cannot provide functional fibrinogen because fibrinogen is consumed during clot formation. The numerical results have been retained exactly as requested, but the original bench worksheet, reagent insert and specimen log should be checked before submission. If citrate plasma cannot be verified, the fibrinogen outcome should not be presented as analytically confirmed. [16,22]
ALT was higher in the GDM group, consistent with a link between dysglycaemia and hepatic insulin resistance. Increased hepatic delivery of free fatty acids, de novo lipogenesis and oxidative stress may produce steatosis and subtle hepatocyte injury. Studies have reported associations between aminotransferases and GDM risk, although effect sizes and useful thresholds vary. In this study, the mean ALT remained below the stated upper reference limit, illustrating that a statistically significant difference does not necessarily indicate clinically overt liver injury in individual participants.[19,20]
Alternative explanations for higher ALT include pre-pregnancy adiposity, gestational weight gain, medications, viral hepatitis, hypertensive disease and unrecognized fatty liver. The exclusion criteria attempted to remove known liver disease and selected viral infections, but no imaging, body mass index, aspartate aminotransferase, gamma-glutamyl transferase or bilirubin data were presented. ALT should therefore be viewed as a marker of relative hepatic metabolic stress in this sample. It is not sufficiently specific to diagnose metabolic dysfunction-associated steatitis liver disease or to guide treatment without additional evaluation.[19,20,29]
The age-stratified findings showed higher MCV, MCH and MCHC in the 40–45-year group, but the result is difficult to attribute to age itself. Each category contained only ten participants, two p values were exactly .050, and post-hoc tests were not reported. Differences in parity, trimester, iron supplementation, diet, haemoglobin genotype or glycemic control could create the pattern. Advanced maternal age is a recognized risk factor for GDM, but it does not provide a simple mechanistic explanation for larger or more highly hemoglobinase erythrocytes after GDM has developed. These subgroup results should generate hypotheses rather than age-specific clinical thresholds. [4,7,11,25]
MCH and MCHC increased across trimester categories, while MCV did not change significantly. Physiological hemodilution and rising iron needs often lower haemoglobin-related measures as pregnancy progresses, but supplementation, participant selection and small numbers may alter that trajectory. Because the study sampled different women at one time point rather than following the same women longitudinally, the trimester analysis blends gestational change with between-person differences. No post-hoc results were reported, and first-trimester classification requires confirmation. Longitudinal sampling would provide a stronger assessment of within-woman change.[1-3,10,11]
The positive correlations between ALT and MCV and MCH were modest. The liver regulates iron homeostasis through hepcidin and synthesizes proteins that influence systemic metabolism, so hepatic and erythropoietic measures can covary. Yet the direction observed—higher ALT accompanying higher MCV and MCH within GDM—does not by itself identify a mechanism and may reflect age, supplementation or other shared determinants. Five correlations were tested without correction, increasing the probability of nominally significant findings. Replication with multivariable models and iron-status measures is needed before the associations are interpreted biologically. [13,20,21,25]
The results have potential clinical relevance but do not justify using MCV, MCH, fibrinogen or ALT to diagnose GDM. OGTT-based glucose assessment remains central. A full blood count is already common in antenatal care and can identify anemia patterns requiring follow-up. ALT may be reasonable when clinical risk suggests liver disease or metabolic dysfunction. Fibrinogen measurement may be useful in specific obstetric or hemostatic contexts, but routine testing of every woman with GDM would require evidence that results change management or improve outcomes. [1-3,13,16,19]
For antenatal services in resource-constrained settings, the most defensible implication is integrated risk assessment. Women with GDM should receive glycemic management, nutritional evaluation, blood-pressure monitoring and appropriate fetal surveillance. A low MCV or MCH should lead to investigation for iron deficiency and haemoglobinopathy rather than automatic iron escalation, because excessive iron may be unnecessary in iron-replete women. Raised ALT warrants clinical review and repeat or expanded liver testing when indicated. Abnormal coagulation results require confirmation with correctly collected specimens and pregnancy-appropriate reference intervals. [1,4,11,13,16]
This study contributes data from Owerri, a setting underrepresented in the literature, and evaluates three biological domains in the same cohort. The use of pregnant controls improves interpretation compared with non-pregnant controls, and the presentation of exact means, dispersion, test statistics and correlations permits appraisal of the observed differences. The work also raises practical questions that can guide a stronger follow-up study, including whether iron status mediates red-cell changes and whether fibrinogen and ALT predict maternal or neonatal outcomes beyond glucose concentration. [8,9,17,19]
Several limitations constrain inference. The cross-sectional design establishes association but not temporality. The sample was small, recruited at one hospital and divided into subgroups of ten. Consecutive recruitment may introduce selection bias, and the available dataset did not support adjustment for body mass index, gestational age, parity, socioeconomic status, iron supplementation, infection, blood pressure, glycemic control or treatment. Multiple comparisons were conducted without adjustment, and no confidence intervals or effect sizes were reported. These features increase uncertainty and limit generalizability. [4,25]
Laboratory and classification limitations are equally important. Manual red-cell measurement may have greater imprecision than automated analysis; the RDW method and values require verification. The blood-volume descriptions conflict, the citrate specimen for Clauss fibrinogen was not documented, and the reported OGTT thresholds do not align fully with current diagnostic categories. The ethics approval identifier and exact GDM diagnostic records should also be inserted. These are correctable reporting issues if original records confirm the procedures, but they should be resolved before the manuscript is submitted to a journal. [1-3,14,22,23]
Future research should recruit a larger cohort early in pregnancy and follow participants through delivery and postpartum. Groups should be matched or adjusted for gestational age and adiposity, with standardised OGTT classification and documentation of treatment. Automated full blood counts, ferritin, transferrin saturation, C-reactive protein, haemoglobin genotype, platelet-poor citrated plasma fibrinogen and a broader liver panel would clarify mechanisms. Recording pre-eclampsia, thrombosis, birth weight, neonatal hypoglycemia and delivery mode would determine whether these biomarkers add prognostic information. [4,13,16,19,27,30]
Pregnant women classified as having GDM in this Owerri cohort had lower MCV and MCH and higher fibrinogen and ALT than age-matched pregnant controls, while MCHC and RDW were not significantly different. Age- and trimester-related findings and ALT correlations were exploratory because subgroup sizes were small and potential confounding was not controlled. The results support attention to haematological and hepatic abnormalities during GDM care, but they do not establish these markers as diagnostic or prognostic tests. Confirmation of GDM criteria, RDW derivation and the citrated-plasma fibrinogen procedure is necessary before journal submission. [1-4,13,16,19]
Clinical care should continue to prioritise validated glucose testing and evidence-based GDM management. Full blood count abnormalities should be investigated with iron and haemoglobinopathy studies where appropriate; ALT elevations should be interpreted alongside clinical findings and a broader liver assessment; and coagulation testing should use rigorously controlled pre-analytical procedures and pregnancy-specific intervals. A larger longitudinal Nigerian study is recommended to test whether these markers independently predict maternal or neonatal outcomes after adjustment for gestational age, adiposity, inflammation, iron status and glycemic control. [1-4, 13,16,19]
The present findings are best treated as a locally grounded signal for confirmation. They show why antenatal laboratory data should be interpreted as an integrated profile: erythrocyte indices may reveal nutritional or inherited conditions, fibrinogen may reflect pregnancy-related hemostatic activation, and ALT may reflect hepatic metabolic stress. None is sufficiently specific to attribute an abnormality to GDM without clinical assessment and appropriate confirmatory tests. Before external peer review, the investigators should reconcile the OGTT thresholds, specimen volume, citrate-plasma collection, RDW calculation, ethics identifier and author contribution statement against the original records. Resolving those items will materially strengthen reproducibility and protect the validity of the intact numerical results. [1-4,13,16,19,22]
Ethics approval and consent to participate: Ethical approval was obtained from the appropriate authority at Imo State Specialist Hospital, Umuganda. All participants provided written informed consent. The approval number should be inserted from the original approval letter before submission.
Consent for publication: Not applicable.
Competing interests: The authors declare no competing interests.
Funding: No external funding was reported.
Acknowledgements: The authors acknowledge the study participants and the antenatal and laboratory staff who supported recruitment and testing.
“I would like to express my sincere gratitude to Ms. Sarah Jacobs, Editorial Coordinator of the IJCCR, for her excellent collaboration and exceptional support throughout the entire process, from article submission and peer review to financial matters and successful publication. Everything went very quickly and smoothly. I would also like to thank the reviewers, whose comments were helpful and contributed to an even better article. I wholeheartedly recommend this deservedly renowned journal to my colleagues for publication.” Best regards, Andreas Schapowal.
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It was my pleasure to submit my testimonial concerning the Reviewer Board of our Scientific Journal “Brain and Neurological Disorders”. The Reviewers focused on some modifications and their contribution was helpful. The ladies of our Editorial Office were also supported my efforts. It was my honor to have such a co-operation and I am looking forward for more collaboration.
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I Appreciate the Opportunity to Share my Experience with the Journal of Clinical Research and Reports. The peer review process was timely and constructive, and the feedback provided helped improve the quality of our manuscript. The editorial office was professional, responsive, and supportive throughout the process, ensuring smooth communication and efficient handling of the submission. Overall, it was a positive experience collaborating with your team.
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Dear Grace Pierce, Editorial Coordinator of the journal IJCCR, I had a very positive experience with Auctores - Journal throughout the publication process. The Editorial Team was highly responsive, professional, and supportive at every stage. I would like to extend my sincere thanks to the Editor: Grace Pierce, for her guidance and assistance. The peer-review process was smooth and constructive, helping improve the quality of my work. I would gladly recommend Auctores Journal to fellow researchers and authors. Dr. SABITA SINHA, Medical Oncologist, MD (Electro Homeopathy).
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Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
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Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
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To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
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My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
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I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
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"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
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