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Long-term follow-up in patients with a history of (H)ELLP syndrome
M G van Pampus1, H Wolf, G Mayruhu
1Academic Medical Centre, Department of Gynecology and Obstetrics, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Women with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome face long-term health risks, including higher rates of hypertension. Subsequent pregnancies may have complications like gestational hypertension, but HELLP syndrome recurrence is rare.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Perinatology
Background:
- Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is a severe pregnancy complication.
- Long-term sequelae of HELLP syndrome are not well-established.
- Understanding recurrence risk and later-life health impacts is crucial for patient management.
Purpose of the Study:
- To assess long-term outcomes for women with a history of HELLP syndrome.
- To evaluate the risk of HELLP syndrome recurrence in subsequent pregnancies.
- To investigate the incidence of other diseases in later life following HELLP syndrome.
Main Methods:
- A cohort of women diagnosed with HELLP syndrome between 1984-1996 was followed.
- Participants completed questionnaires on general health, obstetric, and family medical history.
- Exclusion criteria included pre-existing medical conditions; HELLP was defined by specific laboratory values.
Main Results:
- Hypertension requiring treatment was three times more common in women with a history of HELLP syndrome.
- 29% of subsequent pregnancies were complicated by gestational hypertension; HELLP recurrence was 2%.
- Multiparity, preterm birth, and low birth weight in the index pregnancy increased gestational hypertension risk in subsequent pregnancies.
Conclusions:
- HELLP syndrome has significant short-term and long-term health consequences.
- Women with a history of HELLP syndrome require ongoing monitoring for hypertension.
- While HELLP recurrence is uncommon, other pregnancy complications like gestational hypertension are more frequent.
Objective:
To provide long-term follow-up data on women with a history of hemolysis, elevated liver enzymes, and low platelets [(H)ELLP] syndrome regarding the risk of recurrence in subsequent pregnancies and disease in later life.
Methods:
All women admitted to the Academic Medical Centre between January 1984 and January 1996 with (H)ELLP syndrome and a living singleton fetus in utero were included. Women with known preexisting diseases were excluded. The (H)ELLP syndrome was defined as elevated liver enzymes (serum aspartate aminotransferase or serum alanine aminotransferase >or= 50 U/L) and low platelet count (< 100 x 10(9)/L). Those patients with hemolysis (LDH >or= 600 U/L) were classified as HELLP, the remaining ones were classified as ELLP. The participants were asked to fill out a questionnaire regarding their general health and their own obstetric and medical history and that of their first-and second-degree relatives.
Results:
One hundred sixteen (94%) of 123 women responded; 4 women had died. The median age of the group was 36.0 years at completion of the questionnaire; the median interval after the index pregnancy was 5.7 years (3-12.9). The incidence of hypertension requiring medical treatment was three times higher than in a reference population of Dutch women between 20 and 40 years old. The need for psychological support was frequent. Thirty-nine patients (34%) refrained from further pregnancies. Twenty-nine percent of the first subsequent pregnancies were complicated by gestational hypertension (GH), but only 2% had (H)ELLP syndrome. Birth weight was, on average, 1385 g higher and gestational age at delivery 5 weeks later in the first subsequent pregnancy irrespective of a recurrence of GH. A family history of cardiovascular disease or preeclampsia was common in the total group; however, this did not influence the recurrence rate. Multiparity, gestational age at delivery <30 weeks, and birth weight <1000 g in the index pregnancy increased the risk of recurrence of GH in the first subsequent pregnancy significantly.
Conclusions:
(H)ELLP syndrome is a severe complication of pregnancy that has not only short-term but also long-term sequelae.