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Maternal endothelial function and vascular stiffness after HELLP syndrome: a case-control study.

R Orabona¹, E Sciatti², E Vizzardi²

¹Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy.

Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology

|December 23, 2016

Summary

Women with a history of HELLP syndrome or pre-eclampsia (PE) show similar vascular abnormalities post-pregnancy. However, HELLP syndrome, intrauterine growth restriction (IUGR), and early-onset PE identify women at higher risk for future endothelial dysfunction.

Keywords:

EndoPAT HELLP syndrome IUGR arterial stiffness cardiovascular risk endothelial dysfunction pre-eclampsia pulse-wave velocity

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Area of Science:

Obstetrics and Gynecology
Cardiovascular Medicine
Reproductive Health

Background:

Pre-eclampsia (PE) and HELLP syndrome are severe pregnancy complications with potential long-term cardiovascular implications.
Endothelial dysfunction and arterial stiffness are early markers of cardiovascular impairment.

Purpose of the Study:

To assess endothelial function and arterial stiffness in women with a history of PE with or without HELLP syndrome.
To compare these vascular parameters to women with uncomplicated pregnancies.
To investigate the specific influence of HELLP syndrome on subsequent cardiovascular health.

Main Methods:

A prospective case-control study involving 109 women with PE (49 with HELLP, 60 without) and 60 controls.
Assessment of endothelial function using reactive hyperemia index (RHI) via peripheral arterial tonometry (PAT).
Measurement of arterial stiffness using augmentation index (AIx) and carotid-femoral pulse-wave velocity (cfPWV).

Main Results:

Women with a history of PE (with or without HELLP) exhibited significantly different arterial stiffness and endothelial function compared to controls, except for cfPWV.
No significant differences in RHI, AIx, or cfPWV were observed between women with and without a history of HELLP syndrome.
Multivariate analysis revealed that HELLP syndrome, intrauterine growth restriction (IUGR), and early-onset PE independently predicted postpartum endothelial dysfunction.

Conclusions:

Women with prior HELLP syndrome and those with PE without HELLP demonstrate similar vascular abnormalities.
A history of HELLP syndrome, particularly when combined with IUGR and early-onset PE, identifies a subgroup at increased risk for future endothelial dysfunction.
These findings highlight the importance of long-term cardiovascular monitoring for women with a history of severe PE.