Incidence and risk factors for severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia at preterm and term gestation: a population-based study

Abstract

BACKGROUND:The majority of previous studies on severe preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count syndrome were hospital-based or included a relatively small number of women. Large, population-based studies examining gestational ageespecific incidence patterns and risk factors for these severe pregnancy complications are lacking. OBJECTIVE: This study aimed to assess the gestational ageespecific incidence rates and risk factors for severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia. STUDY DESIGN: We carried out a retrospective, population-based cohort study that included all women with a singleton hospital birth in Canada (excluding Quebec) from 2012 to 2016 (N¼1,078,323). Data on the primary outcomes (ie, severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia) were obtained from delivery hospitalization records abstracted by the Canadian Institute for Health Information. A Cox regression was used to assess independent risk factors (eg, maternal age and chronic comorbidity) for each primary outcome and to assess differences in the effects at preterm vs term gestation (<37 vs !37 weeks). RESULTS: The rates of severe preeclampsia (n¼2533), hemolysis, elevated liver enzymes, and low platelet count syndrome (n¼2663), and eclampsia (n¼465) were 2.35, 2.47, and 0.43 per 1000 singleton pregnancies, respectively. The cumulative incidence of term-onset severe preeclampsia was lower than that of preterm-onset severe preeclampsia (0.87 vs 1.54 per 1000; rate ratio, 0.57; 95% confidence intervals, 0.53e0.62), the rates of hemolysis, elevated liver enzymes, and low platelet count syndrome were similar (1.32 vs 1.23 per 1000; rate ratio, 0.93; 95% confidence interval, 0.86e1.00), and the preterm-onset eclampsia rate was lower than the term-onset rate (0.12 vs 0.33 per 1000; rate ratio, 2.64; 95% confidence interval, 2.16e3.23). For each primary outcome, chronic comorbidity and congenital anomalies were stronger risk factors for preterm-vs term-onset disease. Younger mothers (aged <25 years) were at higher risk for severe preeclampsia at term and for eclampsia at all gestational ages, whereas older mothers (aged !35 years) had elevated risks for severe preeclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome. Regardless of gestational age, nulliparity was a risk factor for all outcomes, whereas socioeconomic status was inversely associated with severe preeclampsia. CONCLUSION: The risk for severe preeclampsia declined at term, eclampsia risk increased at term, and hemolysis, elevated liver enzymes, and low platelet count syndrome risk was similar for preterm and term gestation. Young maternal age was associated with an increased risk for eclampsia and term-onset severe preeclampsia. Prepregnancy comorbidity and fetal congenital anomalies were more strongly associated with severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, a...

Prevalence and Risk Factors of Preterm Birth Among Pregnant Women Admitted at the Labor Ward of the Komfo Anokye Teaching Hospital, Ghana

“…Our study found that pregnant women with HELLP syndrome were approximately 4-fold increased odds of preterm birth. This finding is consistent with findings from previous retrospective cross-sectional study by Lisonkova et al ( 27 ).…”

“…In the present study, the risk of preterm birth associated with HELLP syndrome may be due to its association with preeclampsia ( 26 ). Although HELLP syndrome is sometimes considered to be a form of severe preeclampsia, the major distinct features include abnormal liver function, moderate-to-severe thrombocytopenia accompanied by microangiopathic haemolytic anemia, disrupted or destroyed erythrocytes on peripheral smear, and symptoms such as epigastric pain, nausea, and vomiting ( 27 ). Our study found that pregnant women with HELLP syndrome were approximately 4-fold increased odds of preterm birth.…”

Pregnancy-Associated Liver Diseases

“…HELLP syndrome risk factors mirror those of preeclampsia with older (>35 years) mothers at highest risk. 101,102…”

A Rare Case of HELLP Syndrome with Hematomas of Spleen and Liver, Eclampsia, Severe Hypertension and Prolonged Coagulopathy—A Case Report

“…The HELLP syndrome is a rare (0.5-0.9%) but serious complication of pregnancy or puerperium, associated with a higher risk of maternal and fetal mortality and morbidity [1][2][3][4][5][6]. Liver and spleen hematomas rarely entangle (<2%) HELLP cases [7,8], but rupture of the hematomas is a state of immediate threat to life [5,6,9].…”

“…Delayed diagnosis of the HELLP syndrome may increase potential maternal and fetal mortality and morbidity. However, early diagnostic of HELLP can be a challenge: (1) This syndrome most often occurs in conjunction with preeclampsia (PE), a severe form of pregnancy-induced hypertension (PIH), but can occur on its own (in 10-30% of cases) [3,18,19]. Risk factors for HELLP are similar to those for other PIH forms [19][20][21][22]; (2) Prodromal symptoms of HELLP are nonspecific (malaise, nausea, epigastric pain, headache or visual symptoms) [3,23] but these prodromal symptoms may not be present either [2,3]; (3) Importantly, HELLP syndrome belongs to a broad spectrum of thrombotic microangiopathies (TMAs) characterized by hemolytic anemia, thrombocytopenia and organ damage as a result of microclots.…”