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- Title
Maternal risk factors and adverse birth outcomes associated with HELLP syndrome: a population-based study.
- Authors
Lisonkova, S; Razaz, N; Sabr, Y; Muraca, GM; Boutin, A; Mayer, C; Joseph, KS; Kramer, MS; Muraca, G M; Joseph, K S; Kramer, M S
- Abstract
<bold>Objectives: </bold>We assessed the incidence, risk factors and adverse birth outcomes associated with elevated liver enzymes and low platelets (HELLP) syndrome.<bold>Design: </bold>A retrospective population-based cohort study.<bold>Setting: </bold>Canada (excluding Quebec), 2012/2013-2015/2016.<bold>Population: </bold>Mothers with a singleton hospital live birth or stillbirth at ≥24 weeks' gestation (n = 1 078 323).<bold>Methods: </bold>HELLP syndrome was identified using ICD-10-CA diagnostic code from delivery hospitalisation data. We used logistic regression to identify independent risk factors for HELLP syndrome by obtaining adjusted odds ratios (AOR) and 95% confidence intervals (CI), and to assess the associations with adverse outcomes.<bold>Main Outcome Measures: </bold>Adverse maternal (e.g. eclampsia) and fetal/neonatal outcomes (e.g. intraventricular haemorrhage, perinatal death).<bold>Results: </bold>The incidence of HELLP syndrome was 2.5 per 1000 singleton deliveries (n = 2663). Risk factors included: age ≥35 years, rural residence, nulliparity, parity ≥4, pre-pregnancy and gestational hypertension and diabetes, assisted reproduction, chronic cardiac conditions, systemic lupus erythematosus, obesity, chronic hepatic conditions, placental disorders (e.g. fetomaternal transfusion) and congenital anomalies. PROM and age <25 years were inversely associated with HELLP syndrome (P-values <0.05). Women with the syndrome had a 10-fold higher maternal mortality (95% CI 1.6-84.3) and elevated severe maternal morbidity (9.6 versus 121.7 per 1000; AOR 12.5, 95% CI 11.1-14.1); and higher perinatal mortality (4.3 versus 21.0 per 1000; AOR 4.5, 95% CI 3.5-5.9) and perinatal mortality/severe neonatal morbidity (21.2 versus 202.4 per 1000; AOR 10.7, 95% CI 9.7-11.8).<bold>Conclusion: </bold>HELLP syndrome is associated with specific pre-pregnancy and pregnancy risk factors, higher rates of maternal death, and substantially higher severe maternal morbidity, perinatal mortality and severe neonatal morbidity.<bold>Tweetable Abstract: </bold>HELLP syndrome is associated with higher maternal death rate, and substantially higher severe maternal and neonatal morbidity, and perinatal mortality.
- Subjects
QUEBEC (Quebec); CANADA; HELLP syndrome; HIGH-risk pregnancy; GESTATIONAL diabetes; PERINATAL death; SYSTEMIC lupus erythematosus; INTRAVENTRICULAR hemorrhage; DATABASES; RESEARCH; NEONATAL diseases; RESEARCH methodology; RETROSPECTIVE studies; CASE-control method; EVALUATION research; MEDICAL cooperation; COMPARATIVE studies; RESEARCH funding
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2020, Vol 127, Issue 10, p1189
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.16225