HELLP syndrome

WASHINGTON - Low plasma volume and hypercholesterolemia post partum were good predictors of recurrent hypertensive disease in a subsequent pregnancy in a study of 99 women.

Affected women whose subsequent pregnancies were also complicated by hypertensive disease had higher cholesterol levels and lower postpartum plasma volumes than those who had uncomplicated subsequent pregnancies. Together, low plasma volume and high cholesterol were associated with a 3.4-fold increase in risk for recurrent hypertensive disease, Dr. Robert Aardenburg reported at the annual meeting of the Society for Gynecologic Investigation.

Dr. Aardenburg of Maastricht (the Netherlands) University and his associates examined 99 women with a history of hypertensive disease in pregnancy who also completed a subsequent pregnancy Recurrent hypertensive disease was found in 32 of the women.

Those women who had recurrent hypertensive disease (HELLP syndrome, intrauterine growth restriction, or preeclampsia) had reduced plasma volume and hypercholesterolemia. Mean plasma volume in these women was 230 milliliters per kilogram meter (volume corrected for the influence of height and weight), compared with 249 milliliters per kilogram meter in those without recurrent disease. Mean cholesterol levels were 5.5 mmol/L in the recurrent disease group, compared with 4.9 mmol/L in those without recurrent disease.

Women who had low postpartum plasma volume alone, without hypercholesterolemia, faced a 2.2-fold increase in risk of recurrent disease. Postpartum hypercholesterolemia alone was associated with a 1.8-fold increased risk, he said in a poster presentation.

Dr. Aardenburg theorized that low plasma volume is associated with decreased cardiovascular reserves and that these women lack the hemodynamic adaptation that normally occurs in pregnancy.

"Suboptimal placentation can occur, which leads to an increased risk of preeclampsia at a later stage of pregnancy," he said. "It appears that they have low plasma volume even before pregnancy and consequently they return to their abnormal prepregnancy volume." Cholesterol contributes to the process as an endothelial stressor that negatively influences the vascular wall, Dr. Aardenburg said.

COPYRIGHT 2003 International Medical News Group
COPYRIGHT 2003 Gale Group