Prepregnancy body mass index and other risk factors for early-onset and late-onset haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome: a population-based retrospective cohort study in British Columbia, Canada
Background Obesity increases risk of pre-eclampsia, but the association with haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is understudied.Objective To examine the association between prepregnancy body mass index (BMI) and HELLP syndrome, including early-onset versus late-ons...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-03-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/3/e079131.full |
| _version_ | 1797228937738190848 |
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| author | Neda Razaz Sarka Lisonkova K S Joseph Giulia M Muraca Jeffrey N Bone Li Qing Wang |
| author_facet | Neda Razaz Sarka Lisonkova K S Joseph Giulia M Muraca Jeffrey N Bone Li Qing Wang |
| author_sort | Neda Razaz |
| collection | DOAJ |
| description | Background Obesity increases risk of pre-eclampsia, but the association with haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is understudied.Objective To examine the association between prepregnancy body mass index (BMI) and HELLP syndrome, including early-onset versus late-onset disease.Study design A retrospective cohort study using population-based data.Setting British Columbia, Canada, 2008/2009–2019/2020.Population All pregnancies resulting in live births or stillbirths at ≥20 weeks’ gestation.Methods BMI categories (kg/m2) included underweight (<18.5), normal (18.5–24.9), overweight (25.0–29.9) and obese (≥30.0). Rates of early-onset and late-onset HELLP syndrome (<34 vs ≥34 weeks, respectively) were calculated per 1000 ongoing pregnancies at 20 and 34 weeks’ gestation, respectively. Cox regression was used to assess the associations between risk factors (eg, BMI, maternal age and parity) and early-onset versus late-onset HELLP syndrome.Main outcome measures Early-onset and late-onset HELLP syndrome.Results The rates of HELLP syndrome per 1000 women were 2.8 overall (1116 cases among 391 941 women), and 1.9, 2.5, 3.2 and 4.0 in underweight, normal BMI, overweight and obese categories, respectively. Overall, gestational age-specific rates of HELLP syndrome increased with prepregnancy BMI. Obesity (compared with normal BMI) was more strongly associated with early-onset HELLP syndrome (adjusted HR (AHR) 2.24 (95% CI 1.65 to 3.04) than with late-onset HELLP syndrome (AHR 1.48, 95% CI 1.23 to 1.80) (p value for interaction 0.025). Chronic hypertension, multiple gestation, bleeding (<20 weeks’ gestation and antepartum) also showed differing AHRs between early-onset versus late-onset HELLP syndrome.Conclusions Prepregnancy BMI is positively associated with HELLP syndrome and the association is stronger with early-onset HELLP syndrome. Associations with early-onset and late-onset HELLP syndrome differed for some risk factors, suggesting possible differences in aetiological mechanisms. |
| first_indexed | 2024-04-24T15:04:38Z |
| format | Article |
| id | doaj.art-c8d8117526734a2aa6ccd21c760b7608 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-24T15:04:38Z |
| publishDate | 2024-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-c8d8117526734a2aa6ccd21c760b76082024-04-02T13:45:09ZengBMJ Publishing GroupBMJ Open2044-60552024-03-0114310.1136/bmjopen-2023-079131Prepregnancy body mass index and other risk factors for early-onset and late-onset haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome: a population-based retrospective cohort study in British Columbia, CanadaNeda Razaz0Sarka Lisonkova1K S Joseph2Giulia M Muraca3Jeffrey N Bone4Li Qing Wang5assistant professor1 Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canadaprofessorassistant professorResearch Informatics, BC Children`s Hospital Research Institute, Vancouver, British Columbia, CanadaDepartment of Obstetrics and Gynaecology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, CanadaBackground Obesity increases risk of pre-eclampsia, but the association with haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is understudied.Objective To examine the association between prepregnancy body mass index (BMI) and HELLP syndrome, including early-onset versus late-onset disease.Study design A retrospective cohort study using population-based data.Setting British Columbia, Canada, 2008/2009–2019/2020.Population All pregnancies resulting in live births or stillbirths at ≥20 weeks’ gestation.Methods BMI categories (kg/m2) included underweight (<18.5), normal (18.5–24.9), overweight (25.0–29.9) and obese (≥30.0). Rates of early-onset and late-onset HELLP syndrome (<34 vs ≥34 weeks, respectively) were calculated per 1000 ongoing pregnancies at 20 and 34 weeks’ gestation, respectively. Cox regression was used to assess the associations between risk factors (eg, BMI, maternal age and parity) and early-onset versus late-onset HELLP syndrome.Main outcome measures Early-onset and late-onset HELLP syndrome.Results The rates of HELLP syndrome per 1000 women were 2.8 overall (1116 cases among 391 941 women), and 1.9, 2.5, 3.2 and 4.0 in underweight, normal BMI, overweight and obese categories, respectively. Overall, gestational age-specific rates of HELLP syndrome increased with prepregnancy BMI. Obesity (compared with normal BMI) was more strongly associated with early-onset HELLP syndrome (adjusted HR (AHR) 2.24 (95% CI 1.65 to 3.04) than with late-onset HELLP syndrome (AHR 1.48, 95% CI 1.23 to 1.80) (p value for interaction 0.025). Chronic hypertension, multiple gestation, bleeding (<20 weeks’ gestation and antepartum) also showed differing AHRs between early-onset versus late-onset HELLP syndrome.Conclusions Prepregnancy BMI is positively associated with HELLP syndrome and the association is stronger with early-onset HELLP syndrome. Associations with early-onset and late-onset HELLP syndrome differed for some risk factors, suggesting possible differences in aetiological mechanisms.https://bmjopen.bmj.com/content/14/3/e079131.full |
| spellingShingle | Neda Razaz Sarka Lisonkova K S Joseph Giulia M Muraca Jeffrey N Bone Li Qing Wang Prepregnancy body mass index and other risk factors for early-onset and late-onset haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome: a population-based retrospective cohort study in British Columbia, Canada BMJ Open |
| title | Prepregnancy body mass index and other risk factors for early-onset and late-onset haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome: a population-based retrospective cohort study in British Columbia, Canada |
| title_full | Prepregnancy body mass index and other risk factors for early-onset and late-onset haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome: a population-based retrospective cohort study in British Columbia, Canada |
| title_fullStr | Prepregnancy body mass index and other risk factors for early-onset and late-onset haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome: a population-based retrospective cohort study in British Columbia, Canada |
| title_full_unstemmed | Prepregnancy body mass index and other risk factors for early-onset and late-onset haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome: a population-based retrospective cohort study in British Columbia, Canada |
| title_short | Prepregnancy body mass index and other risk factors for early-onset and late-onset haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome: a population-based retrospective cohort study in British Columbia, Canada |
| title_sort | prepregnancy body mass index and other risk factors for early onset and late onset haemolysis elevated liver enzymes and low platelets hellp syndrome a population based retrospective cohort study in british columbia canada |
| url | https://bmjopen.bmj.com/content/14/3/e079131.full |
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