Anyone have another child after having HELLP?

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Expand view Topic review: Anyone have another child after having HELLP?

Re: Anyone have another child after having HELLP?

Post by mnickerson » Thu Apr 10, 2014 03:44 am

I had HELLP at 36/6 with my first, who was born 2/15/12. I delivered a healthy baby boy six days ago on 4/4/14 at 39/1 with no HELLP at all! I was scared the entire pregnancy, but I am so thankful for a wonderful doctor and my own diligence in watching myself. It was totally worth it.

Re: Anyone have another child after having HELLP?

Post by caryn » Mon Feb 03, 2014 12:38 am

There is some ongoing work into this. A few links:

http://www.ncbi.nlm.nih.gov/pubmed/23399716
"The incidence of gestational hypertension and preeclampsia was 9.7% and 2.5% for women who took folic acid, and 9.4% and 2.4% for women who did not use it. The adjusted risk ratio associated with folic acid use was 1.08 (95% confidence interval, 1.04-1.11) for gestational hypertension and 1.11 (95% confidence interval, 1.04-1.18) for preeclampsia."

So if folic acid is supposed to be antagonizing B12 and causing PE/HELLP, it's responsible for .11 of the risk above 5%, which is to say one patient in every 200 patients, I think. Although the confidence interval is pretty big for me to say that so precisely.

http://www.ncbi.nlm.nih.gov/pubmed/21040211
"Homocysteine levels in both maternal and fetal serum were significantly higher in the severe pre-eclampsia group compared to mild pre-eclampsia and control groups. However, homocysteine levels in both maternal and fetal serum were not significantly different between mild pre-eclampsia and control groups. No significant differences were observed in folic acid and vitamin B12 levels in both maternal and fetal serum between the groups."

So, there are no significant differences between the populations when it comes to serum levels of these vitamins.

More interesting, though, I think is the question of why the placenta might be altering these homocysteine levels in the severe patients! We know that the initial implantation of these placentas is altered in very early pregnancy and that one of the primary jobs of the placenta is to change maternal metabolism to support pregnancy. Does affecting B12 levels when placental implantation is severely compromised do something to allow the placenta to sustain pregnancy? Or is it just a spandrel?

Re: Anyone have another child after having HELLP?

Post by ELP » Fri Jan 31, 2014 09:03 am

I had HELLP (daughter now 24). My next pregnancy ended with fetal death at 20 weeks (at the time-- no known cause) Then I was infertile for many years. Almost nine years after HELLP I had a successful pregnancy (daughter now 15)

Here is what I have learned: Symptoms of HELLP can be caused by masked Vitamin B12 deficiency. We take prenatal vitamins with high folic acid (synthetic folate) but little or no active B12. Folic acid corrects the enlarged red blood cells doctors were taught to look for in B12 deficiency. If you are taking acid suppressing medicines, as many with HELLP do, you cannot digest B12 from food (acid is needed to extract B12 bound to animal protein.) But your growing baby needs increasing amounts of B12. By the third trimester the baby has high needs for B12 --for brain and bone growth-- right when the mother's stores may be severely depleted. Women with opposite extremes of B vitamin status -- high folic acid and low B12 -- are predisposed to high homocysteine. The B vitamins must work in synergy to keep homocysteine down.

Homocysteine is a toxic metabolite that builds up when your B vitamin metabolism is askew. Homocysteine is positively associated with developing preeclampsia and HELLP. So-called HELLP wasn't even a named syndrome until after high folic acid was added to prenatal vitamins. We all think folic acid is the same as real folate from food. In fact it is a synthetic unknown to the human body until the 1940s. Research in the 1940s showed us that people low in B12 should never have folic-acid-only interventions that can mask their B12 deficiency. In my case I have a common MTHFR gene variant that makes folic acid an inferior source of folate for me. Taking folic acid can actually lead to functional folate deficiency in some vulnerable people. In my case I was also eating less meat (the only food sources of B12 are animal products), taking Tums, and this was a second pregnancy, after a first pregnancy with severe unexplained anemia treated with folic acid and iron (no B12) I survived HELLP and DIC with 7 blood transfusions. No one ever tested my B12 or homocysteine, despite my being at one of the best teaching hospitals in America.

Tests are: B12, homocysteine, methylmalonic acid, holotranscobalamin, unmetabolized folic acid, MTHFR genetic testing.

This is from NIH Rare Diseases Information website:
Can the symptoms of HELLP syndrome be caused by a vitamin B12 deficiency?
Although vitamin B12 deficiency is not typically included in the differential diagnosis for HELLP syndrome, there are overlapping features for both conditions. We identified the following reports of suspected HELLP syndrome that were due to deficiency of Vitamin B12.

Chauvet E, Youssef M, Boukhari R, El Guindi W, Carles G. [Symptoms of HELLP syndrome due to vitamin B12 deficiency: report of seven cases]. J Gynecol Obstet Biol Reprod (Paris). 2009 May;38(3):226-30. Article in French.

Hartong SC, Steegers EA, Visser W. Hemolysis, elevated liver enzymes and low platelets during pregnancy due to Vitamin B12 and folate deficiencies. Eur J Obstet Gynecol Reprod Biol. 2007 Apr;131(2):241-2.


http://www.ncbi.nlm.nih.gov/pubmed/?term=hellp+b12

Re: Anyone have another child after having HELLP?

Post by HELLPSurvivorsUnite » Mon Jan 27, 2014 10:21 am

This is a short reply that I've elaborated on in the main HELLP forum.

I was diagnosed with HELLP at 37 1/2 weeks, and the experience was very traumatic.

Despite being told that my liver was recovered enough to have a second, and being cleared medically to do so, I still haven't had another baby and it's been 7 years. I want a second child very much. Obviously, for 6 years (we started trying a year ago), my fears of dying in childbirth or losing a baby were stronger. I'm ready now, but am 45, which means we'll have to be very lucky or have IVF.

I've read through everything I can find on the internet about the 'odds' of recurrence. I've read about women who go on to have normal pregnancies, some who have pre-e, but not full blown HELLP, and others who have a recurrence. In the end, there's no one size fits all solution. HELLP is scary stuff. Those of us who survived it are brave whether or not we decide to get pregnant again. Hugs to all!

Andi

Re: Anyone have another child after having HELLP?

Post by mnickerson » Wed Jan 01, 2014 11:39 am

Hi Whitney,

I delivered my daughter at 37/1 due to sudden onset superimposed Class 1 HELLP (no pre-eclampsia for me!). I am currently 26 weeks pregnant with our second and will be starting close monitoring at 30 weeks with weekly labs to check my platelet count and liver function. For the most part, it sounds like HELLP is most common with first pregnancies/first pregnancies with the same father and recurrence is more likely the earlier it developed the first time. My BP had started to elevate slightly a week or two before I felt the upper quadrant pain and my feet swelled quickly a day or two before. Looking back, those were clear indicators of what was coming, but of course they are also fairly common in all pregnancies. Should I notice either of those this time around, I will absolutely head straight to the hospital. I think that knowing your increased likelihood of having HELLP again (especially considering most people don't know what it even is) will be the biggest factor in having a successful second pregnancy. Best of luck to you if you do decide to try again!

Re: Anyone have another child after having HELLP?

Post by milesymommy » Fri Nov 01, 2013 09:10 am

I had sudden onset of HELLP at 36 weeks. Luckily, my son was small but otherwise healthy. It took me much longer to recover, mentally and physically.
Before getting pregnant again, I had blood tests to ensure my liver and kidneys were functioning normally. They were. We had our second child 2 1/2 years later. I was so paranoid the entire pregnancy, and was seen for NSTs 3x week for weeks 30+ to keep a close eye on things. At 39 weeks, my BP started to be elevated, and we made the decision to induce early and not risk sudden onset again. Second son born healthy.

Good luck!!!

Re: Anyone have another child after having HELLP?

Post by jlstreet » Mon Jul 22, 2013 09:17 am

Whitney I had sever level 1 HELLP at only 24 weeks with my second son. It as most everyone else I have read came out of no where. I delivered my son at 24 weeks weighing only 14.4oz, he did not make it thru the delivery. My OB/GYN did not want me to have another child and the MFM told me I had to wait at least 2 years for my body recover and that I still stood about a 40% chance of reoccurance. At first I was like well I would have to be crazy to think about getting pregnant again....then as time went on it did not seem that crazy. I spoke with my OB/GYN in March and told her that I was going to stop taking the pill in Sept (this would be the 2 year mark) and let God control the rest. If God saw for us to have a child we would and if he did not see we would not. The month of June I thought I missed my period and told my husband, we went immediately and got a HPT and it was positive, of course being in complete disbelief, we took another and again it was positive. I immediately text my OB and told her I needed to see her ASAP, of course this was a Monday and first they could see me was Friday...lol. Anyway I was scheduled a ultrasound first and sure enough there it was a tiny little speck with a very noticeable heartbeat....I can explain how that made me feel. I was so happy but at the same time so scared, it brought back all those feelings of loosing my sweet Michael almost two years before and how much that impacted my life. But happy or scared I know it is all in Gods plan. Just as the loss of Michael was in his plan this is too. I am almost 8 weeks so its still very early and have started having a very itchy, very annoying rash that I had last time, which was medical but not related to the HELLP. I know 9 months is a long time to deal with it but if that is the worse that happens to me this time I will be ok. I know all things that happen in our lives happen according to Gods plans for our lives and I can tell by reading your posts you feel the same. Good luck with what ever you and your husband decide and may God Bless you along your journey.

Re: Anyone have another child after having HELLP?

Post by shadow2356 » Sat Apr 06, 2013 04:12 am

I had class 1 HELLP and delivered my daughter at 34 weeks. The abdominal pain started at 24 weeks so I know my HELLP really started then. I went to a perinatoligist who felt I could get pregnant again but I had a huge risk of a very premature baby. We decided to do gestational surrogacy and my son was born at 26 weeks. He is finally home and doing well. I guess preemies were my destiny.

Re: Anyone have another child after having HELLP?

Post by sarahkm » Fri Mar 08, 2013 03:22 am

Hi Whitney,

I too had HELLP come on very suddenly in my 37th week (I had a normal prenatal appt. 48 hrs before our tragedy happened) and my placenta abrupted leading to our son being stillborn. I was told not to get pregnant again mostly due to my poor kidney function...I was on dialysis for 3.5 months and my kidney values did not improve as fast as wanted/expected after that.
So we had been trying to adopt for the past 4 to 5 years. Now I am expecting again after getting the ok to get pregnant from my OB and MFM. My kidney function has improved and my blood pressure is quite stable. So far things are going well. I'm at 17 weeks. I'm being seen every 2 weeks by my OB at this point and have seen the MFM once so far, but will see him again at my 20 week ultrasound.
I did have an echocardiogram when I was in the hospital which showed some mild abnormalities due to the HELLP syndrome, but then had another 1 year later and things looked better. I don't remember them saying anything about having an enlarged chamber.
I think it is a very good idea to consult with an MFM and go through your history, maybe even talk with another OB that is know for high-risk care. Get as educated as you can about HELLP and preeclampsia, this website is a great resource!
Let me know if you have any other questions.
Sarah

Re: Anyone have another child after having HELLP?

Post by misspagan » Fri Mar 01, 2013 03:38 am

Hi Whitney,

I didn't have hellp but had serious pe with my first (mild w/ my 2nd). About 5 years after I had my daughter, I had some heart issues & they did a stress echo. They found I had a slightly enlarged right ventricle but couldn't figure out why. I always wondered if my pe had something to do with this since I had no risk factors or family history of heart issues. At the time, there was no research that supported pe as a risk factor for heart issues. Research has changed that opinion now but I don't know if any dr will say that's the cause of my enlarged right ventricle.

Good luck with your decision on expanding your family. If you do choose to try again, just know you'll have a lot of supporters sending prayers & good thoughts your way. ;-)

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