Anyone have another child after having HELLP?

Have you suffered from HELLP syndrome or had a pregnancy complicated by an underlying disorder? Discuss your concerns here

Re: Anyone have another child after having HELLP?

Postby 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
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Re: Anyone have another child after having HELLP?

Postby caryn » Mon Feb 03, 2014 00:38 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?
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies? Lectures from researchers?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy
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Re: Anyone have another child after having HELLP?

Postby mnickerson » Thu Apr 10, 2014 03:44 pm

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.
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