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.