Association of HELLP syndrome with autoimmune antibodies and glucose intolerance

OBJECTIVE - HELLP syndrome is a severe form of preeclampsia, characterized by hemolysis (H). elevated liver enzymes (EL), and low platelets (LP), whos e pathogenesis is unclear. Autoimmunity is thought to play an important rol e. After the observation of development of type 1 diabetes in a patient wit h HELLP syndrome, we assumed a possible disease association based on autoim mune reactions. RESEARCH DESIGN AND METHODS - We examined 70 women with HELLP syndrome For the presence of autoimmune markers and glucose intolerance. Free thyroxine, triiodothyronine, thyroid-stimulating hormone, anti-thyroglobulin antibodi es. thyroperoxidase antibodies, thyrotropin receptor antibodies, antinuclea r antibodies (ANAs) and anti-DNA, islet cell antibodies, GADA, an oral gluc ose tolerance test, and HbA(1c) were determined postpartum. Patients with p ositive autoimmune markers or glucose intolerance were prospectively follow ed and repeated testing was performed. There were 60 women with a normal co urse of pregnancy matched for age, BMI, and number of pregnancies, which se n ed as a control group. RESULTS - From the HELLP patients, 22 (31%) compared with only 6 (10%) cont rol subjects had autoimmune antibodies (P < 0.01). There were 16 HELLP pati ents (23%) who exhibited only 1 kind of autoantibody (5 ANA, 9 thyroid anti bodies, and 2 GADA), whereas in 6 HELLP patients (8.5%) 2 different antibod ies were found. In all but 4 patients of the study group, these antibodies disappeared during 3 +/- 1.5 years of follow-up. Glucose intolerance sas de tected in 22 (31%) of the HELLP patients, 17 of them had impaired glucose t olerance (IGT). and 5 had diabetes. whereas only 4 subjects (6.5%) with IGT at postpartum were found in the control group (P < 0.01). During the follo w-up, 2 HELLP patients were still diabetic and another 2 HELLP patients (1 GADA positive) had IGT versus 1 control subject. CONCLUSIONS - Our data give evidence that HELLP syndrome is associated with various autoimmune antibodies and glucose intolerance. Because glucose int olerance and/or autoimmune markers persisted during long-term follow-up in 6 patients with HELLP syndrome versus 1 in the control group, it may become advisable to 1 reexamine patients with HELLP syndrome for detection of dia betes and autoimmune disorders.