The impact of parity on the incidence of HELLP syndrome and small for gestational age infants in hypertensive pregnant women.

OBJECTIVES: To determine whether maternal and fetal complications such as HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome and the incidence of small for gestational age infants in women with preeclampsia and gestational hypertension differ with both gravidity and parity.

STUDY DESIGN: The charts of 441 hypertensive women, 182 with preeclampsia and 259 with gestational hypertension, presenting for delivery at B.C. Women's Hospital were retrospectively reviewed. Multiple clinical parameters, including gestational age at presentation, the incidence of small for gestational age (SGA) infants, HELLP syndrome, and the severity of pre-eclampsia, were compared among three groups of women: (A) primigravid primiparous, (B) multigravid primiparous, and (C) multiparous. Mean values between the groups were compared using analysis of variance with pair-wise comparison using the Tukey test.

RESULTS: The incidence of HELLP syndrome among the women with preeclampsia was similar in groups A and B (35% and 50%, respectively), but significantly lower (p < 0.012) in group C (19%). The incidence of small for gestational age infants among the women with preeclampsia was similar for groups A, B, and C (27%, 31%, and 19%, respectively). In the gestational hypertensive group the incidence of SGA infants was similar for groups A, B, and C (14%, 11%, and 12% respectively).

CONCLUSIONS: The preeclamptic primigravid primiparous and multigravid primiparous groups behaved similarly in their clinical expression of hypertensive complications but differed from the multiparous group by having a higher incidence of HELLP syndrome. The incidence of complications in hypertensive pregnant women varied by parity but not by gravidity. The gestational hypertensive groups did not differ in their clinical expression of hypertensive complications.