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Poster Session 3

Category: Clinical Obstetrics

Poster Session 3

(785) Association between HELLP syndrome and peripartum cardiomyopathy

Thursday, February 12, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Fay Pon, MD (she/her/hers)

Resident Physician
Keck School of Medicine of USC, University of Southern California
Los Angeles, California, United States

Coauthor(s)

Ariane C. Youssefzadeh, MD

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California
Los Angeles, California, United States
ZC

Zaira Chavez Jimenez, MD

Keck School of Medicine of USC, University of Southern California
Los Angeles, California, United States
Yadira L. Bribiesca Leon, MD, MPH (she/her/hers)

Resident
Keck School of Medicine of USC, University of Southern California
Los Angeles, California, United States
Jennifer Yao, BA

University of Southern California, Keck School of Medicine
Los Angeles, California, United States
JO

Joseph G. Ouzounian, MBA, MD

Professor and Chair of Obstetrics & Gynecology
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California
Los Angeles, California, United States
KM

Koji Matsuo, MD, PhD

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California
Los Angeles, California, United States

Objective:
To assess the association between HELLP syndrome and peripartum cardiomyopathy.

Study Design:
This cross-sectional study queried the Healthcare Cost and Utilization Project’s National Inpatient Sample. The study population included 24,976,626 hospital deliveries from 2016-2022 and the exposure was a diagnosis of HELLP syndrome (n=68,840 for HELLP and n=24,907,786 for no HELLP syndrome). The main outcome measure was a diagnosis of peripartum cardiomyopathy. A multivariable generalized linear model was used to assess the exposure-outcome association, adjusted for historical clinico-obstetric characteristics.

Results:
The incidence of peripartum cardiomyopathy (PPCM) was 24.0 and 2.2 per 10,000 deliveries for the HELLP syndrome and non-HELLP syndrome group, respectively (P< 0.001). After controlling for maternal age, race and ethnicity, medical comorbidities (hypertensive disorder of pregnancy, diabetes mellitus, and obesity), socio-economic status (primary payer and household income), substance use disorders, prior uterine scar, gestational age at delivery, cesarean delivery, and hospital parameters (location, teaching status, and region), pregnant people with HELLP were nearly three times more likely to have a diagnosis of PPCM compared to those without HELLP (adjusted-incidence rate ratio [aIR] 1.26, 95% confidence interval [CI] 1.07-1.47). This association was larger for younger maternal age: aIR for < 25, 25-29, 30-34, and ≥35 years, 2.00 (95%CI 1.48-2.70), 1.65 (95%CI 1.24-2.18), 0.80 (95%CI 0.55-1.15), and 0.90 (95%CI 0.63-1.30), respectively. The association was also larger for delivery at later gestational age: aIR for ≥37, 34-36, 28-33, and < 28 weeks gestation, 2.67 (95%CI 1.94-3.66), 1.30 (95%CI 0.93-1.83), 1.05 (95%CI 0.79-1.41), and 1.15 (95%CI 0.72-1.85), respectively.

Conclusion:
This cross-sectional study suggests that although rare, pregnant people with HELLP may have an increased risk of PPCM, particularly if delivery was at term. The role of PPCM as a complication of HELLP syndrome is clinically compelling and warrants further investigation in a prospective sample of patients.