Published online Sep 25, 2022. doi: 10.5501/wjv.v11.i5.310
Peer-review started: August 12, 2022
First decision: August 29, 2022
Revised: September 7, 2022
Accepted: September 13, 2022
Article in press: September 13, 2022
Published online: September 25, 2022
Processing time: 42 Days and 20.1 Hours
Pregnant women are among the high-risk population for severe coronavirus disease 2019 (COVID-19) with unfavorable peripartum outcomes and increased incidence of preterm births. Hemolysis, the elevation of liver enzymes, and low platelet count (HELLP) syndrome and severe preeclampsia are among the leading causes of maternal mortality. Evidence supports a higher odd of pre-eclampsia in women with COVID-19, given overlapping pathophysiology. Involvement of angiotensin-converting enzyme 2 receptors by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for the entry to the host cells and its downregulation cause dysregulation of the renin-angiotensin-aldosterone system. The overexpression of Angiotensin II mediated via p38 Mitogen-Activated Protein Kinase pathways can cause vasoconstriction and uninhibited platelet aggregation, which may be another common link between COVID-19 and HELLP syndrome. On PubMed search from January 1, 2020, to July 30, 2022, we found 18 studies on of SARS-COV-2 infection with HELLP Syndrome. Most of these studies are case reports or series, did not perform histopathology analysis of the placenta, or measured biomarkers linked to pre-eclampsia/HELLP syndrome. Hence, the relationship between SARS-CoV-2 infection and HELLP syndrome is inconclusive in these studies. We intend to perform a mini-review of the published literature on HELLP syndrome and COVID-19 to test the hypothesis on association vs causation, and gaps in the current evidence and propose an area of future research.
Core Tip: Observational studies showed an increased prevalence of preeclampsia and hemolysis, elevated liver enzymes and low platelet (HELLP) syndrome in pregnant women with coronavirus disease 2019 (COVID-19). Despite a possible pathophysiology linkage between COVID-19 and HELLP syndrome, the evidence on temporality to prove a causal association between infection with severe acute respiratory syndrome coronavirus 2 and HELLP syndrome is lacking.