Heparin-mediated extracorporal LDL-precipitation (HELP)-apheresis has the potential to prolong pregnancy in severe preterm preeclampsia.

10-year follow-up of preterm infants exposed to maternal HELP-apheresis in utero showed favorable outcomes.

Comparing apheresis-treated to unexposed control infants, no difference in neurodevelopmental outcomes and growth trajectories was detected.

Preterm preeclampsia represents a significant contributor to maternal and fetal/neonatal morbidity and frequently results in preterm delivery. The Freiburg preeclampsia HELP (heparin-mediated extracorporal LDL-precipitation)-Apheresis study was a pilot study designed to investigate the effects of HELP-apheresis on the clinical and laboratory outcome of severe preeclampsia. Results of the study were promising, indicating that this approach may be beneficial in prolonging pregnancy. Nevertheless, the long-term effects on the children were not determined yet.

Long-term outcomes of the 12 children from the Freiburg preeclampsia HELP-Apheresis study (6 from the intervention group, 6 from the control cohort) were assessed using Bayley Scales at 24 months corrected age and a parent questionnaire (CBCL4-18) at approximately 10 years of age.

Children exposed to maternal HELP-apheresis demonstrated a generally favorable outcome in terms of Bayley Scales, school and social skills, as well as body growth at 10 years of age. No significant difference between the intervention and the control cohort was observed. The results were consistent with larger cohorts studying the long-term outcomes of very low birth weight infants.

Prenatal exposure to maternal HELP-apheresis did not have any negative effect on the long-term outcome of very preterm infants born to mothers with severe preeclampsia. However, a potential beneficial impact of the intervention due to the prolongation of pregnancy would have been too small to be discernible. The results of this study justify further investigation of lipid-apheresis as a possible treatment option in severe, very preterm preeclampsia.

Lipid-apheresis

Preeclampsia

Preterm birth

Long-term neonatal outcome

© 2025 The Authors. Published by Elsevier B.V. on behalf of International Society for the Study of Hypertension in Pregnancy.