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Dyslipidaemia is known as the disorder of lipoprotein metabolism involving inadequate levels of lipoproteins. The condition is characterised by increased levels of total cholesterol, low-density lipoproteins (LDL) and triglycerides along with decreased levels of high-density lipoproteins (HDL).1

Pregnancy commonly brings about changes in lipid metabolism that are essential for the growth of the foetus. However, evidence suggests that there are increasing instances of pre-pregnancy and gestational dyslipidaemia.2 This article focusses on the risks and the treatment of dyslipidaemia in pregnant women.

What is dyslipidaemia?

Several changes occur in LDL during dyslipidaemia. These changes are marked by the presence of small, dense LDL particles, increased levels of triglycerides and decreased concentrations of HDL, which are also a feature of metabolic syndrome and a major risk factor for coronary heart disease.1,3

What is the role of lipid metabolism during pregnancy?

Changes in hormones during pregnancy result in physiological changes in lipid metabolism. During pregnancy, LDL levels start rising during the 36th week, HDL concentration increases at the birth of the baby by 15-24%, while the levels of triglycerides start increasing from the 14th week and their concentrations are tripled by the 36th week of pregnancy. These are the normal changes that are beneficial for the growth of the foetus4 as cholesterol plays a vital role in the formation of cell membranes and membrane integrity. Cholesterol is also an antecedent of the hormones, vitamin D and bile acids and is taken up from the maternal circulation or produced endogenously.5

What is the risk associated with dyslipidaemia during pregnancy?

Cholesterol levels are elevated during dyslipidaemia. Exposure of the foetus to high levels of cholesterol and other oxidative products of cholesterol can predispose the child to atherosclerosis later in life. Studies demonstrate the presence of fatty streaks in the foetus of mothers with dyslipidaemia during pregnancy.5 Since obesity is linked to dyslipidaemia,5 with the greater prevalence of obesity observed in recent times, the number of pregnant women with derangement in their lipid profiles has increased.2

Some other findings show that there are two major disorders associated with lipoprotein metabolism during pregnancy: severe hypertriglyceridaemia (SHTG) and elevated levels of cholesterol.4 SHTG is a major risk factor for the development of pancreatitis in pregnancy. Elevated cholesterol levels marked by the elevated concentration of LDL and other lipoproteins and lowering of HDL can lead to atherosclerosis, which may cause hepatosplenomegaly (enlargement of liver and spleen), abdominal pain, dyspnoea (shortness of breath), peripheral neuropathy (damaged nerves), memory loss and dementia.5 

The foetus may be affected in the following ways:4

  • Resistance to the blood flow from uterus to the placenta, thereby leading to foetal growth restriction in the uterus.
  • Retardation occurs in foetal development due to the slowing of blood flow in the umbilical vessels.
  • Hyperlipidaemia may induce acute atherosclerosis in the blood vessels of the uterus and placenta, which along with hypercoagulation (clot) may cause a blood clot or reduced blood supply to the placenta, which in turn may lead to inadequate supply of oxygen and nutrients to the foetus and cause harm to the foetus.

How is dyslipidaemia in pregnancy treated?

Considering the risks, the mother and foetus are exposed to due to dyslipidaemia during pregnancy, prompt treatment is essential. The following options are available:5

  • The levels of triglycerides should be brought under control with the use of fish oil, medium chained triglycerides, sunflower oil, niacin, gene therapy and plasmapheresis to control
  • Cholesterol could be controlled with bile sequestering agents 
  • Take insulin if you have diabetes
  • Lifestyle and dietary habits should be changed to reduce cholesterol levels
  • Regular follow-up in every trimester or within six weeks and monitoring of lipid profile

Dyslipidaemia in pregnancy needs to be better understood and treated with safe medicines by the evaluation by the doctor to avoid any harm to the foetus. Regular vigilance is necessary to keep the risk of cardiovascular diseases away. Prompt treatment under the guidance of a doctor can help you have a safe pregnancy.5

Regular follow-ups and right treatment along with a proper diet can help keep you and your baby safe and keep the cholesterol away.

References:

  1. Ahmed SM, Clasen ME, Donnelly JF. Management of dyslipidemia in adults. Am Fam Physician. 1998:57(9):2192–204.
  2. Mukherjee M. American College of Cardiology. Dyslipidaemia in pregnancy [Internet]. [updated 2014 May 19; cited 2019 Dec 10]. Available from: https://www.acc.org/latest-in-cardiology/articles/2014/07/18/16/08/dyslipidemia-in-pregnancy.
  3. Thompsom GR. Management of dyslipidaemia. Heart. 2004 90:949–55. doi: 10.1136/hrt.2003.021287t.
  4. Russi G. Severe dyslipidemia in pregnancy: the role of therapeutic apheresis; Transfus Apher Sci. 2015. Dec;53(3):283-7. doi: 10.1016/j.transci.2015.11.008.
  5. Wild R, Weedin EA, Wilson D. Dyslipidemia in pregnancy. Cardiol Clin. 2015 May;33(2):209-15. doi: http://dx.doi.org/10.1016/j.ccl.2015.01.002/.

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