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. 2023 Jun;63(3):402-408.
doi: 10.1111/ajo.13657. Epub 2023 Mar 8.

Familial hypercholesterolaemia in pregnancy: Australian case series and review

Mary Nangrahary  1   2 , Dorothy F Graham  1   3 , Jing Pang  3   4 , Wendy Barnett  4 , Gerald F Watts  3   4
Affiliations

Familial hypercholesterolaemia in pregnancy: Australian case series and review

Mary Nangrahary et al. Aust N Z J Obstet Gynaecol. 2023 Jun.

Abstract

Background: Familial hypercholesterolaemia (FH) is associated with a significant increase in the risk of premature coronary artery disease. Pregnancy is likely a vulnerable time for atherosclerosis progression, with a physiological rise in low-density lipoprotein cholesterol (LDL-C) further exaggerated by the discontinuation of cholesterol-lowering therapy.

Materials and methods: A retrospective review was undertaken of 13 women with familial hypercholesterolemia who were managed during pregnancy between 2007 and 2021 by a multidisciplinary team following individualised risk assessment.

Results: Overall, pregnancy outcomes were good, with no maternal or fetal complications, including congenital abnormalities, maternal cardiac events or hypertensive complications. Loss of statin treatment time ranged between 12 months and 3.5 years resulting from the accumulation of the preconception, pregnancy and lactation periods and was magnified in women having more than one pregnancy. Of seven women treated with cholestyramine, one developed abnormal liver function with an elevated international normalisation ratio which was corrected with vitamin K.

Conclusion: Pregnancy is associated with prolonged cessation of cholesterol-lowering therapy, a concern with respect to the risk of coronary artery disease in FH. Continuation of statin therapy up to conception and even during pregnancy in patients at higher risk of cardiovascular disease may be justified, especially with increasing evidence supporting the safety of statin therapy during pregnancy. However, more long-term maternal and fetal data are required for the routine use of statins during pregnancy. Guideline-informed models of care covering family planning and pregnancy should be implemented for all women with FH.

Keywords: CT coronary angiography; cholestyramine; familial hypercholesterolaemia; pregnancy; statins.

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References

    1. Austin MA, Hutter CM, Zimmern RL, Humphries SE. Genetic causes of monogenic heterozygous familial hypercholesterolemia: a HuGE prevalence review. Am J Epidemiol 2004; 160(5): 407-420.
    1. Hu P, Dharmayat KI, Stevens CAT et al. Prevalence of familial hypercholesterolemia among the general population and patients with atherosclerotic cardiovascular disease: a systematic review and meta-analysis. Circulation 2020; 141(22): 1742-1759.
    1. Watts GF, Sullivan DR, Hare DL et al. Integrated guidance for enhancing the care of familial hypercholesterolaemia in Australia. Heart Lung Circ 2021; 30(3): 324-349.
    1. Humphries SE, Cooper JA, Seed M et al. Coronary heart disease mortality in treated familial hypercholesterolaemia: update of the UK Simon Broome FH register. Atherosclerosis 2018; 274: 41-46.
    1. Balla S, Ekpo EP, Wilemon KA et al. Women living with familial hypercholesterolemia: challenges and considerations surrounding their care. Curr Atheroscler Rep 2020; 22: 60.

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