Characteristics, Physiopathology and Management of Dyslipidemias in Pregnancy: A Narrative Review

Abstract

Dyslipidemia is a significant risk factor for atherosclerotic cardiovascular disease (ASCVD). During pregnancy, physiological changes elevate cholesterol and triglyceride levels to support fetal development, which can exacerbate pre-existing conditions and lead to complications such as pre-eclampsia, gestational diabetes, and increased ASCVD risk for both mother and child. Effective management strategies are necessary, especially for pregnant women with inherited forms of dyslipidemia (i.e., familial hypertriglyceridemia, hyperchylomicronemia), where personalized dietary adjustments are crucial for successful pregnancy outcomes. Pharmacological interventions and lipoprotein apheresis may be necessary for severe cases, though their use is often limited by factors such as cost, availability, and potential fetal risks. Despite the promise of advanced therapies, their widespread application remains constrained by limited studies and high costs. Thus, a personalized, multidisciplinary approach is essential for optimizing outcomes. This review provides a comprehensive overview of current strategies and evidence-based practices for managing dyslipidemia during pregnancy, emphasizing the balance of maternal and fetal health. Additionally, it discusses the physiological changes in lipid metabolism during pregnancy and their implications, particularly for women with inherited forms of dyslipidemia.

Keywords: dyslipidemia; familial hypercholesterolemia; pregnancy.

Figure 1

Metabolic changes during pregnancy initially involve an anabolic state, marked by increased food intake and lipid accumulation. As pregnancy progresses, it shifts to a catabolic state, characterized by enhanced lipolysis and elevated maternal lipid levels in the bloodstream. These adaptations are driven by hormonal changes, particularly the rise in estrogen and progesterone.