INFORMATION FOR WOMEN WHO HAVE HIGH CHOLESTEROL DURING PREGNANCY OR BREASTFEEDING
What is high cholesterol?
High cholesterol refers to the concentration of cholesterol in your blood being higher than it should be. You will hear doctors refer to high cholesterol as hypercholesterolemia or, sometimes, type II dyslipidemia. When people talk about cholesterol levels, they really mean the concentration of special carrier vehicles that surround cholesterol as they transport it through your blood. The carrier vehicles are known as lipoproteins and there are several types. When doctors are talking about your blood cholesterol only (as opposed to your cholesterol plus other substances, namely triglycerides and chylomicrons), the two types of lipoproteins mentioned are called low-density lipoprotein (LDL) and high-density lipoprotein (HDL).
Both HDL and LDL carry cholesterol in the blood, but you will often hear HDL called good cholesterol and LDL called bad cholesterol. This is because damage to blood vessels, leading to disease in the heart, brain, and other organs, is associated with high levels of LDL as well as with low HDL levels. The health of your blood vessels, therefore, relates both your total cholesterol level (the sum of your LDL plus HDL), your LDL level by itself, and the ratio of HDL to LDL. Thus, if somebody says that you have high cholesterol, it means that either your LDL cholesterol (bad cholesterol) is too high, or your total cholesterol is too high. Ideally, your LDL cholesterol should be below 100 mg/dL and your total cholesterol below 200 mg/dL. High cholesterol is defined as LDL cholesterol of 160 mg/dL or above, or total cholesterol of 240 or above. In between the 100 and 160 for LDL, and the 200 and 240 for total cholesterol, you are considered borderline. Additionally, your risk for disease is elevated, if your HDL is too low (below 40 mg/dL), whereas a high HDL can compensate for an LDL that is borderline high.
Since high cholesterol is a very common condition, it often occurs together with pregnancy.
How common is high cholesterol during pregnancy?
An estimated 1 in every 200-500 pregnancies is in women with a condition called “familial hypercholesterolemia (FH).” In this condition, the persons genetic makeup alone leads to very high levels of total cholesterol and LDL, and also of another type of lipoprotein called VLDL. However many more people, including pregnant women, suffer from high blood cholesterol resulting from a combination of genetic factors, lifestyle (dietary factors and inadequate exercise), and environmental factors.
How is high cholesterol during pregnancy diagnosed?
Your LDL, HDL, and total cholesterol values are obtained from a blood sample that is drawn from you following an overnight fast. High cholesterol is defined as LDL cholesterol of 160 mg/dL or above, or total cholesterol of 240 mg/dl or above. If your cholesterol level comes out much higher than these levels, you might be offered genetic tests for familial hypercholesterolemia (FH). Also, since dyslipidemia is very much related to diabetes type 2 and gestational diabetes (diabetes occurring specifically during pregnancy), you will be tested for blood sugar levels, and also for a value called hemoglobin A1C (HbA1c). If HbA1c is higher than normal, this indicates that your blood sugar level has been high over a long period.
Does high cholesterol cause problems during pregnancy?
It can. A mothers blood chemistry is altered during pregnancy, making gestational diabetes fairly common. Diabetes in combination with high cholesterol can be particularly damaging to blood vessels, which can lead to serious problems both in the mother and the developing baby.
Does high cholesterol during pregnancy cause problems for the baby?
There are risks, both in the short-term and the long-term. Just as high cholesterol can damage blood vessels of the heart, brain, and other organs, it can also damage the blood vessels that supply the uterus and the blood vessels within the uterus that supply the placenta. This could lead to the loss of the pregnancy. Additionally, high cholesterol can contribute to a rise in the mothers blood pressure, and this is thought to be a risk factor for the development of a serious pregnancy complication known as preeclampsia. Long-term, high maternal cholesterol has been suggested to increase the risk of neural tube defects (parts of the babys brain or spinal cord may be left without a full covering of bone).
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the high cholesterol. These can be significant
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat high cholesterol during pregnancy?
Various medications are given to treat high cholesterol. Most of these drugs must be stopped during pregnancy. An exception is a group of medications known as bile acid sequestrants.
Who should NOT stop taking medication for high cholesterol during pregnancy?
Women who suffer from familial hypercholesterolemia (FH) usually must continue with some type of medication, such as a bile acid sequestrant. The reason is that, in FH, the cholesterol level can get so high that the mothers life and the babys life are both in danger.
What should I know about choosing a medication for my high cholesterol during pregnancy?
The first choice of treatment for most cases of high cholesterol is statins. These drugs can lower your blood cholesterol by amounts ranging from under 30 percent to above 50 percent, depending on which statin drug is selected. However, these drugs must be stopped during pregnancy and breastfeeding. Other classes of medications that are used to lower cholesterol but that must be stopped during pregnancy include cholesterol absorption inhibitors, nicotinic acid, and PCSK9 inhibitors. However, bile acid sequestrant medications are considered safe for the fetus.
You may find Pregistrys expert reports about the individual medications to treat high cholesterol here. Additional information can also be found in the sources listed at the end of the report.
What should I know about taking a medication for my high cholesterol when I am breastfeeding?
All the groups of cholesterol-lowering drugs that are of concern during pregnancy also are discouraged during breastfeeding although, once you give birth, you can resume any drug and simply not breastfeed. However, bile acid sequestrants may be taken while breastfeeding, as they do not even get absorbed from the mothers gastrointestinal tract into her blood.
What alternative therapies besides medications can I use to treat my high cholesterol during pregnancy?
Lifestyle modification can lower your cholesterol and, thus, is always a part of the treatment, whether you are pregnant or not. The lifestyle changes include dietary and exercise components. You should increase your consumption of fruits, vegetables, and high-fiber grains, replace high-fat meats and high-fat dairy products. Such a diet can include lean poultry and legumes. The diet can also include foods high in friendly fat, such as nuts, certain vegetable oils, olive oil, and plenty of fish. This is known
as the Mediterranean diet (or the modified Mediterranean diet) and whats vital about it is that you limit sugars, saturated fat, trans fat, and red meat. You should also take care to control the amounts of food that you consume and consider dividing your eating into 4-5 light meals spread throughout the day, instead of 2-3 large meals. As for physical activity, you should perform moderate to vigorous aerobic activity, which during pregnancy can be achieved through activities such as long walks or swimming, but other types of exercise are also possible within reason. You should exercise for at least 40 minutes 3-4 times per week.
Another option for lowering cholesterol is called LDL apheresis, which can be used in pregnant patients with severe familial hypercholesterolemia when their LDL level rises to 300 mg/dL or higher.
What can I do for myself and my baby when I have high cholesterol during pregnancy?
Work with your doctors to improve your diet and exercise program and to adjust your medications such that you are not taking any cholesterol-lowering drug other than bile acid sequestrants.
Resources for high cholesterol in pregnancy:
For more information about high cholesterol during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:
- American Heart Association: Cholesterol Lowering Drugs.
- American Heart Association: What Your Cholesterol Levels Mean.