Heterozygous FH in pregnancy does not increase fetal adverse outcomes but homozygous FH poses high maternal morbidity requiring individualized care.
What are the optimal management strategies and risks associated with familial hypercholesterolemia during pregnancy?
Pregnancy in familial hypercholesterolemia requires individualized management to balance maternal ASCVD risk with fetal safety, highlighting a critical gap in care as statins remain contraindicated despite emerging safety data.
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Purpose of review Familial hypercholesterolemia (FH) in pregnancy poses several challenges, requiring a delicate balance between maternal atherosclerotic cardiovascular disease (ASCVD) risk and foetal safety. The review synthesizes current evidence, research gaps, evaluates emerging data on existing lipid-lowering strategies and highlights evolving guideline recommendations. Recent findings Pregnancy in women with FH has unique considerations for both the mother and the foetus. Data from registries and observational studies indicate that heterozygous FH (HeFH) does not significantly increase foetal adverse outcomes such as congenital malformation, prematurity, low birth weight although there may be a predisposition to early atherogenesis. Maternal risks include preeclampsia, endothelial dysfunction and prothrombotic tendency. Pregnant women with homozygous FH (HoFH) carry a substantially higher morbidity. Management strategies emphasize the need for timely, multidisciplinary care, dietary optimization, selective use of low-dose statins in high-risk HoFH and LDL apheresis for severe cases. Despite emerging evidence of lack of a major teratogenic risk, statins remain contraindicated in most guidelines, during pregnancy and lactation. Time off statins represent a critical gap in ASCVD prevention. Summary Pregnancy in FH requires a nuanced, stage-specific, individualized approach. Expansion of FH pregnancy registries and prospective studies is essential to guide evidence based care and refine recommendations for the future.
Ramanathan et al. (Thu,) reported a other. Heterozygous FH in pregnancy does not increase fetal adverse outcomes but homozygous FH poses high maternal morbidity requiring individualized care.