High cholesterol levels during pregnancy are necessary to make steroid hormones, such as estrogen and progesterone, which are vital for carrying a pregnancy to term. Your growing baby uses cholesterol at a high rate for healthy limb and brain development.
"There are essential partnerships that occur to support the developing pregnancy," says Dr. Julie Scott, an Ob-Gyn and medical director of labor and delivery at University of Colorado Hospital. "The mother, placenta, and fetus have specific enzymes to alter and change cholesterol into functional hormones."
Cholesterol levels increase naturally during the second trimester, peak during the third, and typically return to normal about four weeks after delivery. Scott says most cardiologists recommend that bad LDL levels be less than 100 mg/dL and the good HDL cholesterol should be greater than 60 mg/dL. When a women is pregnant, her cholesterol levels increase by 25 to 50 percent, and fortunately, HDL levels seem to increase more.
"We don't often actively treat high cholesterol in pregnant women unless there are extreme concerns for cardiovascular risk," Scott says. "Pregnancy is a small window of time in a woman's life, and the potential to cause harm to the fetus must be weighed."
High cholesterol during pregnancy can lead to pregnancy-induced hypertension, which can threaten the life of both the mother and child. Low cholesterol can lead to premature labor and low birth weight.
Studies have also shown that high cholesterol has had adverse affects on a mother's offspring, both in the womb and later in life. For example, according to the Heart and Stroke Foundation of Canada, children whose mothers had high cholesterol before becoming pregnant are five times as likely to have high cholesterol as adults.
Under normal conditions, doctors may prescribe statins to lower cholesterol levels; however, studies have shown that these cholesterol-reducing drugs are connected to abnormalities in babies' physiological development. While results are limited, Scott still recommends stopping the use of these medications if you are pregnant or are trying to conceive.
"For women who have severely elevated cholesterol levels, there is the potential to use bile acid-binding resins to reduce cholesterol," Scott says. "Unfortunately, women using these medicines tend to complain of severe gastrointestinal problems."
Instead, the best ways to maintain healthy cholesterol levels during pregnancy are to eat a well-balanced diet with fruits, vegetables, and fiber; avoid saturated fats; and exercise at a level approved by your doctor. Also keep in mind that your body only needs about 300 additional calories per day to support you and your baby.
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Cholesterol is an essential compound found in most of the body’s tissues. But at high levels, it can form plaques in the arterial walls of your heart and body, putting you at a greater risk of heart attack or stroke.
When you have your cholesterol tested, you will learn your total cholesterol level. This is further broken down into levels of HDL, LDL, and triglycerides.
High-density lipoprotein, or HDL, is also known as “good” cholesterol. Low-density lipoprotein (LDL), or “bad” cholesterol, can put you at risk of a heart attack at high levels. Triglycerides, a type of fat, are found in the blood and are used for energy.
The most current cholesterol guidelines from the American Heart Association focus on lowering the risk of heart disease rather than targeting specific cholesterol numbers.
Cholesterol levels that may place you at increased risk of heart disease or metabolic problems, such as diabetes, are:
- LDL: greater than 160 milligrams per deciliter (mg/dL)
- HDL: less than 40 mg/dL
- total cholesterol: greater than 200 mg/dL
- triglycerides: greater than 150 mg/dL
Talk to your doctor about your specific cholesterol results and the best ways to lower your risk of heart disease.
How long should I wait before checking the cholesterol levels of a woman who just stopped nursing her 12-month-old child? The patient’s menstrual periods resumed once she completely stopped nursing, so her estrogen levels are still not back to normal.—TARA DANIELLE SPURLING, FNP, Kingsport, Tenn.
Cholesterol levels should return to their pre-pregnancy levels by about six weeks postpartum regardless of whether a new mother is nursing or not. The only cholesterol parameter that differs by nursing status is HDL ratio, which can be elevated during breastfeeding. Your patient should be ready for testing now.—Lisa Stern, APRN (142-1)
From the August 01, 2010 Issue of Clinical Advisor
Being careful about how much saturated fat and cholesterol you consume in your diet will be important. Your doctor may recommend the Mediterranean diet, which is a globally accepted nutrition plan that minimizes processed foods and red meat while emphasizing vegetables, fruits, lean meats, whole grains, and legumes. This eating plan is doable on any budget and can help support lifelong health, regardless of whether you have high cholesterol. A registered dietitian can help you create the optimal meal plan for your nutritional needs.
Getting enough aerobic exercise can also help control cholesterol levels. Make sure you are getting at least 30 minutes a day of pregnancy-safe exercise, such as walking, running, or swimming. Most women can safely continue their pre-pregnancy exercise routines up to and sometimes through the third trimester of pregnancy. Talk with your heart doctor and Ob/Gyn about what exercises are safe during your pregnancy.
Other cholesterol medications
While there are other cholesterol medications besides statins, many are contraindicated for or have not been studied in pregnant or lactating patients. One is bile acid sequestrants, which are not systemically absorbed – meaning the drugs do not pass into other tissues, such as the fetus or breastmilk. However, these drugs are known to affect absorption of fat soluble vitamins (A,D,and K) and folic acid, so talk with your provider about whether you should take specific supplements as well during pregnancy.
Unfortunately, bile acid sequestrants can cause extensive side effects, such as heartburn and constipation, which already plague some pregnant patients. Bile acid sequestrants also can significantly increase a patient's triglycerides, a type of fat in the body that is associated with heart disease – and that already increases 200% to 400% during pregnancy.
PCSK9-inhibitors are another advanced drug patients often ask about. UT Southwestern researchers identified the protein PCSK9, which the drug targets to lower cholesterol. There are currently no data to support safe use of PCSK9-inhibitors during pregnancy. However, data from a recent clinical trial registry may provide safety data we can use to help guide patients in the future.