Familial hypercholesterolemia in pregnancy.

Area of Science:

• Cardiology
• Genetics
• Obstetrics

Background:

• Familial hypercholesterolemia (FH) presents unique challenges during pregnancy, balancing maternal cardiovascular risk with fetal well-being.
• Existing lipid-lowering strategies require careful evaluation for safety and efficacy in pregnant FH patients.

Purpose of the Study:

• To synthesize current evidence on managing familial hypercholesterolemia in pregnancy.
• To identify research gaps and evaluate emerging data on lipid-lowering strategies.
• To highlight evolving guideline recommendations for FH pregnancy care.

Main Methods:

• Literature review of current evidence and guideline recommendations.
• Analysis of data from FH pregnancy registries and observational studies.
• Evaluation of emerging data on lipid-lowering therapies.

Main Results:

• Heterozygous FH (HeFH) shows no significant increase in adverse fetal outcomes, but may predispose to early atherogenesis.
• Maternal risks in FH pregnancy include preeclampsia and endothelial dysfunction.
• Homozygous FH (HoFH) significantly increases maternal morbidity; management includes diet, selective low-dose statins, and apheresis.
• Statins are generally contraindicated during pregnancy and lactation despite limited teratogenic risk data.

Conclusions:

• Pregnancy in FH necessitates a nuanced, individualized, and stage-specific management approach.
• Expansion of FH pregnancy registries and prospective studies is crucial for evidence-based care.
• Refining recommendations for future FH pregnancy management is essential.