Severe familial hypercholesterolemia and pregnancy: handle with care

Pregnancy is a period of both physical and hormonal changes that have the function of ensuring the correct development of the child and providing for its needs, as well as preparing the mother for childbirth and breastfeeding. However, the physiological changes that occur during pregnancy may favor a predisposition to metabolic disorders.

In the case of a woman affected by familial hypercholesterolemia, a pregnancy must obviously be planned with particular attention. Pregnancy involves important maternal physiological changes that lead to an exacerbation of maternal hypercholesterolemia, aggravated by the current practice of interruption or reduction of the dosage of lipid-lowering therapy during pregnancy and breastfeeding, which can have an impact on short- and long-term cardiac morbidity and mortality.

We present our experience based on clinical cases of three women, two with homozygous familial hypercholesterolemia (FH) and one with severe heterozygous FH. Their history is very different, underlining how personalized clinical management is essential in pregnancy.