Elevated lipoprotein(a) and adverse pregnancy outcomes

Lipoprotein(a) [Lp(a)] is gaining attention as a potential marker for adverse pregnancy outcomes, in addition to its well-established role in cardiovascular disease. This review explores the evolving understanding of Lp(a) in pregnancy, focusing on its links to hypertensive disorders of pregnancy, gestational diabetes mellitus, fetal growth restriction, and preterm birth, while also addressing diagnostic and management challenges. During pregnancy, Lp(a) levels rise substantially, nearly doubling between weeks 10 and 35. Although this increase is universal, its clinical implications are unclear. Lp(a) exerts pro-inflammatory, pro-thrombotic, and pro-atherogenic effects, the mechanisms of which are discussed in detail in the body of this review. However, research into Lp(a)'s specific role in increasing the risk of adverse pregnancy outcomes, such as hypertensive disorders of pregnancy, has produced mixed results, highlighting the need for further investigation. Routine screening for Lp(a) during pregnancy is not standard practice, though some experts suggest that it could be beneficial, particularly for high-risk pregnant people. Similar to managing other cardiovascular disease risk factors, managing elevated Lp(a) during pregnancy requires a comprehensive approach, from preconception counseling to lifestyle adjustments such as improving diet, increasing physical activity, and quitting smoking. Pharmacological options like statins and proprotein convertase subtilisin/kexin type 9 inhibitors have shown promise in non-pregnant populations, but their safety during pregnancy remains a concern, limiting their use. Further research is needed to clarify Lp(a)'s role in adverse pregnancy outcomes and to identify safe, effective treatments for managing elevated Lp(a) levels before and during pregnancy.