High Cholesterol In Pregnancy

Cholesterol is a type of fat made by our bodies or ingested in our diet. There are many reasons why we may have high cholesterol levels, such as eating fatty foods or our genetics. There are several different types of cholesterol – some good and some bad.

A total cholesterol level of less than 200 mg/dL is considered normal for the general population.

Your body makes more cholesterol during the second and third trimesters of pregnancy to support the healthy growth of babies. Many women have higher cholesterol levels during the later phases of pregnancy.

Cholesterol levels are expected to remain high for a few weeks after giving birth before decreasing to your baseline levels.

Causes of high cholesterol during pregnancy

There are numerous causes of high cholesterol during pregnancy. Cholesterol increases temporarily because it is needed to make estrogen and progesterone hormones. These are necessary to keep you and your baby healthy throughout pregnancy.

Diets high in saturated fat and insufficient physical activity can also cause high cholesterol.

You may also have inherited a genetic condition called familial hypercholesterolemia (FH), which causes a person to have high baseline cholesterol levels.

Symptoms of high cholesterol

It is uncommon to experience symptoms caused by high cholesterol.

The only way to detect a high cholesterol level is through a lipid profile blood test, which measures different types of fat in your blood. Common types of fat include cholesterol and triglycerides.

When to check your cholesterol

In general, measuring cholesterol levels can reflect your overall heart health and help health professionals decide if interventions would benefit you.

However, monitoring your cholesterol and triglyceride levels is not recommended while pregnant. As cholesterol levels rise during pregnancy, they would not reflect the typical fat levels in your blood. They would be less reliable indicators of your overall health and will only cause unnecessary emotional stress.

Adhering to the following testing time frames would allow you to receive the most reliable blood cholesterol results:

• You can monitor your blood cholesterol levels after giving birth. Wait for at least six to eight weeks after your baby is born before checking your cholesterol levels again.

• If breastfeeding, please wait until you have stopped before checking your blood cholesterol levels.

• If you had recent surgery, including a cesarean section, wait for a few months until you have fully recovered before checking your cholesterol levels.

Potential dangers of high cholesterol

Having temporarily high cholesterol levels during late pregnancy is expected and usually harmless for mothers and their babies.

However, developing high cholesterol within the first trimester can sometimes lead to a greater risk of serious health problems.

High cholesterol may cause blood vessels to block up, which can lead to:

• High blood pressure

• Preterm birth

• Heart attack

• Stroke

The health risks depend on the expectant mother’s health status before her cholesterol levels rise. This includes factors like smoking, which increases a person's heart disease and stroke risk. This is because smoking damages blood vessels.

Lifestyle modifications to lower cholesterol levels

If you have high cholesterol, lifestyle modifications are often enough to keep control of it. This involves increasing physical activity as tolerated and making long-term dietary changes.

Aim for two and a half hours a week of moderate exercise to improve your heart health and reduce cholesterol levels. Consider gentle, brisk walking if your usual workout routine gets too challenging as your pregnancy progresses.

Reduce the saturated or trans fats in your diet and increase your intake of fresh fruits and vegetables. For example, unsaturated fats in moderation is recommended in the form of avocados or nuts.

Diet alone might be enough to control moderate increases in blood cholesterol. Hence, most expectant mothers do not need to start taking cholesterol-lowering medications.

Taking cholesterol-lowering medicines during pregnancy

During pregnancy, your baby receives nutrients from your bloodstream through a net of blood vessels that form the placenta. Common cholesterol-lowering medications like statins may cross the placenta during pregnancy and harm your baby.

Although this risk is small, these medications should be stopped at least three months before trying to conceive. This provides enough time for your body to clear out these medications and reduce potential harm to your baby’s growth.

It is also important to avoid these medications throughout your entire pregnancy and while breastfeeding. It is safe to start taking cholesterol-lowering medications again after you have stopped breastfeeding.

In cases where cholesterol levels are unacceptably high, safer cholesterol-lowering alternatives such as resins are prescribed for women with a high risk of heart disease.

Resins are bile acid sequestrants that increase your body’s ability to use up cholesterol. They do not enter your bloodstream or breast milk and are safe for use during pregnancy and breastfeeding.

When you should see a doctor

Familial hypercholesterolemia (FH)

If you have a known history of FH, you should have regular appointments with specialists such as cardiologists and obstetricians — doctors who specialize in caring for your heart and overall health as a woman.

FH increases a person's risk of early heart disease. Hence, women with FH would benefit from extra monitoring before and throughout pregnancy to protect their heart health.

Medications review

If you are currently taking cholesterol-lowering medications, please discuss this with your healthcare providers. You may have to stop taking them temporarily or switch to a safer medication if strict cholesterol control is required.

Lifestyle recommendations

Your doctor can also refer you to their allied health colleagues to support you with making lifestyle modifications to optimize your health. This includes connecting with dieticians and physiotherapists who can provide helpful information about healthy diets or physical activity.

The lowdown

Raised cholesterol levels are expected during pregnancy. Given this, it is often not recommended to check your cholesterol blood levels at this time. Medications are not usually necessary to control it. Lifestyle modifications are sufficient for most expectant mothers.

If you have established heart disease, FH, or high cholesterol before becoming pregnant, please seek medical advice regarding treatment to manage cholesterol levels during pregnancy.