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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Preconception Counseling for Women with Diabetes and Hypertension
Sponsored by The Indian Health Service Clinical Support Center
Step 7. Hyperlipidemia
Case Scenario #3
IN is a 22 y/o nullipara who hyperlipidemia. There is a strong family history of coronary artery disease, and her cholesterol has not been able to be brought below 250 mg/dL despite diet and exercise. Her triglycerides and LDL are also elevated, but her HDL is normal. Her BMI is 34 kg/M2. She desires to become pregnant within the year and does not wish to use any method of contraception. Would it be appropriate to start her on an HMG-CoA reductase inhibitor (a “statin”) at this time?
Discussion
Ms. N, the woman with hyperlipidemia, also presents a common management dilemma.
Physiology
The hyperlipidemia of pregnancy is accompanied by an increase in the plasma cholesterol esterification rate for the first half of gestation. During the second half of gestation there is little change in the plasma cholesterol esterification rate, in the presence of a continuing increase in plasma lipid levels. (Ordovas 1984)
Total cholesterol is increased by up to 50 per cent during pregnancy, and triglycerides increase three-fold by term. (Interestingly, HDL is unaffected.) The primary modulators of these changes are estrogens, insulin, and lipoprotein lipase. Hyperlipidemia allows the mother to save glucose and energy for the fetus, and is usually reversible postpartum.
