Researchers urge clinicians to integrate lipid management into prenatal care to mitigate elevated obstetric complications and cardiovascular risks.
Pregnant women with preexisting hyperlipidemia face significantly higher risks of obstetric complications and early cardiovascular events in the five years following delivery, according to new research presented at the American College of Cardiology’s Cardio-Obstetrics Essentials conference.
The study, which analyzed data from more than 10,000 women across 66 US health care systems, found that those with high cholesterol had elevated risks of arrhythmia, acute coronary syndrome, antepartum hemorrhage, gestational diabetes, labor and delivery complications, and hypertensive disorders of pregnancy.
“Pre-pregnancy hyperlipidemia is not just a metabolic concern; it is an early signal of increased long-term maternal health risk,” says Srijana Maharjan, MD, lead author of the study and an internal medicine resident at Allegheny General Hospital in Pittsburgh.
Multi-Institutional Analysis Reveals Striking Patterns
Using the TriNetX US Collaborative Network, researchers identified pregnant women with hyperlipidemia ages 18 and older between 2000-2020. The team employed propensity score matching to control for demographics and comorbidities when comparing outcomes to women without hyperlipidemia.
While some findings aligned with expectations, others surprised the research team. “Some outcomes were expected (higher risk of gestational diabetes and hypertensive disorders), but the clear link with arrhythmias and acute coronary syndromes within just five years postpartum was striking. It highlights that cardiovascular sequelae can manifest much earlier in this population than previously assumed,” Maharjan says.
The study found no significant differences in postpartum hemorrhage and maternal mortality risks between the groups.
Biological Mechanisms Drive Risk Elevation
The researchers identified several factors that could contribute to the heightened risks. Higher lipid levels can accelerate atherosclerosis and weaken vascular reactivity, making patients more susceptible to cardiovascular complications like arrhythmias and acute coronary syndromes.
High cholesterol is also associated with chronic systemic inflammation and promotes a hypercoagulable state, which increases the risk of developing blood clots. This mechanism could link to elevated risks of antepartum hemorrhage or obstetric embolism.
Hyperlipidemia, historically considered a midlife condition, has become more common among younger women due to rising rates of metabolic syndrome, obesity, and sedentary lifestyles.
Clinical Practice Implications
The findings suggest a need for enhanced collaboration between medical specialties in managing pregnant patients with hyperlipidemia.
“Obstetricians, internists, and cardiologists should collaborate to integrate lipid management into preconception and prenatal care,” Maharjan says.
The researchers note that young women could benefit from early lifestyle interventions and preventive therapies before conception. However, additional research is needed to determine whether lipid-lowering interventions, such as diet, exercise, or statin therapy, before or during pregnancy could mitigate these risks.
The study calls for clinicians to incorporate lipid screening into preconception care and closely monitor women with hyperlipidemia during and after pregnancy to address the elevated cardiovascular and obstetric risks identified in the research.
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