Medically Reviewed by Dr. Nieca Goldberg
If you're looking to become pregnant or are already expecting, you've likely started thinking about creating the optimal conditions for a healthy pregnancy and birth. As you talk to your doctor about your reproductive health and other factors we typically associate with pregnancy, you should also pay close attention to your heart.
The hormonal changes women experience throughout their reproductive cycles can play a significant role in the onset of heart disease. Estrogen, for example, has a protective effect on the cardiovascular system, putting older women at greater risk for heart disease when their estrogen levels naturally decrease in menopause. Conversely, during pregnancy, cholesterol levels begin to rise in the second trimester to support healthy fetal development, then drop in the postpartum period.
For many pregnant women, this temporary rise in cholesterol levels doesn't pose a problem. Women who had high cholesterol before becoming pregnant, however, face a higher risk of long term cardiovascular issues. In pregnancy, high cholesterol raises the risk of preeclampsia, a dangerous condition that occurs in the second or third trimester and is characterized by high blood pressure. Untreated preeclampsia can lead to serious health risks for mother and baby, and in some cases could cost a mother her life. High levels of low-density lipoprotein, or LDL cholesterol, and elevated triglycerides have been associated with an increased risk for preeclampsia and high blood pressure during pregnancy.
This is why it's imperative to start thinking about your heart health before you have your baby. Managing your cholesterol before you become pregnant can not only improve your pregnancy outcomes, it can set a foundation for a lifetime of cardiovascular health. Cholesterol levels are important indicators of your heart health, and elevated levels put you at risk for heart disease and stroke. Nearly 1 in 3 American adults has high cholesterol, and research shows that women tend to have higher cholesterol than men due to higher estrogen levels in their childbearing years. That factor puts women at greater risk of heart disease, the leading cause of death for women in the United States.
Health care providers don't regularly check cholesterol in pregnant women because they expect to find lipid changes to support fetal growth, but if your care team knows that high cholesterol was part of your health profile before pregnancy, cholesterol management can become part of your prenatal and postpartum care plan.
Take a proactive approach by developing a care plan with your doctors. You should become aware of your personal risk factors for heart disease — whether they be lifestyle or genetic-based — make changes to improve heart health whenever possible and continue regular communication with your doctors.
Get to know your cholesterol
It's important to understand what goes into a cholesterol reading. LDL is considered the "bad" cholesterol because it builds up in the walls of the arteries, putting you at risk of a heart attack. HDL, or high-density lipoprotein, is the "good" cholesterol because of its ability to move excess cholesterol to your liver for removal. Triglycerides, a type of fat found in the blood, are also part of your lipid panel. The hormonal changes that occur during pregnancy cause LDL, triglycerides and lipid protein to rise, while making HDL levels fall. High triglycerides are also a risk factor in women for heart disease, and very high triglycerides can increase the risk of pancreatitis.
Your pre-pregnancy plan should include getting your cholesterol and blood pressure checked, and your sugar checked for diabetes. If you're sent to a cardiologist or internist for high blood pressure, sugar or cholesterol, let them know that you're planning to become pregnant so you can receive medication safe for use in pregnancy.
Cholesterol levels are a combination of lifestyle and genetics, so you can lower your LDL and triglyceride levels (and raise HDL) through diet and exercise. Diets high in sugar, starches, carbohydrates and saturated fat can lead to raised triglycerides, prediabetes, diabetes and an elevated sugar level that accompanies high triglycerides. A Mediterrean diet or a plant-based diet can lower triglycerides, along with aerobic exercise. Talk to your doctor about lifestyle changes to help improve your overall cardiovascular health.
Some women may have familial hypercholesterolemia, which causes a significant predisposition to high cholesterol since it is inherited. The incidence is 1/220 and is actually one of the most common inherited conditions. These women can have LDL cholesterol levels above 200.
This condition could necessitate treatment during pregnancy, but managing high cholesterol during pregnancy, regardless of its cause, isn't the same as it would be for a nonpregnant patient. Statin therapy, the normal course of treatment for high cholesterol, is contraindicated in pregnancy because of the increased risk of fetal abnormalities.
The ideal time to discuss family medical history, including familial hypercholesterolemia, is at a pre-pregnancy appointment. Women who have familial hypercholesterolemia or a general history of high cholesterol before or at the start of their pregnancies might need to work closely with a lipid specialist throughout their pregnancy. Any medications used must be safe for pregnancy and for breastfeeding if the mother chooses to breastfeed after pregnancy.
Check those contraceptives
Certain oral contraceptives can be problematic for women who are hypertensive or who have high levels of triglycerides since hormonal birth control with higher levels of estrogen tend to raise triglyceride levels. Birth control that's higher in progestin, a synthetic form of progesterone, can raise LDL cholesterol levels. While birth control doesn't present a problem for most women, check your triglycerides and LDL levels to ensure they're not within an elevated range before starting birth control or when discontinuing it.
A lifetime of health
Making changes now can have lifelong benefits. Pregnancy-induced health conditions such as high blood pressure, gestational diabetes, preeclampsia and preterm birth can increase a woman's risk of heart disease later in life. If you have a family history of elevated cholesterol, your children can inherit the condition as well. Lifestyle changes you undertake now can pay dividends for your entire family.
It's never too early to think about your heart health, which includes your cholesterol. Take stock now of your diet, levels of physical activity and genetic risk factors. It can ultimately save your life.
This resource was created with the support of Esperion Therapeutics, Inc.