23
Total-C and TG levels in women with normal pregnancies
should not exceed 250 mg/dL. If they do, the clinician
should consider and evaluate preexisting or acquired
medical or obstetrical conditions, including hypothyroidism,
chronic kidney disease, liver disease, uncontrolled diabetes
mellitus, or preeclampsia.
A Moderate
Hypercholesterolemia during pregnancy and breast feeding,
especially in women with FH, may be treated with bile acid
sequestrants.
B Low
Women with FH may be treated with LDL apheresis during
pregnancy and breast feeding.
A Low
Very high TG (≥500 mg/dL) may be treated during
pregnancy with diet/lifestyle management plus prescription
omega-3 fatty acids. Fenofibrate or gemfibrozil may be
administered beginning early in the second trimester, based
on clinical judgment. ese agents may be used during breast
feeding.
B Low
PCOS is a high-risk condition for dyslipidemia, metabolic
syndrome, and obstetrical complications of preeclampsia,
hypertension, diabetes, and premature delivery. All patients
with PCOS, regardless of age, should undergo initial lipid
and diabetes screening. More frequent follow-up screening is
recommended, even if initial values are normal.
A Moderate
e approach to risk stratification and atherogenic
cholesterol treatment goals for women with PCOS should be
the same as described for all patients with dyslipidemia in the
NLA Recommendations for Patient-Centered Management
of Dyslipidemia – Part 1.
A Moderate
erapeutic management of dyslipidemia in PCOS should
focus on diet, exercise, and lipid-lowering medication, if
needed. Use of metformin should also be considered to lower
TG and reduce insulin resistance.
A Moderate
Contraceptive choice affects dyslipidemia. Combination
oral contraceptives should generally not be used by women
≥35 years of age who smoke because of additive stroke and
MI risk.
A High
Sex HT should not be used for prevention or treatment of
ASCVD.
A High
Menopausal sex HT is an option for treatment of significant
menopause symptoms during menopause transition for
women at minimal risk for ASCVD.
A Moderate
Chart 7. Pregnancy to Menopause (cont'd)
Recommendations
Strength Quality
