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4.2.8.4. Management of Dyslipidemia in Persons Planning
Pregnancy, During Pregnancy, or While Lactating
COR LOE
Recommendations
1 C-LD
1. Persons of childbearing age with hypercholesterolemia who
are not at high risk for ASCVD and plan to become pregnant
should stop statin therapy 1 to 2 months before attempting
to become pregnant or as soon as pregnancy is discovered to
avoid uncertain risks to the fetus.
2a B-NR
2. In pregnant or lactating individuals with HoFH, it is
reasonable to undergo lipoprotein apheresis to lower LDL-C
and reduce ASCVD risk.
2a B-NR
3. In pregnant individuals with severe fasting hypertriglyceridemia
(TG ≥500 mg/dL [5.7 mmol/L]), the use of fibrates (after the
first trimester) or high-dose omega-3 ethyl esters is reasonable
as an adjunct to lifestyle management to lower TG levels and
reduce the risk of pancreatitis.
2a C-EO
4. In pregnant or lactating individuals with
hypercholesterolemia but without hypertriglyceridemia, the
use of bile acid sequestrants is reasonable to lower LDL-C.
2b C-LD
5. In pregnant individuals with FH or a history of clinical
ASCVD, it may be reasonable to continue statin therapy to
lower LDL-C and ASCVD risk following an individualized
benefit-risk discussion.*
* e use of a hydrophilic statin, such as pravastatin, should be considered if the benefit of
continued statin therapy is deemed greater than potential risk based on results from available
clinical trials.
