Dyslipidemia in Pregnancy: To Treat or Not To Treat?

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Dyslipidemia in Pregnancy To Treat or Not To
Treat?

• Josephine Carlos-Raboca, MD,FPCP, FPSEM
• Makati Medical Center

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Topics

• Lipid Metabolism in Normal Pregnancy
• Hyperlipidemia in insulin resistant states
• obesity
• gestational diabetes
• diabetes mellitus
• Placental transfer of lipids
• Effects of Maternal dyslipidemia
• Therapeutic Options

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Physiologic Lipid Metabolism

• Triglyceride increases by 200-300
• Total cholesterol increases by 20-30
• LDL increases by 44
• HDL increases slightly and remains high or in
  some goes down but basically normal
• VLDL/TG ratio is appropriate for TG level
• Inherent adaptation to self regulate and self
  protect against atherogenic lipid profile

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Dyslipidemia Insulin Resistance

• Obese
• GDM
• DM

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Effects on Mother Preeclampsia

• Placental vessels had atherosclerotic like
  changes with foam cells and fibrinoid material
• Sattar, Br J OB Gy 1996
• Lipid peroxidation products are high
• Branch, Lancet 1994

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Effects on Mother Preeclampsia

• Higher endothelin levels
• Clark, Am J Ob Gy 1992
• Lipids 1.5 to 2x higher than in normal pregnancy
  
• Murai, Metabolism 1997

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Preeclampsia

• Associated with future
• Cardiovascular Disease
• Smith, Lancet 2001
• Stroke
• Wilson, BMJ 2003
• Metabolic syndrome
• Kaaga, Ob Gy 1995

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Pancreatitis

• High triglyceride levels can lead to pancreatitis
• which can be lethal to both mother and fetus.

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Fetal Growth in GDM and Overweight/Obese Women
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Premature Birth

• Dyslipidemia( total chol gt220 and TG gt140) was
• associated with spontaneous premature birth
• 
  Catov, Ame J of Epid 2007

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Future Cardiovascular Disease?
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Fetal atherosclerosis

• Recent studies show fatty streaks present in
  fetal aorta are related to maternal
  hypercholesterolemia

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Fate of Early Lesions in Children (FELIC)

• 156 children 1-13 y/o
• Atherosclerosis progress faster in those whose
  mothers who were hypercholesterolemic during
  pregnancy
• Hypothesis lipid levels exert constitutive
  changes on gene expression in arterial lining and
  influence later CVD
• Napoli, Lancet 1999

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Maternal Dyslipidemia To Treat Or Not To Treat?

• Yes to prevent complications
• Therapeutic Options?

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Low fat diet

• Low fat diet as in non pregnant can lower
  cholesterol by 20
• 300mg cholesterol/day
• total fat lt30
• Saturated fatlt10
• PUFA 10-15
• MUFA lt10
• Fard Nooshin et al Euro Heart J 2001

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Maternal Recreational Activity

• Any physical activity vs. none
• lower Triglyceride by 12.7 mg/dl
• lower total cholesterol by 5.6 mg/dl
• no association with HDL

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Maternal Dyslipidemia To Treat Or Not To Treat?

• Window of opportunity in screening future disease
  and thus primary prevention
• How best to intervene?
• Weight reduction
• Dietary advise
• exercise