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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 Future Cardiovascular Disease? – PowerPoint PPT presentation

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Title: Dyslipidemia in Pregnancy: To Treat or Not To Treat?


1
Dyslipidemia in Pregnancy To Treat or Not To
Treat?
  • Josephine Carlos-Raboca, MD,FPCP, FPSEM
  • Makati Medical Center

2
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

14
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

28
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

29
Preeclampsia
  • Associated with future
  • Cardiovascular Disease
  • Smith, Lancet 2001
  • Stroke
  • Wilson, BMJ 2003
  • Metabolic syndrome
  • Kaaga, Ob Gy 1995

30
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?
35
Fetal atherosclerosis
  • Recent studies show fatty streaks present in
    fetal aorta are related to maternal
    hypercholesterolemia

36
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

37
Maternal Dyslipidemia To Treat Or Not To Treat?
  • Yes to prevent complications
  • Therapeutic Options?

38
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
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