Women With High Lp(a) & Pregnancy
Lipoprotein(a), or Lp(a), increases significantly during pregnancy. In fact, it can nearly double between 10 and 35 weeks. Women with elevated Lp(a) will experience the same increase. But since they’re starting out with higher levels they can develop very high Lp(a) during pregnancy.
One study compared Lp(a) values in 10 women with pre-eclampsia to 10 women without. They found no difference between the two groups after 32 weeks of pregnancy.1
On the other hand, a much larger study compared women with a history of pregnancy related complications including pre-eclampsia and stillbirth to women with uncomplicated pregnancies.2 It appeared that women with complications were more likely to have high Lp(a).
That being said, 1 out of 5 women have elevated Lp(a) and most of them have normal, healthy pregnancies.
Pre-eclampsia is a pregnancy related complication generally occurring after 20 weeks and characterized by development of high blood pressure in a woman who previously had normal blood pressure and signs of damage to another organ generally the kidney and liver. Stillbirth is defined as fetal death after 24 weeks of pregnancy.
Pregnancy provides a window into a woman’s risk for future medical issues (including metabolic and cardiac related). For example, women who develop diabetes during pregnancy are at higher risk for diabetes in the future even if their pregnancy related diabetes goes away with delivery. Likewise previous studies have linked pre-eclampsia and stillbirth to an increase in cardiovascular disease later in life3,4. The American Heart Association/American College of Cardiology’s 2018 cholesterol guideline considers pre-eclampsia “a risk enhancing factor” meaning that health care providers should consider a woman with a history of pre-eclampsia at higher risk for heart disease and have a lower threshold for beginning cholesterol lowering statin therapy5.
Lp(a) is made of an LDL-like particle attached to an apolipoprotein. Like bad cholesterol (LDL), Lp(a) appears to increase the risk of cholesterol buildup in the arteries.
The (a) part of Lp(a) might increase the chance of clotting, but the most important link between high Lp(a) and pregnancy complications has to do with inflammation.
Lp(a) is an inflammatory lipoprotein that could cause problems in the cells that line artery walls – including placental arteries. This might compromise the arteries of the placenta leading to high blood pressure in the mother and risk to the baby.
Pregnancy provides a window into a woman’s risk for future medical issues.
For example, women who develop diabetes while pregnant, are at higher risk for diabetes in the future – even if their diabetes goes away after having their baby.
Studies have shown that women who have experienced pre-eclampsia or stillbirth are at higher risk for heart disease later in life.
You inherit one “allele” (half of a full gene) for Lp(a) from each of your parents. If you have high Lp(a), it’s likely at least one of your parents has a high Lp(a). If you have elevated Lp(a), each time you have a baby you a have 50/50 chance of passing on the allele for high Lp(a).
This is a personal choice. It should be discussed with your partner and your health care team.
It’s important to know that if your Lp(a) does rise significantly during your pregnancy, there are options.
Lipoprotein apheresis is available to women who have both familial hypercholesterolemia (FH) and elevated Lp(a). It’s a dialysis-like procedure where a machine physically removes both Lp(a) and LDL cholesterol from the blood stream on a weekly or bi-weekly basis. This 3-hour process involves removing blood from one arm, passing it through a special column to extract the LDL and Lp(a), and returning the blood to the other arm.
This has been successful for many pregnant women. As you plan your family, it’s important to know that not everyone starts a family with pregnancy. Some people choose to adopt and others use the help of a gestational surrogate.
This is a personal choice. Everyone must decide what’s best for their family. It’s also important to remember that breastfeeding provides your baby with many benefits including boosting your baby’s immune system. For more information, visit www.womenshealth.gov.
“Lipoprotein(a) levels in normal pregnancy and in pregnancy complicated with pre-eclampsia.” Journal Atherosclerosis. Online: https://www.atherosclerosis-journal.com/article/S0021-9150(99)00296-8/fulltext. “Searching for a common mechanism for placenta-mediated pregnancy complications and cardiovascular disease: role of lipoprotein(a).” Journal of Fertility and Sterility. Online: https://www.fertstert.org/article/S0015-0282(16)00049-2/fulltext. “Is stillbirth associated with long-term atherosclerotic morbidity?” American Journal of Obstetrics and Gynecology. Online: https://www.fertstert.org/article/S0015-0282(16)00049-2/fulltext. “Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysis.” European Journal of Epidemiology. Online: https://www.fertstert.org/article/S0015-0282(16)00049-2/fulltext. “2018 AHA/ACC/AACVPR/AAPA/ ABC/ACPM/ADA/AGS/APhA/ASPC/ NLA/PCNA Guideline on the Management of Blood Cholesterol.” Journal of the American College of Cardiology. Online: https://www.fertstert.org/article/S0015-0282(16)00049-2/fulltext.