Women & Pregnancy with High Lp(a)
The apolipoprotein (a) part of Lp(a) might increase the chance of clotting, but an important effect of high Lp(a) has to do with inflammation.
Lp(a) carries something called oxidized phospholipids. Those trigger inflammation and calcification of the aortic valve making it stiff. This leads to aortic stenosis.
Because Lp(a) isn’t measured with a standard cholesterol profile, many people don’t even know they have elevated levels.
It’s tricky because it can be measured in two different ways.
If your Lp(a) is measured in mg/dl, a normal level is less than 30 and high is greater than 50. If your Lp(a) is measured in nmol/L, a normal level is less than 75 and high is greater than 125.
Your Lp(a) is determined by your genes. You inherit one “allele” (half of a gene) for Lp(a) from each of your parents. If you have high Lp(a), it’s likely that at least one of your parents has high Lp(a).
It’s also important to know that if you have elevated Lp(a), each time you have a child you have a 50/50 chance of passing it to them.
Anyone with a family history of cardiovascular disease or a diagnosis of familial hypercholesterolemia (FH) should have their Lp(a) measured.
While high Lp(a) occurs in about 20% of the general population, people with FH have a 30-50% chance of having both elevated LDL and Lp(a). Added together, this results in a very high risk of early cardiovascular disease.
Other potential treatments are being studied in clinical trials.
Even without medication, you can work to reduce all other risk factors. If you are overweight, try to get to a healthier weight. If you smoke, please quit. These are not easy changes to make, but the sooner you do it – the better. If you have other complications, like high blood pressure or diabetes, take all prescribed medications.
Anyone who has an elevated Lp(a) should work on lowering their LDL cholesterol as much as possible. People with no history of vascular disease should aim for less than 100 mg/dl. People with vascular disease strive for levels less than 70 mg/dL. And people with heart disease and other cardiac risk factors should aim for an LDL-C less than 55 mg/dL.
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.
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. 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.
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.
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.
If you have elevated Lp(a), each time you have a baby you a have 50/50 chance of passing on the gene for high Lp(a).
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.
Most lipid specialists would advise limiting breastfeeding to 6 months so you can go on cholesterol-lowering medications to reduce risk of future heart disease.
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