Checking Cholesterol Before Pregnancy Could Help Protect Mom’s Heart

Credit: Adobe Stock/Anastasiya

Having high cholesterol before pregnancy may increase the risk of both pregnancy-related complications and heart disease in the years after childbirth, according to a new study presented at the American College of Cardiology’s Cardio-Obstetrics Essentials: Team-Based Management of Cardiovascular Disease and Pregnancy conference.

“Prepregnancy hyperlipidemia is not just a metabolic concern; it is an early signal of increased long-term maternal health risk,” said lead investigator Srijana Maharjan, M.D., an internal medicine resident at Allegheny General Hospital in Pittsburgh.

This large U.S. study looked at how high cholesterol (hyperlipidemia) before pregnancy affects pregnancy outcomes and long-term heart health in women. While it’s well known that high cholesterol increases the risk of heart disease, its effects on pregnancy and a woman’s future cardiovascular risk have been less clear.

“Given the physiologic changes in lipid levels during pregnancy and the increasing prevalence of metabolic syndrome among reproductive-age women, it is critical to understand whether preexisting dyslipidemia contributes to adverse pregnancy outcomes or accelerates cardiovascular risk in the postpartum period,” wrote the team.

Investigators analyzed data from more than 16,000 pregnant women (8,431 with high cholesterol and 8,431 without) using the TriNetX U.S. Collaborative Network, which included real-world medical data from multiple hospitals between 2000 and 2020. All women with high cholesterol were diagnosed at least one year before delivery. The study then followed their pregnancy outcomes and tracked heart health for five years after giving birth.

Women with preexisting high cholesterol were more likely to experience the following:

• Hypertensive disorders of pregnancy (such as preeclampsia or gestational hypertension): 5.8% versus 4.9%
• Gestational diabetes: 10.0% versus 9.1%
• Labor complications: 30.6% versus 28.8%
• Antepartum hemorrhage (bleeding before delivery): 3.7% versus 2.8%

In the five years after giving birth, these women also had higher rates of early heart problems, including the following:

• Irregular heart rhythms (arrhythmias): 4.4% versus 3.2%
• Acute coronary syndrome (heart attack or unstable angina): 0.5% versus 0.3%

The study found no difference in postpartum hemorrhage or maternal deaths between groups.

“Some outcomes were expected (higher risk of gestational diabetes and hypertensive disorders), but the clear link with arrhythmias and acute coronary syndromes within just five years postpartum was striking. It highlights that cardiovascular sequelae can manifest much earlier in this population than previously assumed,” said Maharjan.

These findings underscore how heart health and pregnancy health are closely connected. Pregnancy naturally causes changes in cholesterol and other metabolic processes, which can reveal or worsen underlying cardiovascular risks. Experts say that understanding and managing cholesterol early — ideally before conception — can reduce complications and improve both maternal and long-term health outcomes.

While the study was observational and can’t prove cause and effect, it highlights the need for preventive care and coordinated follow-up after pregnancy.

Doctors may want to discuss lifestyle changes, diet, exercise and other preventive strategies with women of childbearing age who have or may be at risk for high cholesterol. The team noted that routine lipid screening before pregnancy could help identify women who might benefit from early intervention to protect both short- and long-term health.

“Obstetricians, internists and cardiologists should collaborate to integrate lipid management into preconception and prenatal care,” Maharjan concluded.