Is High Cholesterol in Pregnancy Normal?

Are you concerned about having a healthy pregnancy with high cholesterol? When it comes to cholesterol levels during pregnancy, the main concern isn't whether your cholesterol levels are higher than before you got pregnant (because they very likely are!), but how high they get.

Higher-than-usual cholesterol levels are not only normal during pregnancy, they're necessary to support hormones like estrogen and progesterone, which are vital for carrying a pregnancy to term. Your growing baby uses cholesterol at a high rate for healthy limb and brain development.

"There are essential partnerships that occur to support the developing pregnancy," says Julie Scott, MD, an OB-GYN and medical director of labor and delivery at the University of Colorado Hospital. "The [pregnant person], placenta, and fetus have specific enzymes to alter and change cholesterol into functional hormones."

There is, however, still such a thing as too much cholesterol during pregnancy, and it's linked to some serious complications. Read on to learn about normal cholesterol fluctuations in pregnancy, what's considered too high, and how to keep cholesterol levels in check during pregnancy.

What Is High Cholesterol?

Determining that a person has high cholesterol (also known as hypercholesterolemia) isn't based on just one measurement. When a health care provider wants to check your cholesterol levels, they will order a blood test known as a lipid panel, which is actually a group of tests that measures the following:

• Total cholesterol
• Low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol)
• High-density lipoprotein (HDL) cholesterol (the "good" cholesterol)
• Triglycerides

It's these measurements along with medical history that help health care providers diagnose high cholesterol and assess the person's risk for health concerns like heart disease and stroke.

What's Considered 'Too High' for Cholesterol During Pregnancy?

Cholesterol levels increase naturally during the second trimester of pregnancy, peak during the third, and typically return to normal about four weeks after delivery. During your entire pregnancy, you can expect your total cholesterol to increase by about 50%.

While it is known that cholesterol levels rise during pregnancy, cholesterol isn't routinely checked during pregnancy, and there are no reference ranges for cholesterol levels in pregnant people. That is to say that experts haven't defined what is considered normal or optimal when it comes to cholesterol in pregnant people.

What is known, however, is that pregnancy-related complications are associated with total cholesterol levels or triglyceride levels that exceed 250 mg/dL.

Risks of Very High Cholesterol in Pregnancy

While you shouldn't stress about a rise in cholesterol during pregnancy, there is growing evidence that very high levels of cholesterol can have a negative impact during pregnancy. Experts don't fully understand the effects of high cholesterol on pregnancy and fetal development, but researchers have found a link between very high cholesterol and certain complications.

For example, abnormally high triglyceride levels are linked to preeclampsia and gestational diabetes, which can pose risks to both the pregnant person and the baby. Some studies show that higher cholesterol levels are also associated with an increased risk of preterm labor. There's also evidence that children born to parents who had abnormally high cholesterol during pregnancy may be more likely to develop fat deposits in their arteries.

Treating High Cholesterol Before and During Pregnancy

"We don't often actively treat high cholesterol in [pregnant people] unless there are extreme concerns for cardiovascular risk," Dr. Scott says. "The potential to cause harm to the fetus must be weighed."

If you are planning to get pregnant, your best bet is to have your cholesterol checked before trying to conceive. Detecting high or borderline high cholesterol before pregnancy gives you time to take steps to lower it before your treatment options are limited because of the risks to a developing fetus.

While ideal, detecting and lowering high cholesterol before pregnancy isn't always possible. In those cases, there are safe steps you can take during pregnancy to help lower your "bad" cholesterol and increase your "good" cholesterol. Be sure to speak to your doctor before any treatment.

Medications

Statins are the gold-standard treatment for high cholesterol in non-pregnant patients, but not in pregnant people. Research has shown that people taking statins do not have a higher risk of birth defects than other pregnant people but may be more likely to go into preterm childbirth and have babies with low birth weight.

In 2021, the Food and Drug Administration (FDA) told statin manufacturers to remove an earlier warning to never use these medications in pregnant patients but maintained that "most pregnant patients should stop taking statins."

When medication is used to control cholesterol during pregnancy, drugs called bile acid sequestrants are more commonly prescribed than statins. "For [people] who have severely elevated cholesterol levels, there is the potential to use bile acid-binding resins to reduce cholesterol," Dr. Scott says. "Unfortunately, [people] using these medicines tend to complain of severe gastrointestinal problems."

Lifestyle changes

The most recommended strategies for maintaining healthy cholesterol levels during pregnancy are lifestyle changes, namely eating a well-balanced diet and exercising at a level approved by your doctor. Here are some doctor-approved lifestyle changes to help keep cholesterol in check:

• Choose healthy fats: Unlike saturated fats, monounsaturated and polyunsaturated fats are healthy fats that boost levels of "good" cholesterol. You can find these healthy fats in nuts and seeds, avocados, low-mercury fish, and olive oil.
• Eat plenty of soluble fiber: By creating a barrier that helps block fats from being absorbed, soluble fibers help control cholesterol and blood sugar spikes. You can get soluble fiber through oats, barley, millet, chia seeds, and other grains; fresh fruits like apples and berries; dried fruits; vegetables such as broccoli and Brussels sprouts; and beans, including garbanzo, soy, black, and lima beans.
• Exercise regularly: Consider adding moderate exercise to your daily routine to help lower your cholesterol or maintain healthy cholesterol levels while pregnant. Walking, swimming, and prenatal yoga are popular ways to maintain your fitness during pregnancy, but be sure to talk to your doctor before starting any exercise regimen.