Hyperlipidaemia and severe hypertriglyceridaemia in pregnancy

Key contentLipid and triglyceride levels increase in pregnancy and do not pose problems for most women. However, pregnancy-specific factors and genetic aberrations, especially mutations, may result in supraphysiological hypercholesterolaemia (HC) and severe hypertriglyceridaemia (sHTG).HC and sHTG are associated with complications in pregnancy, including acute pancreatitis, hyperviscosity syndrome and pre-eclampsia.Abnormally high levels of lipids and triglycerides also affect fetal growth and the onset of gestational diabetes.The clinical presentation and diagnosis of HC and sHTG are varied.Management options include lifestyle and dietary restriction/modification, omega-3, bile-acid sequestrants, fenofibrate, statins and plasmapheresis. Learning objectivesTo understand the physiological changes that occur in lipids in pregnancy and how these are modulated.To appreciate the importance of severe HC and HTG in pregnancy, including their effects on maternal morbidity and mortality.To understand the various approaches to management and the importance of multidisciplinary management. Ethical issuesShould every woman be screened for HTG and HC during pregnancy?How safe are statins and other treatments for lipid disorders in pregnancy?Should women with very severe HTG be discouraged from getting pregnant?