Dyslipidemia in Pregnancy: How to Deal

Pregnancy triggers a shift from early anabolic to late catabolic metabolism that physiologically elevates maternal lipids – total cholesterol and low-density lipoproteins-cholesterol by about 30–50%, high-density lipoproteinscholesterol by 20–40%, and triglycerides by 50–100% – to support fetal development. However, excessive or early dyslipidemia is associated with hypertensive disorders, gestational diabetes, preterm birth, macrosomia, growth restriction via placental dysfunction, and long-term cardiometabolic risk for mother and child, including early aortic fatty streaks in offspring. This review looks at contemporary evidence on gestational lipid trajectories, pathophysiology, and risk associations and outlines selective, risk-based screening with emphasis on preconception counseling and multidisciplinary care. This review also summarizes management that prioritizes lifestyle optimization (omega-3-rich nutrition and moderate exercise) while limiting pharmacotherapy to bile acid sequestrants (BASs) and omega-3 fatty acids in pregnancy, with conditional use of fibrates after the first trimester for refractory severe hypertriglyceridemia and individualized statin continuation only for very high atherosclerotic cardiovascular risk under specialist supervision. Lipoprotein apheresis is highlighted as effective and safe for severe familial hypercholesterolemia and severe hypertriglyceridemia. The review underscores postpartum reassessment at 6–12 weeks to distinguish physiological resolution from persistent dyslipidemia and to guide long-term prevention, noting that most agents are contraindicated during lactation except BASs. India-specific implementation needs are detailed, including selective first-trimester screening in high-risk populations and addressing system-level barriers to dietary quality and omega-3 access. These insights support individualized care and call for prospective studies to define gestational lipid thresholds and pregnancy-safe lipid-lowering therapies.