Unidad de Lípidos, Servicio de Medicina Interna, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España.
Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Zaragoza, España.
Clin Investig Arterioscler. 2021 Jan-Feb;33(1):41-52. doi: 10.1016/j.arteri.2020.10.002. Epub 2020 Dec 9.
During pregnancy there is a physiological increase in total cholesterol (TC) and triglycerides (TG) plasma concentrations, due to increased insulin resistance, oestrogens, progesterone, and placental lactogen, although their reference values are not exactly known, TG levels can increase up to 300mg/dL, and TC can go as high as 350mg/dL. When the cholesterol concentration exceeds the 95 percentile (familial hypercholesterolaemia (FH) and transient maternal hypercholesterolaemia), there is a predisposition to oxidative stress in foetal vessels, exposing the newborn to a greater fatty streaks formation and a higher risk of atherosclerosis. However, the current treatment of pregnant women with hyperlipidaemia consists of a diet and suspension of lipid-lowering drugs. The most prevalent maternal hypertriglyceridaemia (HTG) is due to secondary causes, like diabetes, obesity, drugs, etc. The case of severe HTG due to genetic causes is less prevalent, and can be a higher risk of maternal-foetal complications, such as, acute pancreatitis (AP), pre-eclampsia, preterm labour, and gestational diabetes. Severe HTG-AP is a rare but potentially lethal pregnancy complication, for the mother and the foetus, usually occurs during the third trimester or in the immediate postpartum period, and there are no specific protocols for its diagnosis and treatment. In conclusion, it is crucial that dyslipidaemia during pregnancy must be carefully evaluated, not just because of the acute complications, but also because of the future cardiovascular morbidity and mortality of the newborn child. That is why the establishment of consensus protocols or guidelines is essential for its management.
怀孕期间，由于胰岛素抵抗、雌激素、孕激素和胎盘催乳素的增加，总胆固醇（TC）和甘油三酯（TG）的血浆浓度会升高，尽管其参考值并不明确，但 TG 水平可能会升高到 300mg/dL，TC 则可能升高到 350mg/dL。当胆固醇浓度超过第 95 百分位数（家族性高胆固醇血症（FH）和暂时性孕妇高胆固醇血症）时，胎儿血管就容易发生氧化应激，使新生儿更容易形成脂肪条纹，从而增加患动脉粥样硬化的风险。然而，目前针对高血脂孕妇的治疗方法是饮食和停止使用降脂药物。最常见的孕妇高甘油三酯血症（HTG）是由继发原因引起的，如糖尿病、肥胖、药物等。由遗传原因引起的严重 HTG 则较为少见，但可能会增加母婴并发症的风险，如急性胰腺炎（AP）、子痫前期、早产和妊娠期糖尿病。严重 HTG-AP 是一种罕见但潜在致命的妊娠并发症，无论是对母亲还是胎儿，通常发生在孕晚期或产后即刻，目前尚无针对其诊断和治疗的具体方案。总之，怀孕期间的血脂异常必须仔细评估，这不仅是因为其可能会引发急性并发症，还因为其会增加新生儿未来的心血管发病率和死亡率。因此，制定共识方案或指南对于其管理至关重要。
