The Hidden Risks of Preexisting Hyperlipidemia in Pregnancy: Obstetric and Cardiovascular Implications

New findings from a large-scale analysis suggest that women with preexisting hyperlipidemia face significantly higher risks of both obstetric complications and early cardiovascular events after pregnancy.

The retrospective study, conducted using the TriNetX U.S. Collaborative Network, compared more than 10,000 women with documented hyperlipidemia prior to conception against a propensity-matched control group without lipid abnormalities.

Key findings included that women with preexisting hyperlipidemia had higher rates of gestational diabetes and hypertensive disorders and were more likely to experience labor and delivery complications.

Although maternal mortality and postpartum hemorrhage rates did not differ significantly between groups, the study revealed a concerning increase in early postpartum cardiovascular events—namely arrhythmias, acute coronary syndromes, and cardiac hospitalizations—within five years of delivery among those with prior hyperlipidemia.

Elevated lipid levels, particularly atherogenic profiles, may contribute to endothelial dysfunction, systemic inflammation, and insulin resistance—all pathways implicated in both metabolic and hypertensive complications of pregnancy. The postpartum rise in acute cardiovascular events may reflect a broader cardiometabolic vulnerability that pregnancy helps to unmask, effectively serving as a “stress test” for long-term cardiovascular health.

These findings underscore the need to consider lipid profiles in the preconception and prenatal risk stratification of patients.