Study: Pregnant Women Rarely Screened for Hyperlipidemia

Dipika Gopal, MD

A new study presented at the American College of Cardiology (ACC) 2019 Annual Scientific Sessions has shown that most women of childbearing age have never had their cholesterol levels checked, despite guidelines recommending screenings in early adulthood.

The study, which examined more than 5000 women between March 2009 and August 2018, found that nearly 8 out of every 10 women had never undergone a lipid blood test.

“Not nearly as many people as we think are actually getting cholesterol screening despite very clear recommendations,” lead author Dipika J. Gopal, MD, a fellow in the cardiovascular division at Hospital of the University of Pennsylvania, said in a statement. “In fact, the number of patients who have ever been screened was staggeringly low.”

In what investigators believe may be the first study to highlight real world lipid screening patterns in young women, they believe the results call attention to gaps that often prevent optimally identifying people with elevated cholesterol levels and those with genetic cholesterol disorders including familial hypercholesterolemia (FH) and inherited dyslipidemias. Research shows that these conditions may be more common than previously thought but FH may go undiagnosed as it is often first suspected after someone suffers from a heart attack or stroke at a young age.

Current guidelines do not recommend cholesterol screening during pregnancy because levels have been known to rise during that time period, yet there is evidence that shows elevated cholesterol is associated with preterm births and low birth weights. This is in addition to its role in the development of heart disease, stroke, and related death.

The study examined demographic and cholesterol screening data from 5101 women who gave birth at the Hospital of the University of Philadelphia and Pennsylvania Hospital between March 2009 and August 2018. The women in the study also had to undergo a postpartum visit at 1 of 4 obstetrics clinics within 180 days of delivery.

While 94% of expectant mothers see a health care provider during pregnancy, which presents an opportunity to identify, counsel, and treat patients, only 22% of women included in the study had ever had their cholesterol checked.

“Up to 94% of pregnant women interact with a health care provider during pregnancy and after delivery compared to a much smaller percentage of non-pregnant patients within the same age group,” Gopal explained. “The peri-partum period is a perfect time to capture a population that may otherwise not come into contact with the health system until many years later, perhaps when they have a first cardiovascular complication.”

Of the women who had received a previous lipid screening they were older, more likely to be white and have coronary artery disease, diabetes, and high blood pressure. Gopal found that 20% had low-density lipoprotein cholesterol (LDL-C) levels of 130 or more mg/dl, which she considered to be moderately high, and she points out that this could be indicative of an inherited cholesterol disorder. In addition to this, 5% had several elevated LDL-C, which Gopal defined as more than 190 mg/dl, and this warrants pharmacotherapy intervention according to the most recent ACC/American Heart Association 2018 Cholesterol guideline.

The study, “Screening for Hyperlipidemia in Pregnant Women: An Underutilized Opportunity for Early Risk Assessment,” was presented at ACC 2019.