Can HMG-CoA (3-hydroxy-3-methylglutaryl-coenzyme A) reductase inhibitors, also known as statins, be taken during pregnancy?

From the Guidelines

Statins should ideally be discontinued 3 months before planned conception and during pregnancy and lactation, unless the patient has homozygous familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease, in which case the continued use of statin therapy should be considered after the first trimester. This recommendation is based on the most recent and highest quality study, which suggests that statins inhibit cholesterol synthesis, essential for fetal development, particularly brain and nervous system formation 1.

Key Considerations

• Women with familial hypercholesterolemia or very high cardiovascular risk should discuss their specific situation with both their obstetrician and cardiologist to weigh individual risks and benefits.
• For women who need lipid management during pregnancy, lifestyle modifications including a heart-healthy diet, appropriate physical activity, and weight management are the preferred approach.
• Statins can typically be resumed after pregnancy, once breastfeeding is completed.
• If a woman with familial hypercholesterolemia becomes pregnant while taking a statin, this treatment should be stopped, and she should be reassured that this therapy is unlikely to harm the fetus 1.

Management Strategies

• Bile acid sequestrants should be considered to treat hypercholesterolemia, ideally 3 months before a planned pregnancy, as well as during pregnancy and lactation 1.
• Lipoprotein apheresis should be continued or initiated during pregnancy in women with homozygous familial hypercholesterolemia, especially in those with established atherosclerotic cardiovascular disease and in whom LDL-cholesterol levels are not at guideline-recommended goal 1.
• Women on lipid-lowering therapy in the setting of diabetes or elevated 10-year atherosclerotic cardiovascular disease risk who desire to become pregnant or are already pregnant should have lipid therapy discontinued, be monitored for significant elevations in LDL-C and triglycerides during pregnancy, and be counseled on lifestyle modifications 1.

From the Research

Statin Use During Pregnancy

• Statins are commonly used to treat hyperlipidemia, but their safety during pregnancy has been questioned 2, 3, 4, 5, 6.
• A retrospective cohort study found that maternal statin use during pregnancy was associated with an increased risk of low birth weight and preterm labor, but not with congenital anomalies 2.
• Another study suggested that statins may be safe when used during pregnancy for women with long-term use of statins before pregnancy, but caution is needed due to the potential increased risk of low birth weight and preterm labor 2.
• A review of the literature found that most studies on statins and teratogenicity have limited sample sizes, and the effects of long-term statin use on fetal and neonatal health remain unknown 3.
• Some studies have reported that statins are unlikely to be teratogenic, and that the observed congenital anomalies were isolated and did not suggest a common mechanism 5, 6.
• However, statins are still contraindicated in pregnancy due to the potential risks, and more research is needed to fully understand the risks and benefits of statin use during pregnancy 3, 4, 6.
• The available data suggest that pravastatin may be a safer option for use during pregnancy, but more research is needed to confirm this 3.
• In general, the decision to use statins during pregnancy should be made on a case-by-case basis, taking into account the individual woman's risk factors and medical history 2, 3, 4, 5, 6.