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Statin Safety in Pregnancy

Note: The Pregistry website includes expert reports on more than 2000 medications, 300 diseases, and 150 common exposures during pregnancy and lactation. For the topic Statins, go here. These expert reports are free of charge and can be saved and shared.
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If you’re one of the 35 million people in the United States that take statins—medications prescribed to lower cholesterol—and you’re pregnant, you may be wondering if your statin is safe to take during pregnancy. The short answer is that statins aren’t recommended when you’re pregnant. In this post, though, we’ll discuss some of the nuances around statin use during pregnancy and help you think through some of the questions you might want to ask your doctor if you have a statin prescription and are also pregnant.

Statins refers to any of a group of medicines that work by preventing the liver from making cholesterol and helping remove cholesterol that’s circulating in the blood (either from the diet or cholesterol that’s made in the body). Doctors prescribe statins because having high cholesterol—particularly low density lipoprotein or LDL cholesterol—can increase your risk for stroke or heart attack. The risk of these events increases because cholesterol can stick to your blood vessel walls, forming so-called plaques and making it harder for blood to flow.

Previously, statins were not recommended for anyone during pregnancy due to the risk of miscarriage when they’re taken during the first trimester and the risk of adverse effects to the fetus at other times. And for most people, they’re still not recommended. Last summer, however, the United States Food & Drug Administration (FDA) requested revision of the information that’s provided to consumers to remove the contraindication against statin use in all pregnant people. [1]

In the safety communication, they explain that lifting the contraindication will mean that care providers and their patients can weight the risks and benefits based on an individual’s medical circumstances, rather than a blanket recommendation. Statin benefits might outweigh the risks, for instance, in people who have familial hypercholesterolemia, an inherited condition in which the cholesterol is high in spite of exercise and dietary adjustments or have had a previous heart attack or stroke. If you fall into one of these categories and take a statin, talk to your doctor about the risks and benefits for you and your baby.

And while the adverse effects of statins are generally the reason that people stop taking them, new evidence is coming out all the time about their effects during pregnancy. In a study published in JAMA Network Open, for example, Jui-Chun Chang of Taichung Veterans General Hospital in Taiwan and colleagues analyzed the pregnancies of 469 women who took statins and 4,690 women who did not. [2] They found that there was no evidence that statin use in pregnancy leads to congenital anomalies (when a baby is born with an abnormality). The researchers did find that people who took statins were more likely to have preterm labor or babies with low birth weight.

If you’re one of the people who takes statins for high cholesterol, but you’d like to do other things to manage your cholesterol during pregnancy, you have a couple of options. First, look at your diet. It’s not always easy to eat well during pregnancy, particularly if you experience nausea and vomiting of pregnancy, but do what you can to limit your intake of saturated fats. Eating oatmeal can also help lower your cholesterol, as well as deal with another annoying pregnancy side effect: constipation.

Exercise is also a great weapon against bad cholesterol because it increases the amount of high density lipoprotein (HDL) cholesterol circulating in your bloodstream. HDL helps collect LDL cholesterol and return it to the liver, which removes it from the body. Exercise doesn’t have to be intense to be effective. A 30 minute walk four or five times each week during pregnancy has the potential to help improve your cholesterol and will also help you prepare for labor. Other ideas for pregnancy-friendly exercise include yoga (find a class for the bonus of making friends with other pregnant people) and swimming (there’s nothing like feeling weightless in the water—it can be much better than being pregnant on land).

References

  1. “FDA requests removal of strongest warning against using cholesterol-lowering statins during pregnancy; still advises most pregnant patients should stop taking statins,” FDA Drug Safety Communication, 7-20-2021.
  2. Chang, Jui-Chun et al. “Perinatal Outcomes After Statin Exposure During Pregnancy,” JAMA network open.
Abby Olena
Dr. Abby Olena has a PhD in Biological Sciences from Vanderbilt University. She lives with her husband and children in North Carolina, where she writes about science and parenting, produces a conversational podcast, and teaches prenatal yoga.

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