Maternal and fetal outcomes of lipid-lowering drug use in pregnancy: A Czech nationwide study.

BACKGROUND

Approximately 20% of pregnant women have elevated lipid levels. While nonpharmacological therapy suffices for most patients, some require pharmacotherapy.

OBJECTIVE

This study analyzed the outcomes of pregnancy in women treated with lipid-lowering drugs.

METHODS

Nationwide data on all births and abortions in the Czech Republic (2011-2023) were obtained from the National Registry of Reproductive Health and the National Registry of Reimbursable Health Services. Women with preexisting lipid disorders who were prescribed any lipid-lowering drug from select Anatomical Therapeutic Chemical groups (C10A, C10B) within 1 year before pregnancy, and women with treatment initiation during pregnancy, were included in the analysis. Univariate logistic regression was performed to calculate the odds ratios (ORs) for adverse outcomes.

RESULTS

Among 1,342,432 deliveries, 1100 women were treated with lipid-lowering drugs during pregnancy. Statin treatment had increased odds of cesarean section (OR 1.68-1.96), preterm delivery (OR 1.42-2.58), and low birth weight (OR 1.23-2.16). Atorvastatin and rosuvastatin were comparably safe, but simvastatin had higher odds of complications. Treatment with cholestyramine was associated with higher odds of cesarean section (OR 2.45), preterm delivery (OR 4.78), and low birth weight (OR 3.16) compared to fenofibrate or statins. No detrimental effect on neonatal hypoxia was observed. The fixed combination of atorvastatin and amlodipine was limited in use but associated with a higher risk of adverse outcomes.

CONCLUSION

Atorvastatin and rosuvastatin had a relatively low risk of adverse maternal and fetal outcomes, comparable to fibrates. Cholestyramine and the fixed combination of statin and amlodipine were associated with increased risk.