Table 2

Management of severe hypercholesterolaemia during pregnancy

Non-pharmaceutical interventionsPre-conception plan
Diet, physical activity
In each pregnancy
Bile acid sequestrantsApproved during pregnancy
May lead to hypertriglyceridaemia
Poorly tolerated systemic side effects
In each pregnancy
EzetimibeWhen the benefits outweigh the risksIndividual decision
FibratesWhen the benefits outweigh the risksIndividual decision
Omega-3 fatty acidsWhen the benefits outweigh the risks
Reduce triglycerides
Individual decision
StatinsGenerally contraindicated
For severe hypercholesterolaemia, the decision should be individualized
Individual decision in severe hypercholesterolaemia
PCSK9iLimited dataLacking data
InclisiranNo data regarding pregnancy available
Hypothetically, administration before pregnancy may give a mean 41% reduction of LDL-C
Lacking data, potentially useful in severe hypercholesterolaemia
ApheresisThe potential benefits and risks associated with the procedure should be considered
Available in specialized centres
In some cases, the only one available therapeutic option
In each pregnancy
Limited availability
Non-pharmaceutical interventionsPre-conception plan
Diet, physical activity
In each pregnancy
Bile acid sequestrantsApproved during pregnancy
May lead to hypertriglyceridaemia
Poorly tolerated systemic side effects
In each pregnancy
EzetimibeWhen the benefits outweigh the risksIndividual decision
FibratesWhen the benefits outweigh the risksIndividual decision
Omega-3 fatty acidsWhen the benefits outweigh the risks
Reduce triglycerides
Individual decision
StatinsGenerally contraindicated
For severe hypercholesterolaemia, the decision should be individualized
Individual decision in severe hypercholesterolaemia
PCSK9iLimited dataLacking data
InclisiranNo data regarding pregnancy available
Hypothetically, administration before pregnancy may give a mean 41% reduction of LDL-C
Lacking data, potentially useful in severe hypercholesterolaemia
ApheresisThe potential benefits and risks associated with the procedure should be considered
Available in specialized centres
In some cases, the only one available therapeutic option
In each pregnancy
Limited availability
Table 2

Management of severe hypercholesterolaemia during pregnancy

Non-pharmaceutical interventionsPre-conception plan
Diet, physical activity
In each pregnancy
Bile acid sequestrantsApproved during pregnancy
May lead to hypertriglyceridaemia
Poorly tolerated systemic side effects
In each pregnancy
EzetimibeWhen the benefits outweigh the risksIndividual decision
FibratesWhen the benefits outweigh the risksIndividual decision
Omega-3 fatty acidsWhen the benefits outweigh the risks
Reduce triglycerides
Individual decision
StatinsGenerally contraindicated
For severe hypercholesterolaemia, the decision should be individualized
Individual decision in severe hypercholesterolaemia
PCSK9iLimited dataLacking data
InclisiranNo data regarding pregnancy available
Hypothetically, administration before pregnancy may give a mean 41% reduction of LDL-C
Lacking data, potentially useful in severe hypercholesterolaemia
ApheresisThe potential benefits and risks associated with the procedure should be considered
Available in specialized centres
In some cases, the only one available therapeutic option
In each pregnancy
Limited availability
Non-pharmaceutical interventionsPre-conception plan
Diet, physical activity
In each pregnancy
Bile acid sequestrantsApproved during pregnancy
May lead to hypertriglyceridaemia
Poorly tolerated systemic side effects
In each pregnancy
EzetimibeWhen the benefits outweigh the risksIndividual decision
FibratesWhen the benefits outweigh the risksIndividual decision
Omega-3 fatty acidsWhen the benefits outweigh the risks
Reduce triglycerides
Individual decision
StatinsGenerally contraindicated
For severe hypercholesterolaemia, the decision should be individualized
Individual decision in severe hypercholesterolaemia
PCSK9iLimited dataLacking data
InclisiranNo data regarding pregnancy available
Hypothetically, administration before pregnancy may give a mean 41% reduction of LDL-C
Lacking data, potentially useful in severe hypercholesterolaemia
ApheresisThe potential benefits and risks associated with the procedure should be considered
Available in specialized centres
In some cases, the only one available therapeutic option
In each pregnancy
Limited availability
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