It is particularly difficult for pregnant women to get quality heart care, according to a new study out of the Medical University of Lodz's (MUL) Department of Preventive Cardiology and Lipidology and the Johns Hopkins University School of Medicine's Ciccarone Centre for the Prevention of Cardiovascular Disease. This report published in the European Heart Journal-Open recently demonstrates the critical need for more clinical trials and individualised therapy options.

Excess lipids in the blood are a symptom of dyslipidemia. Treatment for these problems during pregnancy has largely remained unchanged over the past many decades. One major factor is the dearth of clinical trials involving pregnant women. The treatment of cholesterol in pregnant women remains fraught with difficulties, despite the availability of novel medications for non-pregnant persons.

Relatively few women participate in cardiovascular clinical trials, according to the study. Cardiovascular disease still primarily causes maternal mortality, making this particularly worrisome. Due to their disregard for their unique demands, pregnant women typically receive subpar treatment.

Bile acid sequestrants are the only lipid-lowering medication legally approved for pregnant women, according to the study. When the potential advantages outweigh the potential hazards, drugs such as ezetimibe and fenofibrate are considered. Concerns raised in both animal research and individual case reports lead many people to avoid taking statins, commonly prescribed to decrease cholesterol. However, recent studies suggest that statins may be useful and safe for certain high-risk individuals.

According to the study's authors, women with severe familial hypercholesterolemia (FH) or other risk factors for cardiovascular complications during pregnancy may do well to keep taking their statins. They went on to say that, in some cases, it may be riskier to cease treatment than to continue it.

It is crucial to manage dyslipidemia throughout pregnancy with non-drug methods, such as adopting a healthy lifestyle and receiving prenatal care.

Research on pregnant women is challenging and fraught with ethical considerations, which slows down the process of developing safe and effective medications. 

A large number of unintended births result in unwanted medication exposure, according to the study's authors. In addition, they found that the likelihood of pregnancy increases with age in women who have atherosclerotic cardiovascular disease or are at high risk for developing it.

The researchers emphasised that there are global initiatives to address these issues, and that the emerging discipline of cardioobstetrics—which examines the interplay between cardiovascular illness and pregnancy—could identify and address pregnant women's unique circulatory requirements.

Furthermore, the authors of the study observed that doctors increasingly have to balance the advantages and disadvantages of lipid-lowering medications when pregnant.

In order to determine which medications are safe and effective for pregnant women, experts are calling for additional studies. This research should include randomised controlled trials and national registries that track people's health over time.

Individualised treatment programmes, close monitoring, and the option to keep high-risk patients on statins are all things they're after. 

In particular, the researchers highlight the need to close the gaps in cardiovascular care for pregnant women. They argue that additional research is needed in this area and that the potential advantages and disadvantages of treating dyslipidemia should be considered.