Last update April 14, 2024

Maternal Hyperlipidemia, Hypercholesterolemia, Hypertriglyceridemia

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

Hyperlipidemia or hyperlipemia is an excess of fat or lipids (triglycerides and/or cholesterol) in the blood. 

It can be primary, due to a genetic error in fat metabolism (familial combined hyperlipidemia, familial dysbetalipoproteinemia, familial hypercholesterolemia, familial hypertriglyceridemia), or secondary to poor diet (excessive consumption of saturated fats), lack of regular exercise, some medications, alcoholism, diabetes, hypothyroidism, lupus erythematosus, kidney disease or polycystic ovarian syndrome. (MedlinePlus 2023)

Hyperlipidemia causes accumulation of fat, cholesterol and other substances in the walls of the arteries, or atherosclerosis, which increases the risk of angina and myocardial infarction, stroke and other circulatory problems. (MedlinePlus 2022)

Before and in addition to taking lipid-lowering drugs (which lower fat levels in the body), the first step in treatment is to eat a diet low in saturated fat and refined sugar and to exercise daily. (MedlinePlus 2020) 

The problem of treating hyperlipidemia during lactation is that infants need cholesterol for the development of brain tissue, myelination of nerves and it is also the basis of many enzymes.

Some authors and expert consensus advise postponing statin treatment from 3 months before pregnancy and until breastfeeding ends or is not exclusive (FDA 2021, Shala 2020, Lawrence 2016 p 393), since except in severe forms of hypercholesterolemia (Moss 2018), postponing drug treatment for a few months is not likely to alter the long-term outcome of the disease in the mother (FDA 2021).This is due to the fear that the drugs taken by the mother could reach the infant through breast milk and lower its cholesterol levels and/or that these drugs could lower the concentration of breast milk cholesterol.

But other expert authors consider safe or probably compatible or of minimal risk the use of lipid-lowering medication such as statins, especially the hydrophilic ones rosuvastatin or pravastatin, during pregnancy and/or breastfeeding (Hale, Botha 2018, Holmsen 2017, Amir 2011) because: 

  1. Most lipid-lowering drugs are thought very likely or known with certainty not to be excreted in breast milk or to be excreted in negligible amount because of high molecular weight and/or high plasma protein binding and/or high volume of distribution and/or not absorbed in the intestine.
  2. Mothers homozygous for familial hypercholesterolemia (FH) took statins during 18 pregnancies and 11 breastfeedings of 3 to 9 months duration and their infants had no developmental or school learning problems (Botha 2018) and there are no published data indicating that statins taken by the mother during breastfeeding are harmful to the nursing infant (Holmsen 2017) nor that statin use during pregnancy increases the risk of birth defects or miscarriage. (FDA 2021)
  3. Although 102 women affected by FH stopped taking statins for a mean of 2.3 years (range 0 to 14 years) for the times of pregnancy and breastfeeding without it being known whether this increased the risk of cardiovascular disease (Klevmoen 2021), it is known that hypercholesterolemia maintained during pregnancy in a woman with FH increases the risk of atherosclerosis in the child (Napoli 1999), that these women develop very high cholesterol levels during this period (Holmsen 2017, Avis 2009) and that there is an increase in arterial intima media thickness during pregnancy in women with FH who do not take medication. (Kusters 2010) 
  4. Normal breast milk cholesterol concentration ranges from 30 mg/dL in colostrum to 10 - 20 mg/dL in mature milk (Lawrence 2016 p98, 105 and 767). Cholesterol levels are normally increased (by 40%) during pregnancy and lactation in healthy women (Lawrence 2016 p590). Milk cholesterol numbers are very stable even in hypercholesterolemic women and are not severely affected by diet or the mother's nutritional status, leading to the assumption that milk cholesterol is synthesized, at least in part, in the mammary gland (Lawrence 2016, p 289-90). For all these reasons, it is very unlikely that hypolipidemic medication is able to alter the lipid composition of milk.
  5. Cholesterol concentration is greatly increased (up to 3-fold) in the milk of lactating mothers affected with familial hypercholesterolemia in homozygous form (Holmsen 2017, Tsang 1978). Statin treatment would at most reduce it to normal levels. (Holmsen 2017)
  6. Breastfeeding has a cardioprotective effect: it reduces the risk of myocardial infarction and hypertension, improves blood glucose control and lipid profile, and reduces the risk of type 2 diabetes , which is particularly important for women with FH and their infants. (Holmsen 2017)
  7. The health benefits of a woman with FH continuing to breastfeed while using a statin outweigh the low risk to the child. It is safe and beneficial for infants of women with FH to be breastfed while the mother is receiving adequate treatment with a statin, preferably rosuvastatin. (Holmsen 2017)
  8. Breastfed infants have higher plasma cholesterol levels than those fed artificial formula and this would protect them against the consequences of hypercholesterolemia in adult life (Lawrence 2016 p108). Infants fed formula substitutes ("artificial milks") do not receive cholesterol in their diet, as these products do not contain cholesterol (Lawrence 2016 p 109 and 215). The amount of cholesterol in breast milk that would remain after the hypothetical cholesterol reduction produced by the statins taken by the mother would still be much higher than that contributed by artificial formulas. (Holmsen 2017)

In conclusion, it seems wise to advise mothers with severe FH to continue statins and/or other lipid-lowering drugs during lactation. Mothers without FH and with moderately high cholesterol levels can discontinue treatment during the lactation period by monitoring their low-density lipoprotein (LDL) levels.


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Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

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References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on April 10, 2024 Full text (link to original source)
  2. MedlinePlus. High blood cholesterol levels Trusted Health information for you. 2023 Full text (link to original source)
  3. MedlinePlus. Niveles altos de colesterol en la sangre. Información de salud para usted. 2023 Full text (link to original source)
  4. MedlinePlus. Familial combined hyperlipidemia. Trusted health information for you. 2022 Full text (link to original source)
  5. MedlinePlus. Hiperlipidemia combinada familiar. Información de salud para usted. 2022 Full text (link to original source)
  6. Klevmoen M, Bogsrud MP, Retterstøl K, Svilaas T, Vesterbekkmo EK, Hovland A, Berge C, Roeters van Lennep J, Holven KB. Loss of statin treatment years during pregnancy and breastfeeding periods in women with familial hypercholesterolemia. Atherosclerosis. 2021 Oct;335:8-15. Abstract Full text (link to original source)
  7. MedlinePlus. Niveles de colesterol: Lo que usted debe saber. Información de salud para usted. 2021 Full text (link to original source)
  8. FDA (U.S. Food and Drug Administration). Statins: drug safety communication - FDA requests removal of strongest warning against using cholesterol-lowering statins during pregnancy. None 2021 Full text (link to original source)
  9. MedlinePlus. Cholesterol Levels: What You Need to Know. Trusted Health information for you. 2020 Full text (link to original source)
  10. Shala-Haskaj P, Krähenmann F, Schmidt D. [CME: Familial Hypercholesterolemia - Statin Treatment during Pregnancy and Breastfeeding]. Praxis (Bern 1994). 2020 Apr;109(6):405-410. Abstract
  11. Moss S, Tardo D, Doyle M, Rees D. Complex disease management of pregnant young patient with familial hypercholesterolaemia complicated by coronary artery disease and cerebrovascular disease. Cardiovasc Revasc Med. 2018 Dec;19(8S):20-22. Abstract
  12. Botha TC, Pilcher GJ, Wolmarans K, Blom DJ, Raal FJ. Statins and other lipid-lowering therapy and pregnancy outcomes in homozygous familial hypercholesterolaemia: A retrospective review of 39 pregnancies. Atherosclerosis. 2018 Oct;277:502-507. Abstract
  13. Holmsen ST, Bakkebø T, Seferowicz M, Retterstøl K. Statins and breastfeeding in familial hypercholesterolaemia. Tidsskr Nor Laegeforen. 2017 May 23;137(10):686-687. Abstract Full text (link to original source)
  14. Lawrence RA, Lawrence RM. Breastfeeding. A guide for the medical profession. Eighth Edition. Philadelphia: Elsevier; 2016
  15. Amir LH, Pirotta MV, Raval M. Breastfeeding--evidence based guidelines for the use of medicines. Aust Fam Physician. 2011 Sep;40(9):684-90. Review. Abstract Full text (link to original source) Full text (in our servers)
  16. Kusters DM, Homsma SJ, Hutten BA, Twickler MT, Avis HJ, van der Post JA, Stroes ES. Dilemmas in treatment of women with familial hypercholesterolaemia during pregnancy. Neth J Med. 2010 Aug;68(1):299-303. Review. Abstract Full text (link to original source)
  17. Avis HJ, Hutten BA, Twickler MT, Kastelein JJ, van der Post JA, Stalenhoef AF, Vissers MN. Pregnancy in women suffering from familial hypercholesterolemia: a harmful period for both mother and newborn? Curr Opin Lipidol. 2009 Dec;20(6):484-90. Abstract
  18. Napoli C, Glass CK, Witztum JL, Deutsch R, D'Armiento FP, Palinski W. Influence of maternal hypercholesterolaemia during pregnancy on progression of early atherosclerotic lesions in childhood: Fate of Early Lesions in Children (FELIC) study. Lancet. 1999 Oct 9;354(9186):1234-41. Abstract
  19. Tsang RC, Glueck CJ, McLain C, Russell P, Joyce T, Bove K, Mellies M, Steiner PM. Pregnancy, parturition, and lactation in familial homozygous hypercholesterolemia. Metabolism. 1978 Jul;27(7):823-9. No abstract available. Abstract

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