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Many pregnant women or women planning to become pregnant take prescription medications. A 2004 study of a group of women delivering between 1996 and 2000 and enrolled in prescription drug coverage found that 64% of these women received a drug other than a vitamin or mineral supplement in the nine months before delivery.
Due to increasing average maternal age and maternal obesity, some women may be taking cholesterol-lowering medications such as Lipitor before pregnancy or in early pregnancy.
Lipitor (chemical name: atorvastatin) is a prescription statin medication used to lower total cholesterol and “bad” cholesterol (LDL). Elevated cholesterol in the body can lead to plaque build-up in the arteries. Lipitor is used to treat high cholesterol levels and prevent heart disease in high-risk patients. Risk factors for heart disease include age, smoking, family history of heart disease, and high blood pressure. Lipitor may be used along with high blood pressure medication, changes in diet, and other cholesterol-lowering medications.
High Blood Pressure in Pregnancy
Several types of high blood pressure can affect pregnant women including preeclampsia/eclampsia, chronic high blood pressure, gestational high blood pressure, and postpartum high blood pressure. Preeclampsia is characterized by high blood pressure during pregnancy and the presence of proteins in the urine. Preliminary evidence supports the use of statins to treat preeclampsia, but further studies are needed. The American College of Obstetricians and Gynecologists (ACOG) provides guidelines for monitoring and treatment of high blood pressure during pregnancy. Depending on the type and severity of high blood pressure, some women may continue on blood pressure medication or other treatment during pregnancy.
FDA Recommendation on Atorvastatin
Current FDA recommendations state that atorvastatin should NOT be used during pregnancy or breastfeeding. Two of the FDA’s primary reasons for supporting this recommendation include:
- a brief interruption in therapy will not impact the long-term development of heart disease
- cholesterol is needed for formation of cellular structures in normal fetal development
Elevated Cholesterol in Pregnancy
It is normal for maternal cholesterol to increase during pregnancy, even in women with high pre-pregnancy cholesterol levels. Some studies suggest that increased cholesterol during pregnancy is linked to gestational diabetes, preeclampsia, and preterm delivery. Additional information is needed to determine if statins are beneficial in preventing these complications during pregnancy. There is also a need for further research on the potential for long-term maternal or fetal harm if atorvastatin therapy is interrupted during pregnancy.
Risks with Atorvastatin
There are a few small studies that look at fetal exposure to atorvastatin during the first trimester of pregnancy. These studies found no increase in birth defects in fetuses exposed to atorvastatin compared to unexposed fetuses in the general population.
For women who are thinking about conceiving or become pregnant while on atorvastatin, consult your doctor as soon as possible. A discussion with your doctor can provide guidance, next steps, and awareness of potential hazards of taking atorvastatin while pregnant. Your doctor may also discuss other ways to control your cholesterol or help reduce your long-term risk of heart disease. If you do have high blood pressure or high cholesterol levels, your doctor may require close monitoring during your pregnancy.
The Centers for Disease Control and Prevention (CDC) provide additional guidance for women on the use of medications during pregnancy as part of the “Treating for Two” initiative. Women with serious medical conditions including seizures, depression, and high blood pressure may require the use of prescription medications during pregnancy. The CDC recommends talking to your doctor to discuss medications that are safe to use during pregnancy.