Total Cholesterol — Pregnancy Reference Values

Perinatology.com › Reference › Serum Values › Total Cholesterol

Total Cholesterol (serum / plasma)

Maternal cholesterol levels rise substantially during normal pregnancy as estrogen increases hepatic lipoprotein production to support placental steroidogenesis and fetal development.

Units Nonpregnant Adult 1st Trimester 2nd Trimester 3rd Trimester
mg/dL < 200 141 – 210 176 – 299 219 – 349
mmol/L < 5.18 3.65 – 5.44 4.56 – 7.74 5.67 – 9.04

Pregnancy physiology

Total cholesterol increases 30–50% during pregnancy due to:

  • increased estrogen-driven hepatic lipoprotein synthesis
  • greater VLDL and LDL production
  • pregnancy-related insulin resistance enhancing lipolysis
  • placental steroidogenesis requiring cholesterol substrate
Peak levels occur in the third trimester.

Causes of elevated total cholesterol
  • Normal physiologic rise in pregnancy
  • Preeclampsia / endothelial dysfunction
  • Obesity & metabolic syndrome
  • Gestational diabetes
  • Hypothyroidism
  • Cholestatic liver disorders
  • Familial hypercholesterolemia
  • Nephrotic syndrome
  • Medications: steroids, antiretrovirals, atypical antipsychotics
Causes of low total cholesterol
  • Malnutrition or very low dietary fat intake
  • Hyperthyroidism
  • Advanced chronic liver disease
  • Sepsis or severe illness
  • Genetic hypolipidemia

Persistently low cholesterol in pregnancy is uncommon and usually indicates decreased hepatic lipoprotein production.

References

  1. Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol. 2009;114:1326–31.