Reference Values for HDL Cholesterol in Pregnancy

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Reference values — HDL cholesterol (serum / plasma)

HDL cholesterol increases during pregnancy due to estrogen-driven hepatic production. Levels peak in the second trimester and often remain elevated until delivery.

Units Nonpregnant Adult 1st Trimester 2nd Trimester 3rd Trimester
mg/dL 40 – 60 40 – 78 52 – 87 48 – 87
mmol/L 1.04 – 1.55 1.04 – 2.02 1.35 – 2.25 1.24 – 2.25

Pregnancy physiology

Estrogen stimulates increased HDL synthesis. Physiologic hyperlipidemia supports fetal growth and steroidogenesis. HDL levels typically normalize 6–12 weeks postpartum.

Causes of elevated HDL
  • Pregnancy (physiologic)
  • Genetic CETP deficiency
  • Alcohol intake
  • Hyperthyroidism
  • Medications: estrogens, statins, niacin
  • Endurance exercise

Extremely high HDL (>100 mg/dL) can reflect dysfunctional HDL particles.

Causes of low HDL
  • Insulin resistance / Type 2 diabetes
  • Obesity or metabolic syndrome
  • Smoking
  • Hypertriglyceridemia
  • Hypothyroidism
  • Androgen excess
  • Liver disease
  • Genetic disorders (ApoA-I deficiency, Tangier disease)

Low HDL in pregnancy should be interpreted with LDL and triglycerides due to physiologic changes.

References

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