Lipid and lipoprotein (Low Density Lipoprotein) apheresis in pregnancy [Lipidoaferesi ed LDL-aferesi in gravidanza]

Pregnancy and delivery in a women with a severe genetically determined hyperlipidemia is a rare event, but not impossible. Increasing morbidity and mortality of both mother and child due to severe hyperlipidemia already existing, or induced by change of sex hormones concentration may occur during pregnancy. Reasonable therapeutic measures are to be undertaken to prevent complications, inevitably. However, it is also well-known that lipid lowering drugs are contraindicated during pregnancy. Notwithstanding, when critical clinical conditions occur there is the need to provide a therapeutic option. Lipid and Lipoprotein apheresis are recognized effective and reasonably safe, although invasive treatment for severe disorders of lipid and lipoprotein metabolism. Therapeutic Lipid apheresis (Plasma-exchange, Cascade Filtration) and Lipoprotein apheresis (Dextran Sulphate, H.E.L.P., and D.A.Li. Low Density Lipoprotein apheresis) offer an alternative, to be used in selected cases to reduce high LDL-cholesterol levels or insurgent elevation of Triglyceride-rich lipoproteins in plasma, during pregnancy. The existing evidence suggested that Lipid and Lipoprotein apheresis do not interfere with physiologic adaptations of lipid and lipoprotein metabolism during pregnancy in hyperlipidemic subjects, seemingly. This review is aimed at reporting existing clinical evidence on how women with severe hypercholesterolemia who became pregnant on long-term Lipid and/or Lipoprotein apheresis treatment, or affected by severe hypertriglyceridemia and hyperchylomicronemia, who were treated by therapeutic apheresis because of their acute exposure to the risk of pancreatitis during pregnancy, have been treated. Existing guidelines and reccommendations are also reviewed.