Preeclampsia somewhat more common in women with familial hypercholesterolaemia

Women with familial hypercholesterolaemia (FH), an inherited disorder that causes lifelong high cholesterol, may face a slightly higher risk of preeclampsia. An observational study in the European Journal of Preventive Cardiology found the condition in 11% of women with FH, against 7% of matched controls. Most other reproductive and pregnancy outcomes did not differ significantly between the groups.

What the study compared

The team, led from Erasmus MC, University Medical Center Rotterdam, recruited women in the Netherlands and Norway between 2023 and 2025. In total, 484 women with FH were each matched with two controls (968 in all) on age, smoking status, body mass index and ethnicity. All participants were aged 40 or over.

Information on reproductive factors and pregnancy outcomes came from an online survey. Women with FH reported a comparable number of pregnancies to the controls.

Why the question is difficult

FH affects roughly 1 in 200 to 300 people, although most cases go undiagnosed. Earlier work has linked non-inherited high cholesterol to differences in reproductive health and pregnancy outcomes. Those findings are hard to interpret, because the effects of raised cholesterol are tangled up with lifestyle factors. FH offers a cleaner comparison, since the elevated LDL cholesterol has a genetic origin and is present from birth.

Preeclampsia involves high blood pressure in pregnancy together with organ damage. It can lead to slower fetal growth and premature birth, and in some cases becomes life-threatening. It cannot be cured, but treatment and care plans can help manage it.

Interpreting the result

The authors stress that the difference was modest and does not mean any individual woman with FH will develop preeclampsia. Because the design was observational, the study cannot show that FH or high LDL cholesterol causes the condition. Janneke Mulder, one of the study authors, made this point directly.

Several limitations apply. Outcomes were self-reported through a survey rather than taken from clinical records. The cohort was mainly of European ancestry, which limits how far the results can be generalised. Most women with FH were taking lipid-lowering therapy, but probably only began in their 30s or 40s, when such drugs became widely available. Their cholesterol would therefore have been untreated for much of their reproductive lives.

Implications and next steps

The researchers suggest that clinicians could consider preeclampsia history as part of cardiovascular risk assessment, especially when a woman is planning a pregnancy. They also argue that reproductive health counselling should be part of cardiovascular care for women with FH, and possibly for women with high cholesterol more broadly. Women with FH who are planning a pregnancy are advised to discuss cardiovascular risk factors, blood pressure and the management of lipid-lowering treatment around pregnancy with their healthcare team.

Adverse pregnancy outcomes are already associated with long-term cardiovascular risk, and cholesterol levels shift across the menstrual cycle and during pregnancy. Julie van Oortmerssen called for larger longitudinal studies of women with differing levels of lifelong LDL exposure. Such work could show whether high cholesterol combined with a complication such as preeclampsia marks out women at particularly high long-term risk, and who might benefit from closer follow-up or more intensive prevention.

The team adds that further research is needed to establish whether earlier or more intensive lipid-lowering treatment could lower the risk of preeclampsia.

Source: Condition causing lifelong high cholesterol linked to pregnancy complication (Medical Xpress, 5 November 2026).

Image: AI-generated illustration.