The current status of lipoprotein (a) in pregnancy: A literature review

Background and purpose: Lipoprotein (Lp) (a) is a neglected element of the blood lipid profile. It is now recognized as a determinant of coronary heart disease progression and its role in atherosclerosis and its ability to induce thrombosis make it potentially important in the course of normal and complicated pregnancies. Pregnancy involves a major transformation of metabolism to sustain fetal growth. Multiple studies have been conducted on Lp(a) in pregnancy, and it is timely to synthesize and evaluate this evidence. Methods and subjects: We reviewed the MEDLINE database for all articles published concerning lipoprotein a and pregnancy from May 2003 to May 2012. A previous comprehensive review assessed the literature up to May 2003. Results: We critically analyzed 14 studies detailing the effect of complications in pregnancy on Lp(a) profile, and subsequent pregnancy outcomes where available. Studies evaluating the normal metabolic response to pregnancy, pregnancies complicated by pre-eclampsia and intra-uterine growth restriction were reviewed. Conclusions: A substantial mass of data has accumulated describing Lp(a) changes in pregnancy. The diversity of study design limits the ability to draw broad-ranging conclusions, but brings into focus the important questions remaining, which we discuss. (C) 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.