One Pre-Pregnancy Blood Test That Can Reveal Your Risk for Complications, According to a New Study

Having high cholesterol before conceiving could spell trouble down the line.

October 17, 2025

several empty vials and one partly full of blood on a table

Cholesterol doesn’t have the same clout as plenty of other heart-related biomarkers. You can’t check the amount of cholesterol (a.k.a. a waxy fat made by your liver) floating in your blood using a wearable, like you can your heart rate or blood pressure. And even if you pay your doctor a yearly visit (kudos!), they probably aren’t running a blood test for cholesterol unless you’re at high risk for heart disease, for instance due to a family history. But based on new research being presented this weekend at an American College of Cardiology conference, it’s also key to know your cholesterol levels if you’re trying to conceive or even planning to become pregnant in the near future, as elevated numbers could raise your risk of pregnancy complications and heart issues in the years just following.

Drawing from a database of electronic medical records, researchers compared more than 10,000 pregnant women who had a documented history of high cholesterol at least a year before their delivery date with a similarly large group of pregnant women who had no such history. And when they controlled for a handful of variables (like age and health conditions), they found that the women with the pre-pregnancy high cholesterol were significantly more likely than their normal-cholesterol peers to wind up with gestational diabetes, hypertensive disorders of pregnancy (conditions involving high blood pressure, like preeclampsia), hemorrhage during pregnancy, and labor and delivery complications, as well as arrhythmia (a.k.a. irregular heartbeat) and heart attack within just five years postpartum.

It’s the immediacy of these negative effects that’s notable, according to Mahathi Indaram, MD, a board-certified cardiologist at the Allegheny Health Network Cardiovascular Institute, in Pittsburgh, and an author on the study. We’ve long known that hyperlipidemia, or high cholesterol, is a big risk factor for heart disease in the general population, but we haven’t had good data for pregnant people, she says. After all, normal hormonal changes of pregnancy cause cholesterol levels to rise, so health care providers don’t typically test during this period. Hence why Dr. Indaram wanted to investigate what might happen to those who are already walking around with high cholesterol when they get pregnant—which is, in itself, a stressor to the heart. It turns out, the combination doesn’t just raise your risk of pregnancy complications; it may fast-track your path to the kinds of heart conditions typically caused by high cholesterol much later in life.

Why having high cholesterol before getting pregnant can raise your risk of complications and postpartum heart issues

Though this study didn’t explore exactly why pre-pregnancy high cholesterol contributes to negative pregnancy outcomes and heart-related fallout, we know from prior research that a healthy pregnancy hinges on a robust heart and cardiovascular system. Extra cholesterol could get in the way of that by contributing to the formation of waxy plaques in your arteries, which can slow blood flow to your heart, Srijana Maharjan, MD, the lead author of the study and an internal medicine resident at Allegheny General Hospital, in Pittsburgh, tells SELF. There’s also the highly inflammatory nature of excess cholesterol, Dr. Indaram adds, which can damage the lining of your blood vessels, further threatening your heart health.

Think of a cholesterol surplus as essentially piling onto the additional strain that your heart will bear just by nature of being pregnant. It’s the reason research also suggests having other cardiovascular risk factors when you enter pregnancy, like high blood pressure or high blood sugar levels, may bump up your risk of negative obstetric and heart outcomes too.

“There’s always this chicken-and-egg question with pregnancy complications: Is it that you had an underlying cardiovascular vulnerability that was unmasked by pregnancy because it’s such a stressor on the heart, or is it that something happened in early pregnancy that led to the heart issues?” Anais Hausvater, MD, a board-certified cardiologist and co-director of the Cardio-Obstetrics Research Program at NYU Langone, tells SELF. “Studies like this one are helping tease that out and show that a preexisting vulnerability may be in play.”

It’s worth getting your cholesterol levels checked before pregnancy—and leading a heart-healthy lifestyle.

Dr. Maharjan and Dr. Indaram hope their findings push doctors to incorporate cholesterol testing into preconception care, and that in the future, it’ll be part of the standard protocol for anyone trying to conceive or planning to become pregnant. In the meantime, if you fall in these camps, consider asking your doctor for a cholesterol panel at your next visit, particularly if you haven’t ever had your levels checked or you have a family history of heart disease. After all, trends in recent decades toward both leading a less heart-healthy lifestyle (sitting more, eating not-so-nutritious foods) and having kids at an older age could mean more people than ever may have high cholesterol pre-pregnancy, Dr. Indaram says.

If you find out your levels are high, then you can start implementing lifestyle changes to lower both your cholesterol and your risk of pregnancy complications—the sooner the better, but you can and should keep it going during pregnancy too, Dr. Hausvater says. “I always tell my patients that all of the things you’d do to optimize your cardiovascular health to prevent future heart attacks and strokes will also optimize the health of a pregnancy,” she says. For a quick guide, she points to the American Heart Association’s Essential 8, which includes staying on top of a few biomarkers—yes, cholesterol, as well as blood pressure and blood sugar—alongside following a whole-food, plant-rich diet; being physically active; not smoking; routinely getting quality sleep; and maintaining a healthy weight for you.

Though it’s very rare, there is a subset of people who have super high cholesterol levels due to a genetic lipid disorder, and this might not come to light until you’re tested or a heart event occurs, Dr. Indaram says (which is even more reason to get checked pre-pregnancy). Only for these folks—or for people who’ve already had a heart attack or stroke caused by plaque formation, or complications in a prior pregnancy—would a doctor typically recommend using a cholesterol-lowering medication like a statin ahead of or during pregnancy, she notes. Otherwise, the above lifestyle shifts are the gold standard.

It’s also extra-important to stay on top of prenatal visits, so your ob-gyn can keep an eye out for signs of complications. As of now, having high cholesterol is not a factor that would qualify a pregnancy as high-risk (which dictates additional monitoring, typically by a maternal-fetal medicine specialist), Dr. Hausvater says, so the standard of care isn’t any different—“but it’s possible that in the future, we’ll rethink that,” she adds.

Regardless, all three doctors say that if you have high cholesterol pre-pregnancy, it’s also critical to follow up with your ob-gyn or primary care doctor after you give birth to get a cardiovascular risk assessment (for which your doctor will generally do a physical exam and run tests to determine your likelihood of having an event like a heart attack or stroke). Within three months postpartum, any normal pregnancy-related shifts to your cholesterol should have diminished, Dr. Hausvater says, so if you’re still showing elevated levels then, your doctor may refer you to a cardiologist who can dig deeper.

Ultimately, being aware of the risk that high cholesterol can pose during and after pregnancy, embracing heart-healthy habits throughout, and following up postpartum can make the difference between experiencing a heart event and evading one.