Visual Abstract

Background: Lipid levels increase during pregnancy, likely contributing a metabolic advantage to the fetus. While PCSK9 inhibits LDL receptor recycling to the cell surface and increases plasma LDL-C, changes in PCSK9 levels during gestation and correlations between PCSK9 and lipid levels across pregnancy have not been explored.

Methods: We evaluated 42 women (first trimester BMI between 18.5 and 35 kg/m2) at two study visits: early (mean 15.5 weeks) and late (mean 34.1 weeks) gestation. Women with pregestational diabetes and multifetal pregnancies were excluded. PCSK9 and lipid levels were measured on fasting blood plasma. The Wilcoxon signed rank test was used to assess changes in each measure across pregnancy and Spearman’s correlation coefficient was used to assess the correlation between PCSK9 and individual lipids at early and late pregnancy and changes from early to late pregnancy.

Results: 92% of participants were White. At first visit, the mean age was 30.4 yrs and BMI was 25.6 kg/m2. During gestation, levels of PCSK9 increased by 55% and significantly correlated with changes in total, VLDL, and LDL cholesterol, and triglyceride levels, but not Lp(a) or FFA levels (Table).

Conclusion: PCSK9 levels rose over 50% during pregnancy and may account for between 16% and 36% of increases in total and LDL cholesterol, and triglyceride levels. Lp(a) levels also increase in pregnancy but are not related to PCSK9 levels.


C. H. Anadkat: None. J. Q. Purnell: Advisory Panel; Self; Novo Nordisk Pharma Ltd. N. E. Marshall: None. A. M. Valent: None. J. Boone-heinonen: None. K. Vesco: Research Support; Self; Pfizer Inc.


National Institute of Diabetes and Digestive and Kidney Diseases (R01DK098707)

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