When pregnancy is unplanned, statin therapy should be stopped promptly and not restarted until after pregnancy and breastfeeding are completed. Cholesterol levels rise in pregnancy, with a similar percentage rise in normal women and those with heterozygous FH. Women with FH do not appear to have a higher risk of preterm delivery or of having infants with low birth weight or congenital malfor- mations than unaffected women, but undetected bias cannot be ruled out.S4.5.3-16 An experienced lipid specialist should be consulted for women with homozygous FH whose care is beyond the scope of the present guideline. Also, triglyceride levels rise progressively with each trimester, and women with triglyceride levels 500 mg/dL (5.6 mmol/L) at the onset of pregnancy may develop severe hypertriglyceridemia during the third trimester of pregnancy, which can lead to pancreatitis.S4.5.3-17 Advising patients on lifestyle (including both diet and physical activity), optimally managing diseases like diabetes mellitus and hypothyroidism, and choosing medications that are less likely to raise tri- glycerides can reduce levels of triglycerides before pregnancy begins. Treatment of severe hypertri- glyceridemic pregnancy is also beyond the scope of the present guideline and requires consultation with an experienced lipid specialist. 4.5.4. Adults With CKD Recommendations for Adults With CKD Referenced studies that support recommendations are summarized in Online Data Supplements 36 to 38. 