This study aimed to evaluate the effect of continuing or discontinuing statin therapy during pregnancy on maternal lipid profile, maternal complications, and neonatal outcomes in women who took statins before pregnancy. A retrospective cohort study included 180 women who took statins before pregnancy and delivered at perinatal centers in Vladikavkaz between 2021 and 2025. Participants were divided into two groups: those who continued statins during pregnancy (n=94) and those who discontinued therapy upon pregnancy recognition (n=86). Demographic data, lipid profiles at four time points, maternal outcomes (preeclampsia, gestational diabetes, preterm birth, cesarean section, postpartum hemorrhage), and neonatal outcomes (Apgar score, birth weight, low birth weight, congenital anomalies, NICU admission) were assessed. In the discontinuation group, LDL cholesterol increased from 2.5 mmol/L before pregnancy to 4.3 mmol/L in the third trimester. In the continuation group, LDL levels remained stable (2.4–2.7 mmol/L). The decision to continue therapy was made by 52.2% of women and was independently associated with familial hypercholesterolemia and a history of cardiovascular events. Maternal complications did not differ between groups. Statin continuation was associated with lower neonatal birth weight (3180 g vs. 3350 g, p=0.031) and a trend toward higher low birth weight (9.6% vs. 3.5%, p=0.096). Congenital anomalies were comparable between groups (1.1% vs. 1.2%). Discontinuing statins during pregnancy leads to a marked increase in LDL cholesterol but is not associated with increased maternal complications.
