In a pregnant woman with heterozygous familial hypercholesterolemia, which is the best recommendation for her current medications?

For a pregnant woman with heterozygous familial hypercholesterolemia, the best recommendation is to discontinue both atorvastatin and ezetimibe and initiate colesevelam 1.875 g twice daily. This choice is supported by several factors related to medication safety during pregnancy and the management of hyperlipidemia.

Atorvastatin is categorized as a pregnancy category X medication due to its potential teratogenic effects, which means it is contraindicated and should not be used during pregnancy. Ezetimibe, while not classified as category X, has limited safety data in pregnant women, and its use is generally discouraged.

Colesevelam, on the other hand, is a bile acid sequestrant that is considered safe during pregnancy. It can effectively lower LDL cholesterol levels without the associated risks posed by statins. This makes colesevelam a suitable alternative for managing cholesterol levels in pregnant patients, as it does not have the same teratogenic risks associated with atorvastatin or the unclear safety profile of ezetimibe.

Given these considerations, transitioning to colesevelam allows for appropriate lipid management while ensuring the safety of both the mother and the developing fetus.