Dyslipidaemia management in pregnant patients remains a complex issue due to limited clinical trial data. Bile acid sequestrants are the only officially approved lipid-lowering medications for pregnancy. Ezetimibe and fenofibrate may be considered if their benefits outweigh risks, while statins are generally contraindicated due to animal studies and case reports, though recent evidence suggests they may be safe in high-risk patients. Newer drugs like bempedoic acid, evinacumab, and inclisiran are under consideration. Pre-conception management, behavioural interventions, and lipid screening are crucial. Lifestyle changes, including diet and exercise, are recommended alongside pharmacotherapy. Hypertriglyceridaemia poses significant risks, and lipid-lowering therapies must balance potential benefits against risks. Statins may be considered in severe hypercholesterolaemia, particularly in patients with familial hypercholesterolaemia (FH). Lipoprotein apheresis is an option for severe cases. Despite challenges in research, personalized treatment approaches are essential. Guidelines emphasize the need for further studies to establish safety and efficacy of lipid-lowering therapies during pregnancy. Pregnancy increases cardiovascular risk, and dyslipidaemia management requires careful evaluation of risks and benefits. Current recommendations prioritize safety, with statins and bile acid sequestrants being the primary options. In high-risk patients, statin therapy may be considered. Overall, a multidisciplinary approach involving lipidologists, cardiologists, and obstetricians is necessary for optimal management.Dyslipidaemia management in pregnant patients remains a complex issue due to limited clinical trial data. Bile acid sequestrants are the only officially approved lipid-lowering medications for pregnancy. Ezetimibe and fenofibrate may be considered if their benefits outweigh risks, while statins are generally contraindicated due to animal studies and case reports, though recent evidence suggests they may be safe in high-risk patients. Newer drugs like bempedoic acid, evinacumab, and inclisiran are under consideration. Pre-conception management, behavioural interventions, and lipid screening are crucial. Lifestyle changes, including diet and exercise, are recommended alongside pharmacotherapy. Hypertriglyceridaemia poses significant risks, and lipid-lowering therapies must balance potential benefits against risks. Statins may be considered in severe hypercholesterolaemia, particularly in patients with familial hypercholesterolaemia (FH). Lipoprotein apheresis is an option for severe cases. Despite challenges in research, personalized treatment approaches are essential. Guidelines emphasize the need for further studies to establish safety and efficacy of lipid-lowering therapies during pregnancy. Pregnancy increases cardiovascular risk, and dyslipidaemia management requires careful evaluation of risks and benefits. Current recommendations prioritize safety, with statins and bile acid sequestrants being the primary options. In high-risk patients, statin therapy may be considered. Overall, a multidisciplinary approach involving lipidologists, cardiologists, and obstetricians is necessary for optimal management.