This review provides a comprehensive overview of the lipid profile changes during pregnancy and their associated cardiovascular outcomes for both the mother and the child. During pregnancy, women experience significant physiological changes in lipid metabolism, including increased total cholesterol, LDL-cholesterol, and triglycerides, while HDL-cholesterol levels also rise. These changes are influenced by factors such as prepregnancy lipid levels, BMI, age, diet, and ethnicity. Dyslipidemia during pregnancy is particularly concerning in women with familial hypercholesterolemia (FH), who have higher baseline lipid levels and more pronounced increases during pregnancy. The review highlights that an atherogenic lipid profile during pregnancy is associated with adverse outcomes such as preeclampsia, gestational diabetes, metabolic syndrome, and unfavorable lipid profiles in both the mother and the child. Additionally, early gestational lipid levels can serve as early markers for future cardiovascular risk and can be used to identify women at higher risk for cardiovascular disease. The review also discusses the potential benefits of implementing gestational lipid screening to optimize early cardiovascular risk prevention. Future research should focus on understanding the specific risk groups and the impact of gestational lipid levels on short-term and long-term outcomes, particularly in women with FH.This review provides a comprehensive overview of the lipid profile changes during pregnancy and their associated cardiovascular outcomes for both the mother and the child. During pregnancy, women experience significant physiological changes in lipid metabolism, including increased total cholesterol, LDL-cholesterol, and triglycerides, while HDL-cholesterol levels also rise. These changes are influenced by factors such as prepregnancy lipid levels, BMI, age, diet, and ethnicity. Dyslipidemia during pregnancy is particularly concerning in women with familial hypercholesterolemia (FH), who have higher baseline lipid levels and more pronounced increases during pregnancy. The review highlights that an atherogenic lipid profile during pregnancy is associated with adverse outcomes such as preeclampsia, gestational diabetes, metabolic syndrome, and unfavorable lipid profiles in both the mother and the child. Additionally, early gestational lipid levels can serve as early markers for future cardiovascular risk and can be used to identify women at higher risk for cardiovascular disease. The review also discusses the potential benefits of implementing gestational lipid screening to optimize early cardiovascular risk prevention. Future research should focus on understanding the specific risk groups and the impact of gestational lipid levels on short-term and long-term outcomes, particularly in women with FH.