Case Report: Management of a Patient With Chylomicronemia Syndrome During Pregnancy With Medical Nutrition Therapy

Abstract

Background: Hypertriglyceridemia (HTG) during pregnancy may be accompanied by acute pancreatitis, hyperviscosity syndrome, and preeclampsia. HTG during pregnancy should be managed by a multidisciplinary team; however, no clinical guidelines exist for severe gestational HTG.Case Presentation: We herein present a case of a 36-year-old in the first pregnancy (G1P0Ab0), with a history of severe HTG-induced necrotizing pancreatitis 9 years earlier. There was no family history of HTG. During these years, she did not follow any appropriate diet or medical therapy for HTG. She became pregnant in May 2019, without preconception counseling. Eruptive and tuberoeruptive xanthomas appeared in the 27th week of pregnancy. Serum triglycerides (TGs) and fasting blood sugar (FBS) were 6,620 and 124 mg/dL, respectively, indicating HTG and gestational diabetes (GDM). After admission for the management of severe HTG, she was put on parenteral nutrition with dextrose water 5% and infusion insulin therapy without receiving any enteral carbohydrate for 2 days. Following that, a very low-fat diet and omega-3 fatty acids (1,200 mg/day) were started. After 4 weeks, TG levels reached 1,000 mg/dL, and her self-monitoring blood glucose levels showed appropriate blood glucose for pregnancy. She underwent a successful elective cesarean section in the 39th of pregnancy.Conclusion: This case report demonstrates that HTG during pregnancy could be managed by medical nutrition therapy (MNT).

Multidisciplinary diagnosis and treatment of severe acute pancreatitis associated with hypertriglyceridemia in pregnancy: a case report

“…Previously, the application of Beite drugs, heparin, and plasma exchange was reported to rapidly reduce blood lipids in pregnant women ( 28 , 29 ). However, few studies have addressed the management of HTG during pregnancy through medical nutrition therapy ( 30 , 31 ).…”

Posicionamento Brasileiro sobre Síndrome da Quilomicronemia Familiar – 2023

“…Até o momento, tratamento dietoterápico da SQF é a única ferramenta disponível para controle das concentrações plasmáticas de triglicérides nesta condição, conforme demonstrado em recente publicação do acompanhamento de gestante que apresentava concentração plasmática de triglicérides de 8.683mg/dL e que referia episódios de pancreatites anteriores. 144 …”

“…Dietary management of FCS is the only tool available to control plasma triglyceride levels in this condition, as demonstrated in a recent case report of a pregnant woman with plasma triglyceride levels of 8,683 mg/dL who experienced previous episodes of pancreatitis. 144 …”

“…92 Até o momento, tratamento dietoterápico da SQF é a única ferramenta disponível para controle das concentrações plasmáticas de triglicérides nesta condição, conforme demonstrado em recente publicação do acompanhamento de gestante que apresentava concentração plasmática de triglicérides de 8.683mg/dL e que referia episódios de pancreatites anteriores. 144 O nutricionista deve auxiliar a paciente a elaborar o plano alimentar, fornecendo auxílio com receitas e estratégias que facilitem o seguimento da dieta. Preferências alimentares, hábitos culturais e estilo de vida devem ser considerados, bem como adequação nutricional e de calorias.…”