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

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 36-year-old G1P0Ab0, with a history of severe HTG-induced necrotizing pancreatitis 9 years ago. 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 27th week of pregnancy. Serum triglycerides (TGs) and fasting blood sugar (FBS) were 6620 and 124 mg/dL, respectively. Showing HTG and gestational diabetes (GDM). After admission for management of severe HTG; she was put on parenteral nutrition with dextrose water 5% and infusion insulin therapy without receiving any enteral carbohydrate for two days. Following that, very low fat diet and omega-3 fatty acids (1200 mg/day) were stated. After 4 weeks, TG levels reached 1000 mg/dL and her self-monitoring blood glucose levels showed appropriate blood glucose for pregnancy. She underwent a successful elective cesarean section in 39th of pregnancy.Conclusion: This case report demonstrates that HTG during pregnancy could be well managed by medical nutrition therapy (MNT).