Severe Hypertriglyceridemia in Pregnancy: A Case Report and Review of the Literature

Abstract

Objective: Severe gestational hypertriglyceridemia is a rare disease, and there are no published guidelines to assist the clinician in management. However, due to the elevations in lipids that occur during pregnancy, this condition is encountered in clinical practice and presents a therapeutic dilemma. We report the successful management and treatment of a patient with severe gestational hypertriglyceridemia and conducted a review of the literature regarding treatment modalities.Methods: We conducted a search in PubMed from 1990 to 2018 for the following terms: "severe hypertriglyceridemia in pregnancy;" "management of hypertriglyceridemia in pregnancy;" "apheresis for severe gestational hypertriglyceridemia;" "TPN for severe gestational hypertriglyceridemia;" "insulin for severe gestational hypertriglyceridemia;" and "heparin for treatment of severe hypertriglyceridemia." We then reviewed the literature.Results: Given the risks to the mother and fetus of severe hypertriglyceridemia, aggressive therapy should be initiated within a multidisciplinary team. There are multiple treatment modalities, including restrictive diet, various medications such as niacin, fibrates, intravenous heparin, insulin, and apheresis. Choice of treatment will depend on the patient's comorbidities, clinical status, and if there are any associated complications.Conclusion: Treatment for severe gestational hypertriglyceridemia should be initiated immediately and aggressively to avoid risk to the mother and infant, including pancreatitis, hyperviscosity syndrome, preeclampsia, fetal death, and preterm labor. (AACE Clinical Case Rep. 2019;5:e99-e103) Abbreviations: HDL = high-density lipoprotein; LPL = lipoprotein lipase; TG = triglyceride; VLDL = very-low-density lipoprotein METHODS Search StrategyWe conducted a search in PubMed for the following terms: "severe hypertriglyceridemia in pregnancy;" "pathophysiology of gestational hypertriglyceridemia;" "management of hypertriglyceridemia in pregnancy;" "apheresis for severe gestational hypertriglyceridemia;" Abbreviations: LPL = lipoprotein lipase; TG = triglyceride; VLDL = very-low-density lipoprotein. a Table adapted from references (1,3,4).

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 ).…”

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

“…She had received insulin glargine and lispro and a diet consisting of low-fat (<20% of calories) and low-carbohydrate. At the delivery, the serum concentration of TGs was <2,000 mg/dL ( 11 ). None of the previous studies indicated the MNT in detail, as we have provided in the current study.…”

A Case of very Severe Hypertriglyceridemia during Pregnancy

“…6 The risk of preeclampsia, pancreatitis, hyperviscosity syndrome, preterm delivery and fetal death increases when TG levels greater than 2000 mg/dL. 7 Therefore, treatment should be started immediately. In the treatment, besides dietary regulation and lifestyle changes, intravenous insulin, omega-3 support, plasmapheresis and other medical treatments are used.…”