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. Abbreviations: HDL = high-density lipoprotein; LPL = lipoprotein lipase; TG = triglyceride; VLDL = very-low-density lipoprotein 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.