Obstetrical Management of Severe Hypertriglyceridemia in Pregnancy: A Case Report

Nigel Madden; Nevin Kamal; Jared Friedman; Priya Freaney; Susan E. Gerber; Emily D. Szmuilowicz

doi:10.1055/a-2413-2465

American Journal of Perinatology Reports, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · AJP Rep 2024; 14(04): e244-e249
DOI: 10.1055/a-2413-2465

Case Report

Obstetrical Management of Severe Hypertriglyceridemia in Pregnancy: A Case Report

Nigel Madden

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois

,

Nevin Kamal

²Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois

,

Jared Friedman

²Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois

,

Priya Freaney

³Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois

,

Susan E. Gerber

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois

,

Emily D. Szmuilowicz

²Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois

› Institutsangaben

Abstract

Background Pregnant people with baseline hypertriglyceridemia are at increased risk of severe hypertriglyceridemia and the associated complications, yet there are no formal recommendations to guide management of these patients during pregnancy.

Case We report a case of a patient with presumed familial hypertriglyceridemia who was taken off triglyceride-lowering medications preconception and developed acute pancreatitis at 23 weeks of gestation. She was managed with a very-low-fat diet, exercise, fenofibrate, omega-3-fatty acids, pravastatin, insulin infusion, and plasmapheresis. She delivered at 33 weeks of gestation after presenting with a placental abruption and subcapsular liver hematoma associated with HELLP (hemolysis, elevated liver enzyme levels, and low platelet) syndrome.

Conclusion While rare in pregnancy, severe hypertriglyceridemia is associated with serious maternal risks. Preconception and antepartum obstetric management should incorporate shared decision-making considering both the potential fetal risks of treatment and the objective maternal risks of untreated disease.

Keywords

hypertriglyceridemia - pancreatitis - fibrate - plasmapheresis

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