Endocrine Abstracts

Introduction: Pregnancy is associated with physiological rise in triglyceride level and there is increasing evidence that high levels of cholesterol are associated with adverse pregnancy outcomes, including gestational diabetes, pre-eclampsia, fetal growth restriction, large for gestational age, preterm labour, acute pancreatitis, hyperviscosity syndrome; cardiovascular risk to the women such as myocardial infarction in pregnancy and increased atherosclerosis in later life and in offspring.

Case: 36-year-old woman, primigravida, presented at 24 weeks’ gestation with rupture of membrane, was found to have lipemic serum. She got pregnant through IVF in Iraq. She had a history of PCOS, prediabetes, hypertension, and hypertriglyceridemia. There was no family history of dyslipidemia. She was not on dietary fat restriction or lipid-lowering therapy prior to pregnancy. Her pre-pregnancy average fasting triglyceride level was 10 mmol/l. Prior to admission she was on Labetalol, Folic acid, and Aspirin. Upon presentation she had elevated blood glucose (14 mmol/l), plasma triglyceride of 40 mmol/l and total cholesterol of 13.6 mmol/l with normal liver enzymes and amylase. Obstetrical ultrasound showed normal fetal growth but showed anhydramnios. She was managed with a low saturated fat diet (<20% of total calories from fat/day), intravenous insulin and 5% dextrose infusion. Within 72 h of admission, her plasma triglyceride level had reduced by almost 50%. However, due to fetal compromise urgent C-section was required, and a preterm stillborn baby was delivered. Following delivery, insulin infusion was continued, Atorvastatin 40 mg OD and Fenofibrate 200 mg OD were added, and patient was discharged with a Triglyceride level of 9.3 mmol/l, lipid clinic follow up was arranged.

Conclusion: Severe gestational hypertriglyceridemia necessitates preconception planning, regular monitoring during pregnancy, prompt recognition and management to prevent maternal and fetal morbidity and mortality. We discuss the most appropriate approach, safety and role of pharmacological agents and role of plasmapheresis.