EP571 - ECE_2552 - The evolution and management of type V familial hypertriglyceridemia during pregnancy

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Abstract Introduction Pregnancy triggers profound metabolic adaptations characterized by hormonal shifts that can increase lipid levels by up to fourfold. While often physiological, this rise poses significant risks for patients with pre-existing dyslipidemia. We present a case of severe hypertriglyceridemia further complicated by the onset of gestational diabetes. This report highlights the clinical challenges of managing extreme lipid elevations to prevent life-threatening maternal and fetal complications. Observation We report the case of a 31-year-old primigravida referred at 25 weeks of gestation following a pathological oral glucose tolerance test. Her medical history includes familial mixed hypertriglyceridemia, diagnosed at age 19 after an acute pancreatitis episode (triglycerides: 23.4 mmol/L; total cholesterol: 8 mmol/L). Fenofibrate therapy was discontinued at the start of pregnancy. Clinical examination was unremarkable, specifically showing no eruptive xanthomas or hypertension. Upon admission, lipase levels were normal, but labs revealed severe hypercholesterolemia (18.41 mmol/L) and hypertriglyceridemia (14.12 mmol/L). Following a strict low-fat diet and omega-3 supplementation (3 g/day), levels adjusted to 16.11 mmol/L and 13.11 mmol/L by week 27. While glycemia was controlled via lifestyle changes, third-trimester ultrasound suggested a trend toward fetal macrosomia. Conclusion Hypertriglyceridemia was exacerbated by pregnancy, gestational diabetes, and glucose provocations, with acute pancreatitis remaining the primary risk. Furthermore, high triglyceride levels are linked to hyperviscosity syndrome and pre-eclampsia. Because therapeutic options are restricted during pregnancy, omega-3 fatty acids are the preferred treatment due to their safety and efficacy. They function by decreasing hepatic triglyceride secretion and enhancing lipoprotein lipase activity.

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