Insulin Management for Hypertriglyceridemia in Pregnancy

To editor: Hypertriglyceridemia is a major risk factor for cardiovascular disease and acute pancreatitis. Accordingly, during pregnancy, the growing serum lipid levels have potentially critical implications. However, the management of gestational hypertriglyceridemia is further complicated because of the lack of safety data for most of the lipid-lowering agents. Here, we present a casewho is a young pregnant patient who developed very severe hypertriglyceridemia (>1000 mg/dL) and was successfully treated with insulin therapy plus fenofibrate in a timely and effectivemannerwithout noticeable adverse effects, with a purpose of providing a real-world approach or some references for obstetricians. The patient has given her consent to publish the clinical information and figures in the journal. A 32-year-old in vitro fertilization (IVF) multigravid woman, G3P0, in her regular antenatal care, at 30 weeks of gestation presented into the ward with complaints of onset of severe hypertriglyceridemia (HTG) on August 1, 2021. Her obstetric historywas significant for 2 spontaneous abortions. The patient andher husbandweredistantly related, and therewasno family history of lipid disorders. Her history was impressive for HTG pancreatitis, which occurred twice in the year 2011 and 2017, respectively. She was treated with an absolute diet as well as plasmapheresis for almost 1month when the first onset of pancreatitis was triggered byHTG,whichwas fueled by overindulgence in greasy foodwhen shewas 22years old.A recurrence of pancreatitis caused by overeating 6 years later compelled her to be admitted to another hospital again to receive some treatments, butwearenot able to secure enoughdetails.Allwe canapproach as she had been on exercise and taking fenofibrate 160 mg orally per day since the second outbreak, making her level of triglyceride (TG) range from 3 to 5 mmol/L until she