Hypertriglyceridemia in gestational diabetes: Case report and review of the literature

Background

Hypertriglyceridemia is a rare but potentially severe complication of pregnancy. It is seen in women with inherited lipid disorders, thyroid disease, nephrotic syndrome, diabetes and is associated with certain medication. Hypertriglyceridaemia can cause pancreatitis, pre-eclampsia and foetal compromise. Treatment is often challenging-many medications are not approved during pregnancy and much of the evidence comes from small case reports and case series. Here was present the case of a lady with type 2 diabetes and hypertriglyceridemia, outline our treatment plan and progress and review the literature.

Case presentation

We describe the case of a 37 year old pregnant lady with obesity and type 2 diabetes mellitus who developed severe hypertriglyceridemia in her third trimester. Baseline body mass index and triglyceride level entering pregnancy were 45.2 kg/m² and 2.2 mmol/L (0.4–2.0). At week 31 this lady required >1 unit/kg of insulin. A random lipid level done to investigate large foetal size identified a triglyceride level of 27 mmol/L. Treatment with a reduced fat diet, strict glycaemic control and omega 3 fatty acids was initiated and triglycerides reduced to <5mmol/L. A healthy infant weighting 3.3kg was delivered at 36 + 5. Post-partum lipids returned to baseline levels without treatment and insulin was discontinued after delivery.

Conclusion

Treatment of this rare condition is often complex and required multi-disciplinary input. In cases such as this dietic support and strict glycaemic control are the corner stones of treatment, however a number of oral and parenteral treatment options are available for those with severe complications.