Gestational hyperlipidemia and acute pancreatitis with underlying partial lipoprotein lipase deficiency and apolipoprotein E3/E2 genotype

Severe gestational hypertriglyceridemia: A practical approach for clinicians

Severe gestational hypertriglyceridemia is a potentially life threatening and complex condition to manage, requiring attention to a delicate balance between maternal and fetal needs. During pregnancy, significant alterations to lipid homeostasis occur to ensure transfer of nutrients to the fetus. In women with an underlying genetic predisposition or a secondary exacerbating factor, severe gestational hypertriglyceridemia can arise, leading to devastating complications, including acute pancreatitis. Multidisciplinary care, implementation of a low-fat diet with nutritional support, and institution of a hierarchical therapeutic approach are all crucial to reduce maternal and fetal morbidity. To avoid maternal pancreatitis, close surveillance of triglycerides throughout pregnancy with elective hospitalization for refractory cases is recommended. Careful dietary planning is required to prevent neural and retinal complications from fetal essential fatty acid deficiency. Questions remain about the safety of fibrates and plasmapheresis in pregnancy as well as the optimal timing for induction and delivery of these women.

Clinical characteristics of acute pancreatitis during pregnancy

AIM: To describe the clinical characteristics and causes of acute pancreatitis during pregnancy (APP).

METHODS: A retrospective analysis of clinical data for 23 pregnant women with acute pancreatitis treated at the Affiliated Hospital of Qingdao University from January 1, 2000 to January 1, 2015, including age, body mass index, gestational age, hospitalization time, hospitalization expenses and other numerical variables, as well as fetal sex and other classification variables.

RESULTS: Twenty (86.96%) cases occurred in late pregnancy. Seven (30.43%) cases were moderately severe pancreatitis, and 8 (34.78%) cases were severe pancreatitis. Thirteen (56.52%) cases were caused by hyperlipidemia, 4 (17.39%) cases were caused by gallstones and 6 (26.10%) cases were idiopathic. Maternal death occurred in 1 (4.35%) case, and the rate of fetal mortality was 13.63% (3/22). Compared with non-hyperlipidemic acute pancreatitis, cases caused by hyperlipidemia were more severe, however, the prognoses of both mothers and infants were good.

CONCLUSION: Acute pancreatitis occurs mostly in the third trimester of pregnancy, and is mostly caused by hyperlipidemia and gallstones. The rate of acute pancreatitis in patients with hyperlipidemia is increasing year by year, and it is associated with a high mortality rate of fetuses.