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Schatoff D, Jung IY, Goldberg IJ. Lipid Disorders and Pregnancy. Endocrinol Metab Clin North Am 2024; 53:483-495. [PMID: 39084821 DOI: 10.1016/j.ecl.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Practicing endocrinologists are likely to confront 2 major issues that occur with dyslipidemias during pregnancy. The most dramatic is the development of severe hypertriglyceridemia leading to acute pancreatitis. The second is the approach to treatment of familial hypercholesterolemia, a common genetic disorder. This article reviews the normal physiology and the pathophysiology of lipoproteins that occurs with pregnancy and then discusses the approaches to prevention and/or treatment of dyslipidemia in pregnancy with a focus on lifestyle and acceptable drug therapies.
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Affiliation(s)
- Daria Schatoff
- New York University Grossman School of Medicine, New York, USA
| | - Irene Y Jung
- New York University Grossman School of Medicine, New York, USA
| | - Ira J Goldberg
- Department of Medicine, New York University Grossman School of Medicine, New York, USA; Holman Division of Endocrinology, Diabetes & Metabolism, New York University Grossman School of Medicine, New York, USA.
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2
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Saif HS, Al-Ansari B, Raza G, Ghorabah M. Approach to the Management of Hypertriglyceridemia Complicated With Acute Pancreatitis in Pregnancy: A Case Report. Cureus 2024; 16:e56006. [PMID: 38606269 PMCID: PMC11007583 DOI: 10.7759/cureus.56006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
This is a case of a 32-year-old woman, Gravida 3 para 2, previous two cesarean sections, who presented to our emergency department at 24+3 weeks of gestation complaining of severe epigastric pain radiating to the back. She was diagnosed with severe hypertriglyceridemia complicated with acute pancreatitis and was managed by a multi-disciplinary team, which included obstetrics, gastroenterology, endocrinology, hematology, nutrition, and ICU team. Initially, conservative treatment was employed for her management. She was placed on nil per oral status and initiated on a normal saline infusion at a rate of 150 ml/hour, along with insulin infusion at 0.1 unit/kg/hour and dextrose (D5) at 80 ml/hour. Additionally, she received omeprazole, meropenem, clexane (40 mg once daily subcutaneous injection), iron, vitamin supplements, and analgesics as required. Subsequently, due to the failure of the initial conservative medical management, the patient was admitted to the ICU. Plasmapheresis was performed after the insertion of a vascath, using 3000 ml of albumin 5% as replacement fluid and oral calcium. Following this, she was prescribed Omacor (Omega 3) at a dosage of 2 grams orally twice daily, along with a low carbohydrate and fat diet, to manage her triglyceride levels. After the removal of the central line, her triglycerides increased to 14.3 mmol/L, leading to the initiation of fenofibrate at a daily dose of one tablet. With persistent elevation to 16.4 mmol/L, Lipitor at 40 mg once daily was introduced. Following this intervention, her triglyceride levels stabilized, and her overall condition improved. She was discharged at 25+1 weeks with a prescribed regimen, and scheduled follow-ups were arranged in the endocrine and obstetrics clinics. At 36 weeks of gestation, she presented to the emergency room with abdominal, back, and leg pain. Fetal distress, indicated by fetal tachycardia (170-180 bpm) on cardiotocography, prompted an urgent category 1 cesarean section, which proceeded without complications.
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Affiliation(s)
- Hamad S Saif
- General Practice, King Hamad University Hospital, Busaiteen, BHR
| | - Basma Al-Ansari
- Obstetrics and Gynecology, King Hamad University Hospital, Busaiteen, BHR
| | - Gulmeen Raza
- Obstetrics and Gynecology, King Hamad University Hospital, Busaiteen, BHR
| | - Maha Ghorabah
- Obstetrics and Gynecology, King Hamad University Hospital, Busaiteen, BHR
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3
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Baracchi A, Piani F, Degli Esposti D, Agnoletti D, Borghi C, D'Addato S. When pregnancy-associated hypertriglyceridemia goes above and beyond the risk of pancreatitis. Intern Emerg Med 2024; 19:477-481. [PMID: 37468772 DOI: 10.1007/s11739-023-03378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/21/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Alessandro Baracchi
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Dept., Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Federica Piani
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Dept., Alma Mater Studiorum University of Bologna, Bologna, Italy.
- Cardiovascular Medicine Unit, Heart, Chest and Vascular Dept., IRCCS Azienda-Ospedaliero Universitaria Di Bologna, Bologna, Italy.
| | - Daniela Degli Esposti
- Cardiovascular Medicine Unit, Heart, Chest and Vascular Dept., IRCCS Azienda-Ospedaliero Universitaria Di Bologna, Bologna, Italy
| | - Davide Agnoletti
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Dept., Alma Mater Studiorum University of Bologna, Bologna, Italy
- Cardiovascular Medicine Unit, Heart, Chest and Vascular Dept., IRCCS Azienda-Ospedaliero Universitaria Di Bologna, Bologna, Italy
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Dept., Alma Mater Studiorum University of Bologna, Bologna, Italy
- Cardiovascular Medicine Unit, Heart, Chest and Vascular Dept., IRCCS Azienda-Ospedaliero Universitaria Di Bologna, Bologna, Italy
| | - Sergio D'Addato
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Dept., Alma Mater Studiorum University of Bologna, Bologna, Italy
- Cardiovascular Medicine Unit, Heart, Chest and Vascular Dept., IRCCS Azienda-Ospedaliero Universitaria Di Bologna, Bologna, Italy
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Mori K, Rajakumar P, Yalamanchi A, Rajeswari KS, Balachandran K, Asirvatham AR, Mahadevan S. Severe Hypertriglyceridemia-Induced Pancreatitis in Pregnancy: A Dreaded Combination. J Obstet Gynaecol India 2023; 73:255-258. [PMID: 38143970 PMCID: PMC10746649 DOI: 10.1007/s13224-023-01777-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/28/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Krishna Mori
- Department of Endocrinology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu 600056 India
| | - Priyadarshini Rajakumar
- Department of Endocrinology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu 600056 India
| | - Amulya Yalamanchi
- Department of Endocrinology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu 600056 India
| | - K. S. Rajeswari
- Department of Obstretics and Gynecology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Karthik Balachandran
- Department of Endocrinology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu 600056 India
| | - Adlyne Reena Asirvatham
- Department of Endocrinology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu 600056 India
| | - Shriraam Mahadevan
- Department of Endocrinology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu 600056 India
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Williamson C, Nana M, Poon L, Kupcinskas L, Painter R, Taliani G, Heneghan M, Marschall HU, Beuers U. EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy. J Hepatol 2023; 79:768-828. [PMID: 37394016 DOI: 10.1016/j.jhep.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 07/04/2023]
Abstract
Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy. Whether related to pregnancy or pre-existing, liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality. Thus, the European Association for the Study of Liver Disease invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations, based on the best available evidence, for the management of liver disease in pregnancy for hepatologists, gastroenterologists, obstetric physicians, general physicians, obstetricians, specialists in training and other healthcare professionals who provide care for this patient population.
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Paquette C, Careau AM, Bergeron J, Carpentier C, Claveau J. A case of eruptive xanthomas associated with pregnancy unmasking a G188E heterozygous mutation of the lipoprotein lipase gene: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221131865. [PMID: 36274861 PMCID: PMC9580080 DOI: 10.1177/2050313x221131865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A case of eruptive xanthomas with exceptionally high levels of blood triglycerides without any complication during pregnancy is reported. Eruptive xanthomas may develop in the setting of severe hypertriglyceridemia. Clinically, patients present with small and smooth papules with a characteristic yellow hue. The condition can also be associated with morbid systemic complications. Estrogen replacement therapy is a known cause of secondary hypertriglyceridemia. Estrogen increase in pregnancy is associated with a physiologic elevation of blood triglycerides in order to provide sufficient nutrition for the fetus. However, in the setting of primary dyslipidemia, severe hypertriglyceridemia can occur. The case presented here was explained by a partial primary lipoprotein lipase deficiency with a heterozygous G188E mutation of the LPL gene. The delivery by induced labor and the introduction of fenofibrate led to a rapid decrease of triglycerides and a resolution of cutaneous lesions without any complication for the patient or her baby.
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Affiliation(s)
- Caroline Paquette
- Division of Dermatology, CHU de Québec, Laval University, Quebec, QC, Canada,Caroline Paquette, Division of Dermatology, CHU de Québec, Laval University, 380 rue de la Couronne app 1310, Québec, QC G1K 0G5, Canada.
| | - Anne-Marie Careau
- Division of Endocrinology and Lipidology, CHU de Québec, Laval University, Quebec, QC, Canada,Medical Faculty, Laval University, Quebec, QC, Canada,Division of Endocrinology-Nephrology, CHU de Québec, Laval University Research Center, Quebec, QC, Canada
| | - Jean Bergeron
- Division of Endocrinology-Nephrology, CHU de Québec, Laval University Research Center, Quebec, QC, Canada,Division of Medicine and Lipidology, CHU de Québec, Laval University Research Center, Quebec, QC, Canada
| | - Caroline Carpentier
- Division of Obstetrics and Gynecology, CHU de Québec, Laval University, Quebec, QC, Canada
| | - Joël Claveau
- Division of Dermatology, CHU de Québec, Laval University, Quebec, QC, Canada
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Barclay K, Koysombat K, Padmagirison R, Kaplan F. Hypertriglyceridaemia in pregnancy: an unexpected diagnosis and its management. BMJ Case Rep 2022; 15:15/8/e249000. [PMID: 36038155 PMCID: PMC9438015 DOI: 10.1136/bcr-2022-249000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A woman in her 30s with gestational diabetes presented at 36 weeks’ gestation with reduced fetal movements and diminishing insulin requirements. In view of her gestation, she was induced and incidentally found to have profound hyponatraemia. Further biochemical investigations confirmed severe hypertriglyceridaemia and hypercholesterolaemia. This raises the possibility of secondary causes such as familial dysbetalipoproteinemia and polygenetic hypertriglyceridaemia. She was successfully managed by aggressive dietary modification. This involved a supervised fast followed by a fat-free diet. A fenofibrate was proposed but declined due to our patient’s wish to breastfeed. Management required considerable input from the multidisciplinary team. Treatment options to consider are aggressive dietary restriction of fat or the addition of a cholesterol-lowering medication, such as a fibrate. In refractory cases, a supervised fast may be required or, in cases where complications have arisen, apheresis. The patient and her baby made a good recovery with no long-lasting health implications.
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Affiliation(s)
- Kathryn Barclay
- Department of Endocrinology and Diabetes Mellitus, Lister Hospital, Stevenage, UK
| | - Kanyada Koysombat
- Department of Endocrinology and Diabetes Mellitus, Lister Hospital, Stevenage, UK
| | | | - Felicity Kaplan
- Department of Endocrinology and Diabetes Mellitus, Lister Hospital, Stevenage, UK
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HYPERLIPIDEMIA AND RISK FOR PRECLAMPSIA. J Clin Lipidol 2022; 16:253-260. [DOI: 10.1016/j.jacl.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 11/22/2022]
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Management Considerations for Lipid Disorders During Pregnancy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00926-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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AYDEMİR E, ÇETİN SB, AYDOĞAN ÜNSAL Y, ATEŞ C, CANDER S, ÖZ GÜL Ö, ERTÜRK E, ERSOY C. A Case of very Severe Hypertriglyceridemia during Pregnancy. TURKISH JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.46310/tjim.882279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Zahedi M, Asghari G, Mirmiran P, Hosseinpanah F. Case Report: Management of a Patient With Chylomicronemia Syndrome During Pregnancy With Medical Nutrition Therapy. Front Nutr 2021; 8:602938. [PMID: 33748172 PMCID: PMC7973004 DOI: 10.3389/fnut.2021.602938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Hypertriglyceridemia (HTG) during pregnancy may be accompanied by acute pancreatitis, hyperviscosity syndrome, and preeclampsia. HTG during pregnancy should be managed by a multidisciplinary team; however, no clinical guidelines exist for severe gestational HTG. Case Presentation: We herein present a case of a 36-year-old in the first pregnancy (G1P0Ab0), with a history of severe HTG-induced necrotizing pancreatitis 9 years earlier. There was no family history of HTG. During these years, she did not follow any appropriate diet or medical therapy for HTG. She became pregnant in May 2019, without preconception counseling. Eruptive and tuberoeruptive xanthomas appeared in the 27th week of pregnancy. Serum triglycerides (TGs) and fasting blood sugar (FBS) were 6,620 and 124 mg/dL, respectively, indicating HTG and gestational diabetes (GDM). After admission for the management of severe HTG, she was put on parenteral nutrition with dextrose water 5% and infusion insulin therapy without receiving any enteral carbohydrate for 2 days. Following that, a very low-fat diet and omega-3 fatty acids (1,200 mg/day) were started. After 4 weeks, TG levels reached 1,000 mg/dL, and her self-monitoring blood glucose levels showed appropriate blood glucose for pregnancy. She underwent a successful elective cesarean section in the 39th of pregnancy. Conclusion: This case report demonstrates that HTG during pregnancy could be managed by medical nutrition therapy (MNT).
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Affiliation(s)
- Maryam Zahedi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nguyen NT, Nath PV, Mai VQ, Shakir MKM, Hoang TD. Treatment of Severe Hypertriglyceridemia During Pregnancy With High Doses of Omega-3 Fatty Acid and Plasmapheresis. AACE Clin Case Rep 2021; 7:211-215. [PMID: 34095491 PMCID: PMC8165119 DOI: 10.1016/j.aace.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 01/23/2023] Open
Abstract
Objective Severe hypertriglyceridemia carries increased health risks, including the development of pancreatitis. The objective of this study was to report on management of 2 cases with severe gestational hypertriglyceridemia. Cases In case 1, a 33-year-old pregnant woman presented with serum triglyceride level of 14 000 mg/dL after discontinuing hypolipidemic medications. She was treated with Lovaza 12 g/day, and serum triglyceride remained near normal at level of less than 800 mg mg/dL until delivery. In case 2, a 28-year-old patient (29th week gestation) presented with acute pancreatitis and triglycerides >4000 mg/dL. She was treated with Gemfibrozil, Lovaza, insulin infusion, subcutaneous heparin, and escalated to plasmapheresis. She successfully delivered a baby at the week of 36th and her triglyceride level was 304 mg/dL after that. Discussion Case 1 was treated with high-dose Lovaza and case 2 was treated with plasmapheresis successfully. Triglyceride levels were reduced to less than 500 mg/dL until delivery of healthy babies in both cases. Conclusion Omega-3 fatty acids and plasmapheresis may be effective and safe to treat pregnant women with severe hypertriglyceridemia and pancreatitis.
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Affiliation(s)
- Nguyen T Nguyen
- Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Priti V Nath
- Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Vinh Q Mai
- Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Mohamed K M Shakir
- Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Thanh D Hoang
- Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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