Case: A 34 years old lady presented to the antenatal clinic at 7 weeks gestation with unplanned pregnancy. She had background history of HTN, poorly controlled T2DM and hypercholesterolemia . She continued taking metformin, gliclazide, sitagliptin and simvastatin which were stopped at the booking appointment . Metformin continued and started on insulin. Blood tests at booking showed HbA1c 126, Cholesterol 5.2 , Triglycerides 2.7. She was started on thyroxine for subclinical hypothyroidism. During the course of treatment her insulin requirements increased with gradual improvement in HbA1c at 76 mmol/mol at insulin dose of >300 units/day. At 28th week gestation, she presented with abdominal pain and found to have Cholesterol of 12.9 mmol/L, Triglycerides 54.5 mmol/L with normal HDL, LDL and amylase. Abdominal USS was unremarkable. She was started on dietary restriction along with metformin, heparin and intravenous insulin which was discontinued after triglycerides improved to <11 mmol/L with improved glucose. Her triglycerides increased again immediately after IV insulin discontinued and therefore insulin was restarted. Once triglycerides improved , she was started on Fenofibrate and omega3 acid alongwith adjustment of sc insulin dose at 420 units/day and heparin. Subsequent tests showed triglycerides again at 20 mmol/L with hyperglycemia, it was therefore decided for her to have early delivery at 32 weeks by C-section and an alive healthy baby born with no complications. Lipid profile the next day showed triglycerides at 4.5 mmol/L with improved blood glucose levels.
Discussion: Pregnancy induced hypertriglyceridemia is rare condition associated with risk of life threatening complications. Estrogen induced increase in lipoprotein production and decrease lipoprotein lipase activity in the liver can cause hypertriglyceridemia in pregnancy with more profound increase during the 3rd trimester. There is need to have case based longitudinal studies due to lack of formal guidelines for management.