Severe Hypertriglyceridemia Managed in a Pregnant Patient Using Nonstatin Therapies

BACKGROUND: Severe hypertriglyceridemia (HTG) in pregnancy is associated with increased maternal-fetal morbidity. Treatment options remain limited because of fetal safety concerns. CASE SUMMARY: A 34-year-old pregnant patient with type 2 diabetes mellitus and HTG was referred to our cardio-obstetrics multidisciplinary team for management of HTG at 16 weeks of gestation. She was managed with omega-3 acid ethyl esters, insulin, and lifestyle modifications, with improvement in levels noted over 4 months. DISCUSSION: This case highlights the complexities of managing severe HTG in pregnancy. Although many lipid-lowering agents are avoided during pregnancy, high-risk women with concurrent type 2diabetes mellitus may be treated with insulin and omega-3 fatty ethyl esters. TAKE-HOME MESSAGES: Severe HTG in pregnancy is associated with increased risk of maternal-fetal morbidity. Management of severe HTG in pregnancy includes preconception risk assessment, multidisciplinary care, intensive lifestyle modification, selective use of nonstatin agents, and monitoring throughout and after pregnancy.