Case report

Preventive Management of Hypertriglyceridemia in Pregnancy   Open Access

--A Case Report

Mei Peng, Jian Huang, Yiling Ding

September 20, 2020

DOI: 10.36316/gcatr.02.0033


Background: Hypertriglyceridemia in pregnancy is a rare but well-known cause of hypertriglyceridemia-induced acute pancreatitis (HTGP) in pregnancy, a life-threatening condition that lacks an established guideline for treatment management.

Case presentation: We report a case with a successful treatment management of hypertriglyceridemia in pregnancy. A pregnant woman had been with hypertriglyceridemia for more than seven years and a history of pregnancy termination due to the development of HTGP. Eleven months after her last pregnancy termination, the woman was pregnant again and she started managing her elevated levels of lipids in the second trimester throughout the pregnancy, with low molecular weight heparin and then combined with metformin, to prevent thrombosis.

Results: The entire pregnancy progressed smoothly, and the triglycerides' level fluctuated during the second and the third trimester of pregnancy with a range of 16.15 to 47.65 mmol/L. A full-term delivery, with a reasonable outcome for both mother and newborn, was obtained. Compared with her last pregnancy, the outcomes of recent pregnancy were better off.

Conclusion: Low molecular weight heparin combined with metformin can avoid maternal hypertriglyceridemia-induced pancreatitis in this single case. To our knowledge, such a combination of treatment management of patients with hypertriglyceridemia in pregnancy to prevent acute pancreatitis has not been reported previously.


Metformin; low molecular weight heparin; hypertriglyceridemia in pregnancy; hypertriglyceridemia-induced pancreatitis.

Copyright©2020 by the author(s).

Licensee Global Clinical and Translational Research. This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution License (CCBY4.0,, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.

How to cite this article:

Peng M, Huang J and Ding Y. Preventive Management of Hypertriglyceridemia in Pregnancy: A Case Report. Glob Clin Transl Res. 2020; 2 (3): 73-77. DOI:10.36316/gcatr.02.0033


1.         Párniczky A, Kui B, Szentesi A, Balázs A, Szűcs Á, Moszt-bacher D, et al. Prospective, multicentre, nationwide clinical data from 600 cases of acute pancreatitis. PLoS One. 2016;11(10):e0165309.

2.         Zhu Y, Pan X, Zeng H, He W, Xia L, Liu P, et al. A Study on the Etiology, Severity, and Mortality of 3260 Patients With Acute Pancreatitis According to the Revised Atlanta Classification in Jiangxi, China Over an 8-Year Period. Pancreas. 2017; 46(4).

3.         Eddy JJ, Gideonsen MD, Song JY, Grobman WA, O'Halloran P. Pancreatitis in pregnancy. Obstet Gynecol. 2008;112(5): 1075-81.

4.         Ducarme G, Maire F, Chatel P, Luton D, Hammel P. Acute pancreatitis during pregnancy: a review. Journal of Peri-natology. 2014;34(2):87-94.

5.         Sun L, Li W, Geng Y, Shen BO, Li J. Acute pancreatitis in pregnancy. Acta Obstetricia et Gynecologica Scandinavica. 2011;90(6):671-6.

6.         Papadakis EP, Sarigianni M, Mikhailidis DP, Mamopoulos A, Karagiannis V. Acute pancreatitis in pregnancy: an overview. Eur J Obstet Gynecol Reprod Biol. 2011;159(2):261-6.

7.         Lippi G, Albiero A, Montagnana M, Salvagno GL, Scevarolli S, Franchi M, et al. Lipid and lipoprotein profile in physio-logical pregnancy. Clin Lab. 2007;53(3-4):173-7.

8.         Pusukuru R, Shenoi AS, Kyada PK, Ghodke B, Mehta V, Bhuta K, et al. Evaluation of Lipid Profile in Second and Third Trimester of Pregnancy. J Clin Diagn Res. 2016;10(3):QC12-6.

9.         Tulchinsky D, Hobel CJ, Yeager E, Marshall JR. Plasma estrone, estradiol, estriol, progesterone, and 17-hydro-xyprogesterone in human pregnancy. I. Normal pregnancy. Am J Obstet Gynecol. 1972;112(8):1095-100.

10.      Fortson MR, Freedman SN, Webster PD, 3rd. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol. 1995;90(12):2134-9.

11.      Huang C, Liu J, Lu Y, Fan J, Wang X, Liu J, et al. Clinical features and treatment of hypertriglyceridemia‐induced acute pancreatitis during pregnancy: A retrospective study. Journal of clinical apheresis. 2016;31(6):571-8.

12.      De Chalain TM, Michell WL, Berger GM. Hyperlipidemia, pregnancy and pancreatitis. Surg Gynecol Obstet. 1988;167(6):469-73.

13.      Khan R, Jehangir W, Regeti K, Yousif A. Hypertriglyceri-demia-Induced Pancreatitis: Choice of Treatment. Gastro-enterology Res. 2015;8(3-4):234-6.

14.      Tenner S, Baillie J, DeWitt J, Vege SS, American College of G. American College of Gastroenterology guideline: manage-ment of acute pancreatitis. Am J Gastroenterol. 2013; 108(9):1400-15; 16.

15.      Koizumi M, Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, et al. JPN Guidelines for the management of acute pancreatitis: diagnostic criteria for acute pancreatitis. J Hepatobiliary Pancreat Surg. 2006;13(1):25-32.

16.      Patel AD. Hypertriglyceridemia-induced acute pancreatitis treatment with insutin and heparin. Indian J Endocrinol Metab. 2012;16(4):671-2.

17.      Monga A, Arora A, Makkar RP, Gupta AK. Hypertriglyceri-demia-induced acute pancreatitis--treatment with heparin and insulin. Indian J Gastroenterol. 2003;22(3):102-3.

18.      Mikhail N, Trivedi K, Page C, Wali S, Cope D. Treatment of severe hypertriglyceridemia in nondiabetic patients with insulin. The American journal of emergency medicine. 2005;23(3):415-7.

19.      Gursoy A, Kulaksizoglu M, Sahin M, Ertugrul DT, Ozer F, Tutuncu NB, et al. Severe hypertriglyceridemia-induced pancreatitis during pregnancy. J Natl Med Assoc. 2006; 8(4):655-7.

20.      Bailey CJ, Turner RC. Metformin. N Engl J Med. 1996; 334 (9):574-9.

21.      Gregorio F, Ambrosi F, Filipponi P, Manfrini S, Testa I. Is metformin safe enough for ageing type 2 diabetic patients? Diabetes Metab. 1996;22(1):43-50.

22.      Jeppesen J, Zhou MY, Chen YD, Reaven GM. Effect of metformin on postprandial lipemia in patients with fairly to poorly controlled NIDDM. Diabetes Care. 1994;17(10): 1093-9.

23.      Wu RR, Zhang FY, Gao KM, Ou JJ, Shao P, Jin H, et al. Metformin treatment of antipsychotic-induced dyslipidemia: an analysis of two randomized, placebo-controlled trials. Mol Psychiatry. 2016;21(11):1537-44.

24.      Li X, Li Y, Ding H, Dong J, Zhang R, Huang D, et al. Insulin suppresses the AMPK signaling pathway to regulate lipid metabolism in primary cultured hepatocytes of dairy cows. J Dairy Res. 2018;85(2):157-62.

25.      Li L, He ML, Wang K, Zhang YS. Buffering agent via insulin-mediated activation of PI3K/AKT signaling pathway to regulate lipid metabolism in lactating goats. Physiol Res. 2018;67(5):753-64.

26.      Oropeza D, Jouvet N, Bouyakdan K, Perron G, Ringuette LJ, Philipson LH, et al. PGC-1 coactivators in beta-cells regulate lipid metabolism and are essential for insulin secretion coupled to fatty acids. Mol Metab. 2015;4(11):811-22.

27.      Misra P. AMP activated protein kinase: a next generation target for total metabolic control. Expert Opin Ther Targets. 2008;12(1):91-100.

28.      Yang C, Wu T, Huang C. Low molecular weight heparin reduces triglyceride, VLDL and cholesterol/HDL levels in hyperlipidemic diabetic patients on hemodialysis. Am J Nephrol. 1998;18(5):384-90.

29.      Katopodis KP, Koliousi E, Gouva C, Balafa O, Bairaktari E, Ikonomou M, et al. Acute effect of heparin on lipid para-meters in patients on renal replacement therapy. ASAIO J. 2007;53(1):46-9.

30.      Berger Z, Quera R, Poniachik J, Oksenberg D, Guerrero J. [heparin and insulin treatment of acute pancreatitis caused by hypertriglyceridemia. Experience of 5 cases]. Rev Med Chil. 2001;129(12):1373-8.