Successful plasmapheresis treatment of severe hypertriglyceridemia during late pregnancy

Abstract

During pregnancy, physiologic hormonal changes provoke a significant increase in triglyceride levels. Genetic abnormalities of triglyceride metabolism and secondary factors may multiply the risk of severe lipid abnormalities. Although severe gestational hypertriglyceridemia can be a life-threatening condition for both mother and fetus, its optimal treatment has not been fully clarified. A 33-year-old woman at 37 weeks of her second pregnancy was admitted to our clinic. Her triglyceride level was 57.8 mmol/L. Abdominal pain, nausea, vomiting or any other complaints were not reported. She kept a fat-restricted diet, however her triglyceride level remained 41 mmol/L. Therefore we decided to perform plasmapheresis with a replacement of human albumin as a colloidal solution. Complications did not occur during the treatment. Plasmapheresis reduced her triglyceride level by 54.1% (to 18.8 mmol/L), and the patient delivered a healthy female neonate at 40 weeks. In case of significantly increased values, plasmapheresis is a fast, effective and safe method for decreasing triglyceride level even in the third trimester.

Keywords

Hypertriglyceridemia / pregnancy / plasmapheresis

References

[1] Butte NF.Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus..Am J Clin Nutr2000;71:1256S-61

[2] Herrera E,López-Soldado I.Maternal lipid metabolism and placental lipid transfer..Horm Res2006;65:59-64

[3] Brizzi P,Esposito F,Dessole S.Lipoprotein metabolism during normal pregnancy..Am J Obstet Gynecol1999;181:430-4

[4] Knopp RH,Charles D,Li JR.Lipoprotein metabolism in pregnancy, fat transport to the fetus, and the effects of diabetes..Biol Neonate1986;50:297-317

[5] Ma Y,Liu MS,McPherson R.High frequency of mutations in the human lipoprotein lipase gene in pregnancy-induced chylomicronemia: possible association with apolipoprotein E2 isoform..J Lipid Res1994;35:1066-75

[6] Wong B,Keely E.Severe gestational hypertriglyceridemia: a practical approach for clinicians..Obstet Med2015;8:158-67 PMCID:PMC4935053

[7] Goldberg AS.Severe hypertriglyceridemia in pregnancy..J Clin Endocrinol Metab2012;97:2589-96

[8] Gallos ID,Kilby MD,Thangaratinam S.Pre-eclampsia is associated with, and preceded by, hypertriglyceridaemia: a meta-analysis..BJOG2013;120:1321-32

[9] Tang SJ,Singh S,Jazrawi SF.Acute pancreatitis during pregnancy..Clin Gastroenterol Hepatol2010;8:85-90

[10] Eapen DJ,Reddy S.Management of familial hypercholesterolemia during pregnancy: case series and discussion..J Clin Lipidol2012;6:88-91

[11] Sivakumaran P,Gregory K,Klapper EB.Management of familial hypertriglyceridemia during pregnancy with plasma exchange..J Clin Apher2009;24:42-6

[12] Basar R,Canbaz B,Kalayoglu-Besisik S.Therapeutic apheresis for severe hypertriglyceridemia in pregnancy..Arch Gynecol Obstet2013;287:839-43

[13] Piolot A,Cavallero E,Jacotot B.Prevention of recurrent acute pancreatitis in patients with severe hypertriglyceridemia: value of regular plasmapheresis..Pancreas1996;13:96-9

[14] Alberti KG.Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation..Diabet Med1998;15:539-53

[15] Group ECW.Social determinants of human reproduction..Hum Reprod2001;16:1518-26

[16] Steiner AZ.Impact of female age and nulligravidity on fecundity in an older reproductive age cohort..Fertil Steril2016;105:1584-8.e1 PMCID:PMC4893975

[17] Callaway LK,Chang AM.The prevalence and impact of overweight and obesity in an Australian obstetric population..Med J Aust2006;184:56-9

[18] Reper P,Gucciardo L,Devriendt J.Early plasmapheresis as a successful treatment in hypertriglyceridemia-induced acute pancreatitis in first trimester pregnancy following in vitro fertilization..Eur J Obstet Gynecol Reprod Biol2014;179:257-8