The Price of Poor Glycemic Control Before and During Pregnancy: Gestational Hypertriglyceridemia
https://doi.org/10.15605/jafes.041.S1
- Author:
Pei Shin Lee
1
;
Poh Shean Wong
2
;
Fauzi Azizan Bin Hj Abdul Aziz
1
Author Information
1. Hospital Tuanku Ampuan Najihah
2. Hospital Tuanku Ja’afar
- Publication Type:Journal Article
- MeSH:
Female;
Pregnancy;
Glycemic Control;
Hypertriglyceridemia
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):49-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Severe hypertriglyceridemia, though rare in pregnancy,
is a clinically significant condition that poses substantial
maternal and perinatal risks.
Case:We present a case of a 42-year-old pregnant female
with class I obesity and pre-existing type 2 diabetes
mellitus, with a booking hemoglobin A1c 12.1%. Her
poorly controlled diabetes was complicated by nephrotic
syndrome, with a 24-hour urine protein 4.9 g/day. She
also had bilateral diabetic retinopathies requiring multiple
sessions of panretinal photocoagulation. Throughout the
pregnancy, her triglycerides rose progressively, peaking
at 30 mmol/L by 33 weeks. Investigations revealed normal
thyroid function, urea 4.8 mmol/L, creatinine 66 umol/L,
and albumin 26 g/dL. The patient was hospitalized at 33
weeks of gestation and started on an intravenous insulin
infusion along with a very low-fat, low-carbohydrate
diet prescribed by a dietitian. Pulmonary embolism was
diagnosed during evaluation for maternal tachycardia, and
subcutaneous enoxaparin was initiated. One week after
admission in 35 weeks of gestation, the baby was delivered
via emergency Caesarean section due to fetal distress. The
baby was small for gestational age, with a birth weight of
1.9 kg, below the 10th percentile for gestational age, and
required admission to the neonatal intensive care unit with
oxygen support for pneumonia-related respiratory distress.
Post-delivery, intravenous insulin infusion and dietary
control were continued, reducing her triglyceride level to
the lowest level of 8.3 mmol/L. Both mother and baby were
discharged well. Lipid-lowering agents such as rosuvastatin
and fenofibrate were started after breastfeeding stopped,
aiming to normalize her triglyceride levels.
Conclusion:Hypertriglyceridemia in this patient was the result of
uncontrolled diabetes mellitus with nephrotic-range
proteinuria. Severe hypertriglyceridemia can cause acute
pancreatitis and/or hyperviscosity syndrome, both of
which are life-threatening to the mother and baby. Thus,
rapid reduction of triglyceride levels is crucial. This case
highlights the importance of achieving good diabetes
control prior to pregnancy, with strict adherence to
treatment and enhanced patient education.
- Full text:2026073011471457245EP_A055.pdf
