Hyperlipidemia-associated pancreatitis in pregnancy managed with fenofibrate.
BACKGROUND
Pancreatitis is a concerning clinical event during pregnancy, with high morbidity and mortality rates for mother and fetus. Hypertriglyceridemia is considered a rare cause of pancreatitis in pregnancy, with the majority of reported cases being associated with the lipid metabolism disorders.


METHODS
We report on a case of hypertriglyceridemia-induced pancreatitis in a woman presenting at 32 weeks of gestational age. Her dyslipidemia was not controlled with diet alone, necessitating medical intervention. Fenofibrate was used successfully. Recurrence of pancreatitis during the pregnancy was avoided, and a healthy neonate was delivered at 35 weeks of gestation.


CONCLUSIONS
Fenofibrate was used safely and successfully during pregnancy in this case of hypertriglyceridemia-associated pancreatitis refractory to conservative measures.
From the Departments of Obstetrics and Gynecology and Maternal Fetal Medicine, William Beaumont Hospital, Royal Oak, Michigan.
Amy E
AE
Whitten
Robert P
RP
Lorenz
Joann M
JM
Smith
D000328:Adult; D001786:Blood Glucose / Q000187:drug effects; D005260:Female; D011345:Fenofibrate / Q000627:therapeutic use*; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use; D050498:Live Birth; D008297:Male; D010195:Pancreatitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000178:diet therapy / Q000188:drug therapy*; D016896:Treatment Outcome
D001786:Blood Glucose; D000960:Hypolipidemic Agents; D007328:Insulin; D011345:Fenofibrate
Wilkinson EJ. Acute pancreatitis in pregnancy: A review of 98 cases and a report of 8 new cases. Obstet Gynecol Surv 1973;28:281–303.
Ramin KD, Ramin SM, Richey SD, Cunningham FG. Acute pancreatitis in pregnancy. Am J Obstet Gynecol 1995;173:187–91.
Hernandez A, Petrov MS, Brooks DC, Banks PA, Ashley SW, Tavakkolizadeh A. Acute pancreatitis and pregnancy: A 10-year single center experience. J Gastrointest Surg 2007;11:1623–7.
Ramin KD, Ramsey PS. Disease of the gallbladder and pancreas in pregnancy. Obstet Gynecol Clin North Am 2001;28:571–80.
De Chalain TMB, Michell WL, Berger GMB. Hyperlipidemia, pregnancy and pancreatitis. Surg Gynecol Obstet 1988;167:469–73.
Crisan LS, Steidl ET, Rivera-Alsina ME. Acute hyperlipidemic pancreatitis in pregnancy. Am J Obstet Gynecol 2008;e57–9.
Warth MR, Arky RA, Knopp RH. Lipid metabolism in pregnancy. II. Altered lipid composition in intermediate, very low, low and high-density lipoprotein fractions. J Clin Endocrinol metab 1975;41:649–55.
Athyros VG, Giouleme OI, Nikolaidis NL, Vasiliadis TV, Bouloukos VI, Kontopoulos AG, et al. Long-term follow-up of patients with acute hypertriglyceridemia-induced pancreatitis. J Clin Gastroenterol 2002;34:472–5.
Dominguez-Munoz JE, Malfertheiner P, Dischuneit HH, Blanco-Chavez J, Uhl W, Buchler M, et al. Hyperlipidemia in acute pancreatitis. Relationship with etiology, onset, and severity of disease. Int J Pancreatol 1991;10:261–7.
Gan SI, Edwards AL, Symonds C, Beck PL. Hypertriglyceridemia-induced pancreatitis: A case-based review. World J Gastroenterol 2006;12:7197–202.
Lloret Linares C, Pelletier AL, Czernichow S, Vergnaud AC, Bonnefont-Rousselot D, Levy P, et al. Acute pancreatitis in a cohort of 129 patients referred for severe hypertriglyceridemia. Pancreas 2008;37:13–7.
Yuan G, Al-Shali KZ, Hegele RA. Hypertriglyceridemia: its etiology, effects and treatment. CMAJ 2007;176:1113–20.
Piolot A, Nadler F, Cavallero, Coquard JL, Jacotot B. Prevention of recurrent acute pancreatitis in patients with severe hypertriglyceridemia: value of regular plasmapheresis. Pancreas 1996;13:96–9.