A multidisciplinary management model for severe gestational hypertriglyceridemia: using plasmapheresis to prevent pancreatitis in pregnancy

Severe gestational hypertriglyceridemia can lead to life-threatening pancreatitis with high maternal and fetal mortality, yet there are no established guidelines for managing these patients. We report two cases of severe gestational hypertriglyceridemia managed through a multidisciplinary approach. With the collaboration of obstetricians, endocrinologists, and nephrologists, we utilized a novel plasmapheresis circuit-combining centrifugation and filtration plasmapheresis (CFPP)-and performed regular sessions via peripheral venous access without the use of plasma or albumin. This treatment effectively lowered triglycerides in an attempt to prevent gestational pancreatitis, with no major maternal or fetal complications. We also conducted a systematic review of published reports on regular apheresis for severe gestational hypertriglyceridemia, identifying twenty-one additional cases. In these cases, treatment was generally administered twice weekly or every other week, with therapeutic plasmapheresis being the most frequently employed modality. The mean triglyceride reduction rate was 45.1%, and CFPP achieved the highest reduction rate (68.3% ± 7.2%). No maternal deaths were reported. Despite regular apheresis, four out of 23 patients (17.4%) experienced acute pancreatitis. The average triglyceride level at the onset of pancreatitis was 45.20 ± 4.65 mmol/L. Case reports support the use of regular apheresis for severe gestational hypertriglyceridemia. Multidisciplinary collaboration is essential for the care of these patients. More prospective and interventional studies are needed to guide clinical practice.