Blood purification for pregnancy-related severe hypertriglyceridemia: a single-centre case series

Severe hypertriglyceridemia in pregnancy may precipitate acute pancreatitis and is associated with adverse obstetric outcomes. Blood purification has been used in selected severe cases, but evidence supporting clinical benefit remains limited. We conducted a single-centre retrospective case series of consecutive patients with pregnancy-related severe hypertriglyceridemia who were hospitalised between August 2020 and July 2024 and underwent blood purification during pregnancy or the peripartum period. The primary descriptive per-session analysis was restricted to the 20 sessions with directly measured pre- and post-treatment TG values. A supportive analysis included all 34 sessions, incorporating 14 sessions in which the preceding post-treatment TG value was carried forward as the subsequent pre-treatment value. Secondary analyses included the patient-level overall relative reduction in TG from before the first blood purification session to before discharge, an exploratory comparison of TG change rates during blood purification and BP-off intervals, treatment-related adverse events, and maternal and neonatal outcomes. Fifteen patients received 34 blood purification sessions. In the primary analysis of 20 sessions with directly measured paired pre- and post-treatment TG values, the median per-session TG reduction was 43.31% (IQR 31.67–56.77; patient-cluster bootstrap 95% CI 32.64–54.42), and the median TG change rate was −5.21 mmol/L per hour (95% CI − 7.07 to −2.79). In the supportive analysis of all 34 sessions, which included 14 sessions with carried-forward pre-treatment TG values, the median per-session reduction was higher at 56.94% (IQR 37.48–65.23; 95% CI 46.32–62.40), reflecting the upward influence of the carry-forward assumption. The median TG concentration decreased from 45.72 mmol/L (IQR 28.60–73.22) before the first blood purification session to 6.48 mmol/L (IQR 4.81–6.87) before discharge, corresponding to a median patient-level overall reduction of 85.6% (IQR 82.5–91.4) over this interval during multimodal inpatient management. Acute pancreatitis was present in 6 patients at admission; all episodes resolved during the index hospitalisation. All pregnancies resulted in live birth (5 preterm), and no maternal or neonatal deaths were observed during the index hospitalisation. In this uncontrolled case series, directly measured blood purification sessions were temporally associated with rapid within-session biochemical TG reduction. The larger patient-level decline reflects multimodal inpatient management and cannot be attributed to blood purification or interpreted as evidence of clinical benefit over conservative management. Not applicable.