{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T13:35:46Z","timestamp":1782135346026,"version":"3.54.5"},"reference-count":18,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2012,9,18]],"date-time":"2012-09-18T00:00:00Z","timestamp":1347926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetic Medicine"],"published-print":{"date-parts":[[2012,10]]},"abstract":"<jats:sec><jats:label\/><jats:p>Diabet. Med. 29, e398\u2013e401 (2012)<\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p><jats:bold>Background\u2002<\/jats:bold> We describe an unplanned pregnancy in a 19\u2010year\u2010old with lipodystrophic diabetes caused by a mutation in the peroxisome proliferator\u2010activated receptor gamma (<jats:italic>PPARG<\/jats:italic>) gene. The pregnancy was complicated by poor compliance with treatment, severe hypertriglyceridaemia and pancreatitis.<\/jats:p><jats:p><jats:bold>Case report\u2002<\/jats:bold> The patient presented at 6\u2003weeks\u2019 gestation with an HbA<jats:sub>1c<\/jats:sub> of 140\u2003mmol\/mol (15%), cholesterol 8.1\u2003mmol\/l and triglycerides 20.1\u2003mmol\/l. She wished to continue the pregnancy so lipid\u2010lowering therapy was discontinued. She was severely insulin resistant and poorly compliant with diet and medication. A continuous subcutaneous insulin infusion was required for efficient delivery of large doses of basal insulin, alongside injected mealtime boluses, (up to 300\u2003units insulin per day). At 17\u2003weeks\u2019 gestation she developed acute pancreatitis secondary to hypertriglyceridaemia (triglycerides &gt;\u2003100\u2003mmol\/l) and required plasmapheresis. Lipid\u2010lowering therapy was reinstated in the third trimester and plasmapheresis was required repeatedly to maintain triglycerides &lt;\u200310\u2003mmol\/l. Delivery was arranged at 32\u2003weeks, because of deteriorating glycaemic and lipid control (blood pressure was normal). Following betamethasone for fetal lung maturation, 20\u2003units\/h of intravenous insulin were required to maintain glycaemic control. A baby boy with significant subsequent developmental delay was delivered.<\/jats:p><jats:p><jats:bold>Discussion\u2002<\/jats:bold> The features of <jats:italic>PPARG<\/jats:italic> mutations are discussed, with literature on lipodystrophy and pancreatitis in pregnancy reviewed. There are few documented cases of pregnancy in women with <jats:italic>PPARG<\/jats:italic> mutations. The notable features of this case include the consequences of non\u2010concordance with treatment, the use of continuous subcutaneous insulin infusion to treat insulin\u2010resistant diabetes and the need for repeated plasmapheresis during pregnancy to avert pancreatitis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/j.1464-5491.2012.03742.x","type":"journal-article","created":{"date-parts":[[2012,7,19]],"date-time":"2012-07-19T04:51:00Z","timestamp":1342673460000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["A complicated pregnancy in a patient with lipodystrophic diabetes attributable to a peroxisome proliferator\u2010activated receptor gamma (PPARG) mutation"],"prefix":"10.1111","volume":"29","author":[{"given":"M.","family":"Madhra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. M.","family":"Noh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. N.","family":"Zammitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. W.","family":"Patrick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. D. B.","family":"Love","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,9,18]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2006.09.003"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-199504000-00005"},{"key":"e_1_2_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(93)90366-K"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2007.02905.x"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2005.11.026"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/79216"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/47254"},{"key":"e_1_2_5_9_2","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.52.4.910"},{"key":"e_1_2_5_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-199011000-00067"},{"key":"e_1_2_5_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/13.8.2121"},{"key":"e_1_2_5_12_2","doi-asserted-by":"publisher","DOI":"10.4158\/EP.6.1.34"},{"key":"e_1_2_5_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(87)90142-6"},{"key":"e_1_2_5_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(83)90051-0"},{"key":"e_1_2_5_15_2","first-page":"850","article-title":"Successful pregnancy in a woman with lipoatrophic diabetes mellitus. 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