BACKGROUND Hypertriglyceridemia-induced pancreatitis in pregnancy is a rare condition that requires emergency management to prevent maternal morbidity and fetal loss. Physiological lipid shifts during pregnancy can severely exacerbate underlying dyslipidemia, leading to an increase in triglyceride levels >11.3 mmol/L, which can trigger acute pancreatitis, which requires rapid lipid lowering. This report describes the case of a 35-year-old woman with recurrent hypertriglyceridemia-induced pancreatitis in pregnancy managed with fenofibrate and therapeutic plasma exchange (TPE), resulting in successful delivery at 36 weeks. CASE REPORT A 35-year-old pregnant woman presented at 22 weeks of gestation with acute abdominal pain. Laboratory tests revealed a triglyceride level of 29.57 mmol/L, leading to the diagnosis of hypertriglyceridemia-induced pancreatitis in pregnancy following the careful exclusion of other common etiologies. She was initially treated with fasting, fluid resuscitation, and TPE, which successfully lowered her triglyceride levels. However, she experienced a recurrence at 25 weeks of gestation. A second TPE was performed, followed by the initiation of oral fenofibrate (200 mg/day) for maintenance therapy due to triglyceride rebound. This sustained regimen maintained her triglyceride levels safely below 13 mmol/L. She successfully delivered a healthy male infant at 36 weeks via cesarean section. CONCLUSIONS This report highlights the presentation, diagnosis, and management of hypertriglyceridemia-induced pancreatitis in pregnancy and the role of fenofibrate and TPE in its treatment. For severe recurrent hypertriglyceridemia in pregnancy, acute TPE alone is insufficient. Early TPE followed by continuous fenofibrate safely mitigates triglyceride rebound, prevents pancreatic injury, and prolongs pregnancy to term.