Severe hypertriglyceridemia causing pancreatitis is a rare complication of pregnancy, usually occurring in the second and third trimesters. Treatment includes a very low-fat diet, intravenous fluids, total parenteral nutrition, and plasma apheresis. In this article, the authors report the case of a pregnant woman who presented with a plasma triglyceride level of 65 mmol/L, abdominal pain, and a threatened abortion at 8 weeks of gestation. Treatment included restriction of dietary fat to below 10% of total calories, liquid protein supplementation, multiple hospitalizations for treatment with intravenous fluids, and total parenteral nutrition. Continuous intravenous heparin was started at 29 weeks of gestation for pulmonary embolism. This was associated with a dramatic decrease in plasma triglyceride levels. A normal female child was born at 37 weeks of gestation. The mother's weight at 2 weeks postpartum was 15 lb below her pregnant weight. It was concluded that a successful pregnancy is possible even when plasma triglyceride levels are very high early in the pregnancy.