Introduction: Hypertriglyceridemia (HTG) is a physiological condition of pregnancy. However, in some patients, it could be harmful due to possible complications such as pancreatitis. Treating this clinical condition during pregnancy is controversial as many drugs are not allowed in different trimesters. The current report discussed 2 cases of HTG and their outcomes during pregnancy. Case Presentation: The 1st patient had twin pregnancy and a "milky" blood sample raised suspicion on abnormal lipid profile (LP) during the pregnancy screening tests. There was a positive history of HTG and the available laboratory results showed triglyceride (TG) 3920 mg/dL, cholesterol (Chol) 1370 mg/dL, and normal amylase and lipase serum levels. The patient received daily LP and blood glucose monitoring as well as insulin, gemfibrozil, and fish oil prescription. In the 30th week of gestation, one of the fetuses was lost and a cesarean section, because of preterm uterine contractures, was performed. Mother and baby were discharged in good conditions. The 2nd patient presented with nausea, vomiting, and abdominal pain in the 22nd week of gestation. The patient had gestational diabetes without the history of HTG. Laboratory results were as follows: TG 878 mg/dL, Chol 249 mg/dL, amylase 251 U/L, and lipase 29 U/L. The patient was treated as pancreatitis induced by HTG. Therefore, gemfibrozil and fish oil were prescribed in addition to hydration and low fat diet. A healthy term baby was the result of pregnancy. Conclusions: Establishing prompt medical treatment and controlling comorbid conditions are essential in gestational HTG. Although there are controversial reports about using medications such as fibrates and fish oil, gemfibrozil and fish oil were recommended as an effective treatment for the patients with gestational HTG.