Background and Aims Acute pancreatitis in pregnancy (APIP) is a rare but serious complication during pregnancy, and severe progression of APIP can lead to maternal and fetal death. In recent years, hypertriglyceridemia (HTG) has emerged as a primary cause of APIP. Reports on the clinical characteristics and prognosis factors of APIP caused by HTG are scarce. Therefore, this study was performed to investigate the clinical features of hypertriglyceridemia-induced acute pancreatitis in pregnancy (HTG-APIP) and predictive factors for severe progression.Methods The clinical data from 39 APIP patients treated in the Department of Critical Care Medicine, Hubei Maternal and Child Health Care Hospital and Department of Biliary and Pancreatic Surgery of Wuhan Maternal and Child Health Hospital and Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, from January 2018 to December 2020 was retrospectively analyzed. Patients were categorized into the HTG-APIP group (17 cases) and the non-HTG-APIP group (22 cases) based on triglyceride concentrations. General characteristics, disease severity, and various laboratory parameters were compared between the two groups. Differences in laboratory parameters between mild (MAP) and severe (SAP) cases among the HTG-APIP patients were also analyzed, and risk factors for severe progression of HTG-APIP were assessed using Logistic regression analysis, with the predictive efficacy evaluated using ROC curve.Results Compared with the non-HTG-APIP group, the HTG-APIP group showed significantly higher blood triglyceride level and lower blood calcium level (both P<0.05). In contrast, all other variables showed no significant differences (all P>0.05). Among HTG-APIP patients, there were 8 MAP cases and 9 SAP cases. The SAP group exhibited a significantly higher neutrophil-to-lymphocyte ratio (NLR) compared to the MAP group (P<0.05). Logistic regression analysis revealed NLR as an independent risk factor for severe progression of HTG-APIP (OR=1.120, 95% CI=1.004-1.250, P=0.042), and the area under the ROC curve for predicting severe HTG-APIP was 0.847, with a sensitivity of 75.0%, and a specificity of 88.9%.Conclusions There were no significant differences in the clinical features between HTG-APIP and non-HTG-APIP; elevated NLR can be used to predict the severe progression of HTG-APIP.