Nutritional management of pregnancy in patients on home parenteral nutrition

Abstract

Three pregnancies are reported in two patients on home parenteral nutrition for intestinal failure. The nutritional regimen, 2300 kcal (9.63 MJ) (18% as lipid emulsion), 14 g amino acid nitrogen and electrolytes supplied daily in a 'big bag', was based on the measured resting energy expenditure and urinary nitrogen excretion during the third trimester in a 30-year-old woman on home parenteral nutrition. Commercial preparations of trace elements were added to the infusion as dictated by serum levels. Iron, iodine and fluoride were given orally, and vitamin B,, by monthly intramuscular injection. There were no serious deficiencies in trace elements and maternal weight-gain and fetal growth were satisfactory in all three pregnancies. The two pregnancies in one patient went to term and both infants had birthweights at the 50th centile for gestational age. The second patient who had had two spontaneous abortions went into premature labour at 30 weeks and gave birth to a baby with a minor facial deformity who subsequently developed the idiopathic respiratory distress syndrome. All three placentas were histologically normal. The growth and development of all three babies has been satisfactory. This nutritional regimen should be adequate for most pregnant patients who have attained a normal nutritional status on parenteral nutrition.

Conception, Pregnancy, and Lactation Despite Chronic Intestinal Failure Requiring Home Parenteral Nutrition

“…Fetal demise has not been reported, and two‐thirds of the 15 newborns were healthy (Table 2). Only 2 neonates were born prematurely, with 1 suffering from minor facial deformities and acute respiratory distress syndrome 10 . Still, various adverse fetal outcomes most likely linked to micronutrient deficiencies have been reported 12 , 15 , 20 .…”

“…In a systematic literature review, we identified 14 publications describing 15 cases of parenteral nutrition from preconception to delivery in 14 women dependent on long‐term HPN 7 – 20 . Here, we additionally report the case of a 26‐year‐old Caucasian woman with SBS secondary to recurrent thromboembolic mesenteric infarctions receiving both HPN and high‐dose dual anticoagulation throughout pregnancy and beyond.…”

A Historical Perspective and Review of the Safety of Lipid Emulsion in Pregnancy

“…13,16 Parenteral nutrition with the lipid system was initiated before conception in 3 of the entire 32 cases reported and was continued through the entire pregnancy. [19][20][21] In one pregnancy, premature contractions occurred before the initiation of parenteral nutrition and contractions stopped after 2 weeks of therapy with the lipid system. 15 In each case, no correlation between the onset of labor and the administration of lipid emulsion was observed.…”