Managing Successful Pregnancies in Patients with Chronic Intestinal Failure on Home Parenteral Nutrition: Experience from a UK National Intestinal Failure Unit

Abstract

Background & Aim: There are minimal reports of pregnancy in the chronic intestinal failure (CIF)/ home parenteral nutrition (HPN) population, with some concern relating to the risk associated with such pregnancies. The aim of this retrospective observational study was to evaluate pregnancy experience and outcomes in patients with CIF requiring HPN in a national UK CIF referral centre.Method: All known pregnancies in patients treated with HPN for CIF between 1982 and 2016 were identified retrospectively from a prospectively maintained database. Maternal and foetal outcomes were collated, along with PN requirements before and during pregnancy.Results: There were 5 pregnancies in 5 mothers in our cohort consisting of over 700 patients, males and females. The median age at conception was 28 years (range 24-33 years). The median duration on HPN prior to pregnancy was 26 months (range 4-85 months). One patient had Crohn’s disease, another had pan-enteric dysmotility and the other three patients had ischaemic complications leading to short bowel syndrome (SBS). All mothers were intensively monitored in an obstetric clinic and a dedicated CIF multi-disciplinary clinic throughout pregnancy. There were 2/5 preterm deliveries. One of the preterm deliveries was associated with spontaneous labour and the other had a planned induction as a result of maternal clinical need. Neonatal complications were seen in both prenates. There were no recorded maternal catheter related line infections during the 5 pregnancies.Conclusion: Successful pregnancy whilst receiving HPN is feasible but requires close, intensive monitoring and dedicated optimisation of PN in order to minimise maternal and foetal complications. All women of child-bearing age on HPN should be counselled about pregnancy.Abbreviations: ALP: alkaline phosphatase; ALT: alanine transaminase; CIF: chronic intestinal failure; HPN: home parenteral nutrition; IBD: inflammatory bowel disease; IF: intestinal failure; IFALD: Intestinal Failure associated liver disease; LFT: liver function test; PN: parenteral nutrition; RDA: Recommended daily allowance; SBS: short bowel syndrome; TPN: total parenteral nutrition.

Successful pregnancy in a patient with short bowel syndrome after surgical rehabilitation and sGLP-2 treatment: novel report on endogenous GLP-2 levels at delivery and during breastfeeding

“… 7 In this sense, the largest series of pregnancy in patients with IF estimates maternal complications in 67% of cases (mainly due to underlying disease or home PN complications). 8 , 9 The present manuscript, not only reports a case of a patient with post-surgical SBS that was able to achieve intestinal adaptation with the combination of AGIRS and sGLP-2, 10 but also enlightens the possibility of carrying out an uneventful pregnancy and lactation without any nutritional support and remaining independent of sGLP-2.…”

“…7 In this sense, the largest series of pregnancy in patients with IF estimates maternal complications in 67% of cases (mainly due to underlying disease or home PN complications). 8,9 The present manuscript, not only reports a case of a patient with post-surgical SBS that was able…”

Experience and opinions relating to pregnancy in patients with chronic intestinal failure: an international survey

“…In the largest series of pregnancy in CIF to date from France, patients had an increased PN energy need during pregnancy, especially in the second and third trimesters, and some individuals required more days of PN 3. Similarly, in the UK series, patients also required an increase in energy and nitrogen during pregnancy 4. Notably, neither the French nor the UK series reported using fish-oil based lipids, although the majority of respondents in this survey felt that a third-generation lipid containing fish-oils would be an optimal choice for pregnant patients.…”

“…Indeed, while a minority would actively advise against pregnancy in patients with CIF, most stated that they did not feel it was their role to discuss pregnancy with their patients. Given the—although small numbers of—published reports of safe pregnancy in patients with CIF,2–5 and the likelihood of an increasing number of HPN-dependent patients of childbearing age as the prevalence of CIF continues to increase in many countries,7–9 there is a clear need for a registry to provide further evidence for international guidance on this issue. It must be noted that the scarcity of data and experience is likely to originate from the relative infrequency of pregnancy in CIF.…”

“…Although there are multiple reports describing the safe use of short-term parenteral nutrition (PN) in hospitalised women, for example, for hyperemesis gravidarum,1 there are fewer published studies detailing the outcomes and risks of pregnancies in home parenteral nutrition (HPN)-dependent patients. Buchholz and colleagues collated details on 15 pregnancies that had been described in the literature to 20152 and since then, three subsequent case series were published from France,3 the UK,4 Israel and Poland,5 describing a total of 35 pregnancies in 25 women occurring between 1982 and 2016 6. Thus, many healthcare professionals will likely have very limited or no experience of managing pregnancy in HPN-dependent patients.…”