Pregnancy is possible on long-term home parenteral nutrition in patients with chronic intestinal failure: Results of a long term retrospective observational study.

Lore Billiauws, Laura Armengol Debeir, Florian Poullenot, Cécile Chambrier, Nicolas Cury, Pierre-François Ceccaldi, Emilie Latour Beaudet, Olivier Corcos, Evelyne Marinier, Olivier Goulet, Eric Lerebours, Francisca Joly

Journal: Clinical nutrition (Edinburgh, Scotland) 2018;36(4):1165-1169

PMID: 27624996

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND & AIMS

Home parenteral nutrition (HPN) improves survival and quality of life in patients with chronic intestinal failure (IF). Few cases of pregnancy on HPN have been published. The aim of this study was to report pregnancy cases on long-term HPN in benign IF.

METHODS

This retrospective study included all pregnant patients on HPN from 4 HPN referral centers. Data on demographics, ongoing pathology, HPN type, maternal and newborn complications were collected.

RESULTS

From 1984 to 2014, 21 pregnancies occurred in 15 patients (short bowel syndrome (n = 11), motility disorders (n = 3), mucosal disease (n = 1)) of whom 14 occurred after 2010. Median follow-up was 12 years. Median HPN duration before pregnancy was 8 years. HPN was adapted monthly during pregnancy, with close monitoring and supplementations. Energy intake was regularly increased and median maternal weight gain was 10 kg. Median age at the first pregnancy was 27 years. In 55% of cases, the newborn was preterm. Maternal complications occurred in 67% of cases (mainly due to underlying disease or HPN complications). There were 3 post-partum hemorrhages and 6 hypotrophic newborns. Eighteen infants were healthy and 2 chronic intestinal pseudo-obstruction (CIPO) were suspected.

CONCLUSION

Our series, the largest reported to date, shows that pregnancy is possible in HPN patients but the complication rate is high. A specific support is necessary, particularly in CIPO patients. As pregnancies have increased over the last 15 years, physicians practicing in HPN referral centers should be aware of the need for implementing a specific multidisciplinary monitoring in HPN patients considering pregnancy.

Address: Department of Gastroenterology and Nutrition Support, APHP Beaujon Hospital, Clichy, France; Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Inserm UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, UFR de Médecine Paris Diderot, France.; Department of Gastroenterology, Rouen University Hospital, Rouen, France.; Department of Gastroenterology and Hepatology, Saint-André Hospital, University Hospital of Bordeaux, France.; Nutrition Intensive Care Unit, HCL - Croix Rousse Hospital, Lyon, France.; Emergency Department, APHP Saint-Antoine Hospital, Paris, France.; Department of Obstetrics and Gynecology, AP-HP Beaujon Hospital, Clichy, France.; Department of Gastroenterology and Nutrition Support, APHP Beaujon Hospital, Clichy, France.; Department of Pediatric Gastroenterology, Hepatology and Nutrition, APHP Robert Debré, Paris, France.; Department of Pediatric Gastroenterology, Hepatology and Nutrition, APHP Necker-Enfants Malades Hospital, Paris, France.; Department of Gastroenterology and Nutrition Support, APHP Beaujon Hospital, Clichy, France; Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Inserm UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, UFR de Médecine Paris Diderot, France. Electronic address: [email protected].

DOI: 10.1016/j.clnu.2016.08.007