Managing Successful Pregnancies in Patients with Chronic Intestinal Failure on Home Parenteral Nutrition: Experience from a UK National Intestinal Failure Unit
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Ashley Bond1, Dipesh H. Vasant1,2, Wadiamu Gashau1, Arun Abraham1, Antje Teubner1, Kristine Farrer1, Gavin Leahy1, Simon Lal1,2
1) Intestinal Failure, Salford Royal Foundation NHS Trust, Salford, United Kingdom;
2) Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
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.
Key words: Pregnancy – home parenteral nutrition – intestinal failure.
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.