Total Parenteral Nutrition During Pregnancy in a Patient Requiring Long-Term Nutrition Support

Total parenteral nutrition (TPN) has been used successfully in preventing intrauterine growth retardation, premature labor, and perinatal morbidity and mortality associated with poor maternal nutrition. Parenteral nutrition support is provided in most instances for short intervals during pregnancy when oral intake is compromised, eg, hyperemesis gravidarum or during complications from comorbid conditions that develop or are exacerbated during pregnancy. Few reports describe continuous parenteral nutrition support from conception through labor and delivery.

To support successfully a 19-year-old woman on long-term TPN since age 8 years because of short bowel syndrome complicated by chronic pancreatitis.

Estimated energy requirements were based on indirect calorimetry and current recommendations for maternal weight gain for optimal fetal growth and development. A strategy was formulated to improve her low maternal weight during early pregnancy.

The fetus grew normally throughout pregnancy. There were no significant metabolic or obstetric complications as a result of the parenteral support.

Patients on long-term TPN can conceive successfully and carry a pregnancy to term without any adverse outcome for the mother or the fetus. TPN feeding during pregnancy and recommendations for maternal weight gain are reviewed.