Total parenteral nutrition during pregnancy

Several years ago, most obstetricians would have thought that any disease severe enough to require parenteral nutrition would also lead to infertility or early pregnancy loss. Women with many complex disease states have now been successfully treated by TPN during pregnancy, resulting in favorable outcomes for both mother and fetus. Theoretically, these patients, if not supplied with an adequate amount of essential nutrients by TPN, might have experienced excessive perinatal morbidity and mortality. The difficulties involved with studying maternal-fetal exchange processes in humans leave considerable gaps in our current knowledge about nutritional requirements during normal pregnancy. Some have suggested that subtle degrees of malnutrition may jeopardize normal growth and development. In states of severe protein calorie malnutrition, there remains little doubt that intrauterine growth is diminished. In such cases in which there is poor maternal weight gain, it may be critical to initiate some method of nutritional support. Whereas TPN during pregnancy has been sporadically employed in the treatment of cases of suspected fetal growth retardation, limited experience with this therapy suggests that at present we primarily direct treatment toward patients with specific disease states that are accompanied by overt malnutrition. Parenteral nutrition support should begin only after a period of adequate nutritional assessment and monitoring. If such support is necessary, TPN should be administered by a team of qualified knowledgeable individuals who are very familiar with the techniques. The relatively high rate of premature delivery associated with patients requiring TPN during pregnancy requires the presence of an intensive care nursery in the institution.