Artificial Nutrition Support During Acute Illness in Pregnancy: A Scoping Review

The delivery of artificial nutrition support during acute illness in patients who are pregnant is complex with considerations for both maternal and foetal health outcomes. However, there is little known about the research available to guide the artificial nutrition support during pregnancy. This scoping review aims to examine the literature related to artificial nutrition support practices during acute illness in pregnancy, to understand current research, identify gaps and inform directions for future research.

The review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. A systematic search of five databases (MEDLINE, Embase, CINAHL, Web of Science and the Maternal and Infant Care Database (MIDIRS)) was conducted. Eligible studies involved adult pregnant patients aged 18 or over, hospitalised across a variety of care settings, and receiving artificial nutrition in the form of enteral nutrition or parenteral nutrition. Studies not written in English Language were excluded. Data were extracted on weight, gestation period, type and route of feeding, indication for artificial feeding, energy target and provision, protein target and provision, duration of intervention, micronutrient delivery and supplementation, method of delivery, foetal birthweight and maternal and foetal outcomes.

A total of 24 studies were included of which the majority were case reports (n = 12 studies), followed by case series (n = 7), and only one randomised controlled trial (early enteral feeding vs standard care). The most common indication for artificial nutrition support was hyperemesis gravidarum (n = 14 studies) and the most common method was parenteral nutrition (n = 14). There was considerable heterogeneity in reporting of energy and protein targets and delivery, micronutrient supplementation, weight change over pregnancy and maternal and foetal outcomes.

This scoping review highlighted the very limited number of studies regarding artificial nutrition support during pregnancy. Hugh quality research is urgently required to inform guidelines and standardise and optimise management strategies and improve outcomes in this complex patient cohort.