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



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.



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.



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.
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.
Lore
L
Billiauws
Department of Gastroenterology, Rouen University Hospital, Rouen, France.
Laura
L
Armengol Debeir
Department of Gastroenterology and Hepatology, Saint-André Hospital, University Hospital of Bordeaux, France.
Florian
F
Poullenot
Nutrition Intensive Care Unit, HCL - Croix Rousse Hospital, Lyon, France.
Cécile
C
Chambrier
Emergency Department, APHP Saint-Antoine Hospital, Paris, France.
Nicolas
N
Cury
Department of Obstetrics and Gynecology, AP-HP Beaujon Hospital, Clichy, France.
Pierre-François
PF
Ceccaldi
Department of Gastroenterology and Nutrition Support, APHP Beaujon Hospital, Clichy, France.
Emilie
E
Latour Beaudet
Department of Gastroenterology and Nutrition Support, APHP Beaujon Hospital, Clichy, France.
Olivier
O
Corcos
Department of Pediatric Gastroenterology, Hepatology and Nutrition, APHP Robert Debré, Paris, France.
Evelyne
E
Marinier
Department of Pediatric Gastroenterology, Hepatology and Nutrition, APHP Necker-Enfants Malades Hospital, Paris, France.
Olivier
O
Goulet
Department of Gastroenterology, Rouen University Hospital, Rouen, France.
Eric
E
Lerebours
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: francisca.joly@bjn.aphp.fr.
Francisca
F
Joly
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology / Q000209:etiology; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000503:physiopathology / Q000628:therapy*; D007418:Intestinal Pseudo-Obstruction / Q000453:epidemiology / Q000209:etiology; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D016562:Parenteral Nutrition, Home Total / Q000009:adverse effects*; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D018566:Pregnancy, High-Risk; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D012778:Short Bowel Syndrome / Q000503:physiopathology / Q000628:therapy
Home parenteral nutrition; Intestinal failure; Pregnancy; Short bowel syndrome