P1304 - TPN and Pregnancy: A Series of Successful Conceptions

Ammad Chaudhary, MD¹, Muhammad Zarrar Khan, MD¹, Hamna Fahad, MD¹, Yakir Muszkat, MD¹, Syed-Mohammed Jafri, MD^2
1Henry Ford Hospital, Detroit, MI; ²Henry Ford Health System, Detroit, MI

Introduction: Short bowel syndrome (SBS) and chronic intestinal failure (CIF) are conditions that require total parenteral nutrition (TPN) as a vital lifeline. TPN provides essential nutrients intravenously, which becomes even more important in pregnant patients with SBS and CIF. However, there is a paucity of clinical data regarding the management of pregnancy and lactation in women requiring long-term TPN. We present a case series of two TPN-dependent patients after failed intestinal rehabilitation who conceived successfully.

Case Description/Methods: A 29-year-old primigravid lady with history of fistulizing Crohn’s Disease underwent ileocectomy and total proctocolectomy with end-ileostomy that was complicated by adhesions and inability to tolerate oral feeds. She remained on TPN prior to conception. She successfully conceived while being on TPN and currently, she is in the 36th week of gestation appropriately gaining weight. The intrapartum course was without any complications.



A 30-year-old primigravid lady with history of Hirschsprung disease underwent end ileostomy with rectal sparing. Due to poor functionality reattachment was not possible. She has been on TPN for 25 years. She successfully conceived while being on TPN and is currently in the 16th week of gestation. She continues TPN 7 days per week for over 8 hours. She is gaining weight appropriately and tolerating pregnancy well without any complications.

Discussion: Conditions such as SBS, inflammatory bowel disease, and surgical resections of the bowel which lead to intestinal failure can disrupt normal reproductive function. Additionally, TPN itself is associated with subfertility and miscarriage from nutritional deficiencies, such as vitamin and mineral deficiencies, can disrupt hormonal regulation and impair reproductive capacity. Our case series highlights the journey of pregnancies of two TPN-dependent patients after failed intestinal rehabilitation. The patients were able to conceive while being on TPN. One of them carried her pregnancy to term without any complications and the other one is near the end of 2nd trimester without any complications.
The management of a pregnant patient on TPN after failed intestinal rehabilitation requires a multidisciplinary approach involving obstetricians, gastroenterologists, nutritionists, pharmacists, and other relevant healthcare providers. Collaborative decision-making are vital to address the complex medical and nutritional needs to ensure the best possible outcomes for both the mother and the baby.


Disclosures:


Ammad Chaudhary, MD¹, Muhammad Zarrar Khan, MD¹, Hamna Fahad, MD¹, Yakir Muszkat, MD¹, Syed-Mohammed Jafri, MD². P1304 - TPN and Pregnancy: A Series of Successful Conceptions, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.