Introduction: There have been few reports on the use of long-term Total Parenteral Nutrition as the primary nutrition source during pregnancy from conception to birth.

Methods: A 30 year old female who suffered a volvulus resulting in intestinal failure required TPN as her primary source of nutrition. Given the extent of resections and no intestinal rehabilitation possible she required an intestinal transplant. During the evaluation process, she was found to be 5 weeks pregnant. It was decided to put the transplant evaluation on hold. She was transferred to the registered dietitian and physician for TPN management during her pregnancy.

Results: The patient’s pre-pregnancy weight was 46kg with a BMI of 18 and was receiving 30 kcals/kg in 3 liters of TPN. Given that she was underweight and pregnant it was our goal for her gain the right amount of weight throughout each trimester. The guidelines for weight gain for underweight pregnant women is 28 to 40 pounds. The patient’s calories were gradually increased from 35 kcals/kg to 41 kcals/kg by the end of her pregnancy. She gained 28 pounds during her pregnancy. Her fluid requirements increased to an average of 3500 liters of TPN daily with additional fluids for hydration used as needed. The patient’s protein requirements throughout pregnancy averaged 2 g/kg. The patient had been on Intralipid from the time she was started on TPN but given a slight elevation in liver function tests as well as long-term TPN dependence it was decided to change her to SMOF lipid. She required an average of 1.6 g/kg of SMOF lipid throughout the pregnancy. Her LFT’s remained stable during pregnancy with no significant increases. The patient had low adjusted calcium levels and ionized calcium levels resulting in a daily need of 50 milliequivalents of calcium gluconate in her TPN. Vitamin and mineral levels were measured every 3 months and remained normal throughout pregnancy with the patient receiving 10mL of multivitamin in the TPN and standard dose trace elements. Iron levels were low later in pregnancy in which she received a course of intravenous iron sucrose for correction. The patient had no complications during her pregnancy and delivered a healthy full-term infant.

Conclusion: When properly managed by a multidisciplinary team pregnant women can carry a successful full term pregnancy while dependent on long-term TPN. Labs, weight and outputs should be closely monitored during pregnancy.