Managing Home Parenteral Nutrition during Pregnancy in Patient with Short Bowel Syndrome: Case Report of a Successful Experience in Sabah, Malaysia

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Short bowel syndrome (SBS) is one of the pathophysiological mechanisms of chronic intestinal failure (IF) which warrants long-term parenteral nutrition (PN). Despite the common use of PN, there has been few literature on PN use for IF patients since before pregnancy. Our patient was diagnosed with gangrenous bowel secondary to congenital malrotation in 2015. Extensive bowel resection resulted in SBS requiring lifelong home PN. In February 2020, patient discovered her pregnancy and PN pharmacists were informed. Energy from PN was increased with addition of multivitamins, trace elements (TEs) and electrolytes tailored to weekly blood results. At gestation week 34, 24-hour urine urea test showed positive nitrogen balance of +3g/day, demonstrating adequate supply from PN. At gestation week 37, a small-for-gestational-age female infant was delivered via spontaneous labour. Apgar score demonstrated excellent condition and the infant managed to thrive subsequently. Patient’s pre-pregnancy underweight status and insufficient weight gain throughout pregnancy are believed to have put her at higher risk for low-birth-weight infant. Vitamins and TEs supplementation generally met the recommendation for pregnancy, which is however established for oral/enteral intake. This case report proved that successful pregnancy is possible in SBS patients on HPN with close monitoring and effective communication with patient.