open access publication

Article, 2023

Experience and opinions relating to pregnancy in patients with chronic intestinal failure: an international survey

Frontline Gastroenterology, ISSN 2041-4145, 2041-4137, Volume 14, 5, Pages 377-383, 10.1136/flgastro-2023-102384

Contributors

Bond, Ashley D (Corresponding author) [1] [2] Allan, Philip James 0000-0003-2682-772X [3] Conley, Thomas Edward [2] Farrer, Kirstine [2] Mackillop, Lucy H 0000-0002-1927-1594 [4] Bozzetti, Federico 0000-0002-4517-8078 [5] Cuerda, Cristina [6] Jeppesen, Paller Bekker 0000-0001-9680-6938 [7] Joly, Francisca 0009-0001-6664-8569 [8] Lamprecht, Georg 0000-0003-0997-3135 [9] Mundi, Manpreet S 0000-0001-7902-3544 [10] Szczepanek, Kinga [11] Van Gossum, Andre M [12] Wanten, Geert J A [13] Pironi, Loris 0000-0002-1773-8330 [14] Lal, Simon 0000-0002-6245-8864 [1] [2]

Affiliations

  1. [1] University of Manchester
  2. [NORA names: United Kingdom; Europe, Non-EU; OECD];
  3. [2] Salford Royal NHS Foundation Trust
  4. [NORA names: United Kingdom; Europe, Non-EU; OECD];
  5. [3] University of Oxford
  6. [NORA names: United Kingdom; Europe, Non-EU; OECD];
  7. [4] Oxford University Hospitals NHS Trust
  8. [NORA names: United Kingdom; Europe, Non-EU; OECD];
  9. [5] University of Milan
  10. [NORA names: Italy; Europe, EU; OECD];

Abstract

Introduction: Pregnancy in patients with chronic intestinal failure (CIF) is a relatively rare occurrence but is an important contemporary topic given both the increasing use of home parenteral nutrition (HPN) and the demographics of patients with CIF. Method: An opinion-based survey was produced in a multidisciplinary manner, which was then distributed internationally, via the European Society for Clinical Nutrition and Metabolism network, using a web-based survey tool for healthcare professionals with a specialist interest in the management of CIF. Results: Seventy specialists from 11 countries completed the survey. Fifty-four per cent of the respondents reported some experience of managing pregnancy in patients with CIF. However, 60% stated that they did not feel that it was their role to discuss the topic of pregnancy with their patients, with fewer than 10% stating that they routinely did so. Respondents felt that an individualised approach was required when considering alterations to parenteral support prior to conception, during pregnancy and in the postnatal period. Most respondents also felt there was no increased risk of catheter-related blood stream infections, while catheter-related thrombosis was deemed to be the most significant HPN-related complication for pregnant women. Conclusion: This study reports a variable experience, knowledge and confidence of healthcare professionals when considering pregnancy in patients with CIF. The risk of HPN-related complication was felt to be greater during pregnancy, with an individualised approach being the preferred route for most aspects of care. The findings support the need for an international registry and subsequent consensus guidelines for the management of pregnancy in CIF.

Keywords

European, European Society for Clinical Nutrition, HPN-related complications, Variability Experiment, alterations, approach, blood stream infections, care, catheter-related blood stream infection, catheter-related thrombosis, chronic intestinal failure, clinical nutrition, complications, concept, confidence, confidence of healthcare professionals, consensus, consensus guidelines, contemporary topics, countries, demographics, demographics of patients, experiments, failure, findings, guidelines, healthcare, healthcare professionals, home parenteral nutrition, increased risk, increased use, individualised approach, infection, interest, international registry, international survey, intestinal failure, knowledge, management, management of pregnancy, managing pregnancy, manner, metabolic networks, metabolism, multidisciplinary manner, network, nutrition, occurrence, opinion, opinion-based survey, parenteral nutrition, parenteral support, patients, period, postnatal period, pregnancy, pregnant women, professionals, rare occurrence, registry, respondents, risk, risk of catheter-related blood stream infection, seventies, specialist interest, specialists, study, support, survey, survey tool, thrombosis, tools, topics, web-based survey tool, women

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