Use of parenteral nutrition to maintain adequate nutritional status in hyperemesis gravidarum

A retrospective study was performed to demonstrate that safe parenteral nutrition (PN) support can be given during pregnancy. There has been some hesitation to use PN during pregnancy partly due to the unknown consequences of the lipid emulsions in the PN solution. Twenty-three women received PN including lipid daily but at varying stages of pregnancy. The regimen was based on individual calculated requirements plus 300 kcal for pregnancy. Approximately 50% of the nonprotein calories were provided by lipid. At delivery, no gross abnormalities of the placenta were seen. The majority of the women (52%) received PN during the first trimester of pregnancy. The mean duration of PN therapy was 2.7 weeks (SE +/- 0.4) with a range of 0.5 to 7.5 weeks, and the mean weight gain on PN therapy was 2.4 lb (SE +/- 0.5). The majority of the women (84%) were able to gain appropriate weight to maintain the pregnancy. Although there was a 20% incidence of prematurity and a 30% incidence of low birthweight, this was not significantly different from the control group of women matched for age and parity. It was concluded that PN can provide a safe means of maintaining adequate maternal nutrition and continued fetal growth during a period when oral intake is severely curtailed. The nutrition regimen should include lipid and should be customized to meet the specific needs of each individual.