PP272 - FAVORABLE MATERNAL-FETAL OUTCOME IN A PREGNANT PATIENT WITH TYPE III SHORT BOWEL SYNDROME RECEIVING HOME PARENTERAL NUTRITION
PP272
FAVORABLE MATERNAL-FETAL OUTCOME IN A PREGNANT PATIENT WITH TYPE III SHORT BOWEL SYNDROME RECEIVING HOME PARENTERAL NUTRITION
I. M. C. D. C. Ortega1,*, D. Waitzberg2, L. T. da Silva1, A. C. C. Vicedomini1, R. S. Torrinhas2
1Ganep, 2Gastroenterology, HC-FMUSP, Sao Paulo, Brazil
Rationale: Pregnancy in patients with Type III Short Bowel Syndrome (SBS) requiring Home Parenteral Nutrition (HPN) is rare and carries high risks for maternal malnutrition and fetal growth restriction. This case describes the successful multidisciplinary management of a pregnancy complicated by extensive intestinal resection in the first trimester.
Methods: A 29-year-old woman at five weeks of gestation presented with acute mesenteric ischemia due to heterozygous Factor V Leiden mutation. Extensive resection resulted in Type III SBS with 20 cm of remaining small bowel (10 cm jejunum, 10 cm ileum) and intact colon. Management included cyclic nocturnal HPN via an individualized all-in-one formulation using third-generation mixed lipid emulsions (SMOF: soybean, MCT, olive, and fish oil- Fresenius-Kabi). Energy requirements were estimated by predictive equations and refined with indirect calorimetry (IC) in the third trimester to prevent overfeeding.
Results: The patient maintained metabolic stability throughout gestation with no catheter-related complications or intestinal failure-associated liver disease (IFALD). Oral intake was advanced to 1,500 kcal/day in the second trimester. IC measured resting energy expenditure of 1,832 kcal/day, enabling precise HPN adjustments. Despite COVID-19 infection at 28 weeks, fetal growth remained appropriate for gestational age. Cesarean section at 36 weeks and 4 days; newborn weight 3,240 g, Apgar scores 8/9. Mother and infant had favorable outcomes.
Conclusion: Successful pregnancy in severe Type III SBS is achievable through individualized HPN. Modern mixed lipid emulsions and objective metabolic monitoring via IC are critical to ensure maternal safety and optimal fetal development. This case underscores the need for a specialized multidisciplinary team in managing intestinal failure during pregnancy.
Disclosure of Interest: None declared