Parenteral Nutrition and Breastfeeding

Summary of use during lactation

Several women receiving either partial or total parenteral nutrition have reportedly breastfed their infants successfully. One prominent group encourages lactation among their patients receiving parenteral nutrition if the mother wishes, with the understanding that formula supplementation may be necessary depending on the adequacy of her milk supply. Infants' growth should be monitored closely as a means of determining adequate nutrition.[1] Intravenous amino acids used alone in postpartum mothers may hasten the onset of lactation and increase weight gain in their breastfed infants.[2]

Drug levels in milk and infant serum

Maternal Levels. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

A woman with chronic intestinal pseudo-obstruction was treated with home parenteral nutrition 5 days a week for 5 years at which time she became pregnant. She was maintained on parenteral nutrition during pregnancy and postpartum while she successfully breastfed her infant on the same regimen used during pregnancy.[3] Twenty months after the first delivery, the mother became pregnant again and delivered a full-term infant by cesarean section. Parenteral nutrition was increased to 7 days a week and she successfully breastfed her second infant with slight modifications in the parenteral nutrition formula.[4] A woman was treated with home parenteral nutrition for 24 years for chronic intestinal pseudo-obstruction. She became pregnant at age 25 and continued with parenteral nutrition that was adjusted as pregnancy progressed. She delivered a preterm infant by cesarean section at 33 weeks gestation and was able to partially breastfeed her infant.[5] A woman with maple syrup urine disease had been treated since birth with special oral formulas low in branched-chain amino acids. She became pregnant and was maintained with oral nutrition until week 37 when partial parenteral nutrition was begun to met increased metabolic demands. Following a cesarean section, the mother successfully breastfed (extent not stated) her infant for over 6 months. Infant growth at 7 months was normal and the Bayley Scales of Infant and Toddler Development Cognitive Composite Score was above average.[6] A 26-year-old woman who was receiving long-term home parenteral nutrition due to short bowel syndrome caused by recurrent thromboembolic mesenteric infarctions. During the third trimester and postpartum, she received only home parenteral nutrition. Following a cesarean section at 37 weeks, she breastfed (extent not stated) her infant. The infant was judged as doing well at 6 months of age and thriving at 1 year of age.[7]

Effects on lactation and breastmilk

Several case reports exist in which a mother receiving either partial or total parenteral nutrition successfully breastfed an infant.[1,3-8] A randomized, controlled, but unblinded study compared lactation onset and duration among women who on the first day postpartum received intravenous infusions of saline (n = 152) daily for 4 days to those who received intravenous amino acids (n = 153) for 4 days (containing isoleucine 5.6 mg, leucine 12.5 mg, lysine hydrochloride 11 mg, methionine 3.5 mg, phenylalanine 9.35 mg, threonine 6.5 mg, tryptophan 1.3 mg, valine 4.5 mg, histidine hydrochloride 8.11 mg, arginine hydrochloride 9.55 mg, alanine 6.2 mg, aspartic acid 3.8 mg, cysteine hydrochloride 1.45 mg, glutamic acid 6.5 mg, proline 3.3 mg, serine 2.2 mg, tyrosine 0.35 mg, glycine 10.7 mg, and xylitol 50.0 mg.) A greater percentage of mothers receiving amino acids achieved lactation onset on the first day postpartum than with saline (86% vs 32%). All mothers in the amino acid group achieved lactation by day 2 postpartum, compared to day 3 postpartum in the saline group. Weight gain in the infants of mothers who received amino acids was greater than thos who received saline at 2 weeks and 1 month of age. Infants in the amino acid group had better sleep than those in the saline group. A quarter of women in the amoino acid group dropped out of the study because of excessive milk production.[2]

References

1. RayburnW WolkR MercerN Parenteral nutrition in obstetrics and gynecology. Obstet Gynecol Surv 1986 41 200 14 3083312 PubMed
2. NagarathnammaR BhushanP DuttaT A prospective, randomized, placebo-controlled comparative study of amino acid supplementation in lactation insufficiency. J SAFOG 2020 12 408 14 10.5005/jp-journals-10006-1848
3. CampoM AlbinanaS García-BurguilloA Pregnancy in a patient with chronic intestinal pseudo-obstruction on long-term parenteral nutrition. Clin Nutr 2000 19 455 7 11104598 PubMed
4. MorenoJM GomisP Pregnancy in a patient with chronic intestinal failure on long-term parenteral nutrition. Clin Nutr 2002 21 438 40 12430564 PubMed
5. ElchlalU SelaHY GimmonZ Defying physical limitations: Successful pregnancy and birth in a patient on home total parenteral nutrition since infancy. Eur J Obstet Gynecol Reprod Biol 2009 147 111 2 19619931 PubMed
6. WesselAE MogensenKM RohrF Management of a woman with maple syrup urine disease during pregnancy, delivery, and lactation. JPEN J Parenter Enteral Nutr 2015 39 875 9 24618664 PubMed
7. BuchholzBM RulandA KieferN Conception, pregnancy, and lactation despite chronic intestinal failure requiring home parenteral nutrition. Nutr Clin Pract 2015 30 807 14 25788322 PubMed
8. Borbolla FosterA DixonS Tyrrell-PriceJ Pregnancy and lactation during long-term total parenteral nutrition: A case report and literature review. Obstet Med 2016 9 181 4 27829882 PubMed