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-.0061 -2.8109 .1101 -2.3363 .2935 -1.6678 c .2813 -1.6604 l .0613 -2.2141 -.3972 -3.192 -1.1369 -3.192 c -1.5769 -3.192 -1.8153 -2.8612 -1.8153 -2.106 c -1.8153 -.7904 -1.2347 .511 .0917 .511 c .4403 .511 .7642 .4677 1.0452 .4029 c .7213 -1.5957 .6113 -2.2642 .4828 -3.1199 c f Q q 1 0 0 1 562.503 720.583 cm 0 0 m -.5622 .1865 -1.1611 -1.2152 -1.3202 -2.2072 c -1.4485 -3.0125 l -1.9865 -3.0125 l -1.4119 .5607 l -.8862 .5607 l -.9352 .2513 -1.0207 -.1296 -1.198 -.755 c -1.1857 -.762 l -.8434 .1075 -.4767 .7402 .1101 .6254 c 0 0 l f Q q 1 0 0 1 564.251 720.72 cm 0 0 m -.4829 0 -.8069 -.496 -.9475 -1.1 c -.0061 -1.0566 .4097 -.8337 .4097 -.4025 c .4097 -.1439 .2446 0 0 0 c h -1.0148 -1.5744 m -1.033 -1.6824 -1.0453 -1.862 -1.0453 -1.9915 c -1.0453 -2.5449 -.8802 -2.6887 -.3914 -2.6887 c -.1039 -2.6887 .2017 -2.6096 .4645 -2.4804 c .4645 -2.9981 l .1713 -3.1345 -.1833 -3.2136 -.5807 -3.2136 c -1.2775 -3.2136 -1.6014 -2.8613 -1.6014 -2.0559 c -1.6014 -.6686 -.9475 .4889 .0611 .4889 c .7092 .4889 .9537 .1008 .9537 -.3234 c .9537 -1.093 .2872 -1.5168 -1.0148 -1.5744 c f Q EMC /Artifact <>BDC q 0 841.89 595.276 -841.89 re 297.645 420.96 m W n .015015 841.89 595.29 -841.89 re W n 1 .89 0 0 k q 1 0 0 1 298.843 634.978 cm 0 0 m 257.014 0 l 258.58 0 259.849 -1.2693 259.849 -2.835 c 259.849 -130.394 l 259.849 -131.96 258.58 -133.229 257.014 -133.229 c -257.014 -133.229 l -258.58 -133.229 -259.85 -131.96 -259.85 -130.394 c -259.85 -2.835 l -259.85 -1.2693 -258.58 0 -257.014 0 c h f* Q EMC /P <>BDC BT /TT2 1 Tf 11 0 0 11 61.6929 605.2912 Tm 0 0 0 0 k .01 Tc .2252 Tw (Successful conception and pregnancy are possible for an increasing number of women of)Tj ET EMC /P <>BDC BT 11 0 0 11 536.0293 605.2912 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 541.6729 605.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 547.3166 605.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 552.9601 605.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 558.6036 605.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 564.2473 605.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 569.8909 605.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 575.5344 605.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 581.1781 605.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 586.8217 605.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 592.4653 605.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.6929 589.2912 Tm .0362 Tw (childbearing age living with chronic intestinal failure \(CIF\) and receiving parenteral nutrition \(PN\).)Tj ET EMC /P <>BDC BT 11 0 0 11 536.0291 589.2912 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.6929 573.2912 Tm .0046 Tc .0649 Tw (There have been case reports and series describing the outcomes of home parenteral nutrition)Tj ET EMC /P <>BDC BT 11 0 0 11 536.0312 573.2912 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.6929 557.2912 Tm .01 Tc .0939 Tw (\(HPN\) dependent women becoming pregnant. Enhanced data capture of both successful and)Tj ET EMC /P <>BDC BT 11 0 0 11 536.0293 557.2912 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 540.2281 557.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 544.4271 557.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 548.626 557.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 552.8248 557.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 557.0238 557.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 561.2227 557.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 565.4217 557.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 569.6205 557.2912 Tm ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.6929 541.2912 Tm -.0094 Tc -.0323 Tw (unsuccessful pregnancies within national and international CIF databases will give future information)Tj ET EMC /P <>BDC BT 11 0 0 11 536.0248 541.2912 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.6929 525.2912 Tm (for patients and clinicians.)Tj ET EMC /P <>BDC BT 11 0 0 11 188.2628 525.2912 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 12 0 0 12 38.9931 485.1936 Tm 1 .89 0 0 k (Key points)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 100.3349 485.1936 Tm 0 0 0 .8 k ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 38.9931 467.6244 Tm (Pre-pregnancy \(conception\) counselling)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 191.9033 467.6244 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.9931 453.2897 Tm (1.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 453.2897 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 453.2897 Tm (In an ideal scenario, clinicians should have an open discussion with )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 441.7897 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 441.7897 Tm (their female CIF patients of childbearing age about pregnancy and )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 430.2897 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 430.2897 Tm -.005 Tc [(potential foetal health. )18.1(This should aid an)]TJ ET EMC /P <>BDC BT 8 0 0 8 193.9017 430.2897 Tm 0 Tc ( informed decision about )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 418.7897 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 418.7897 Tm [(trying to conceive or preventing pregnancy)74.2(.)]TJ ET EMC /P <>BDC BT 8 0 0 8 202.7145 418.7897 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.9931 401.6204 Tm (2.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 401.6204 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 401.6204 Tm (The chances of becoming pregnant and carrying a pregnancy to )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 390.1204 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 390.1204 Tm (term may be reduced due to the underlying illness, treatment and )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 378.6204 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 378.6204 Tm -.005 Tc [(previous abdominal/pelvic/anal surgery)74.2(. )18.1(The use/dif)18.1(ficulties of in-vitro)]TJ ET EMC /P <>BDC BT 8 0 0 8 290.6877 378.6204 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 367.1204 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 367.1204 Tm (fertilisation \(IVF\) may be discussed.)Tj ET EMC /P <>BDC BT 8 0 0 8 177.0426 367.1204 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.9931 349.9511 Tm (3.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 349.9511 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 349.9511 Tm (The risks of a pregnancy are dependent on the underlying condition,)Tj ET EMC /P <>BDC BT 8 0 0 8 291.8238 349.9511 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 338.4511 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 338.4511 Tm (previous surgery and the current health of the patient \(including )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 326.951 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 326.951 Tm (weight and the presence of inflammation\). )Tj ET EMC /P <>BDC BT 8 0 0 8 201.0818 326.951 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.9931 309.7818 Tm (4.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 309.7818 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 309.7818 Tm (For all patients planning conception, or as soon as the clinical team )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 298.2819 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 298.2819 Tm (is made aware of conception, a detailed review of all current)Tj ET EMC /P <>BDC BT 8 0 0 8 47.4971 286.7818 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 286.7818 Tm (medication must be performed to identify any high-risk medications. )Tj ET EMC /P <>BDC BT 8 0 0 8 291.777 286.7818 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.9931 269.6125 Tm (5.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 269.6125 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 269.6125 Tm (Standard pre-conception advice of optimising folic acid, stopping )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 258.1125 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 258.1125 Tm (smoking, avoiding alcohol, recreational drugs and certain foods )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 246.6125 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 246.6125 Tm (\(e.g. with a listeria contamination risk\) should be given. )Tj ET EMC /P <>BDC BT 8 0 0 8 249.0934 246.6125 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.9931 229.4433 Tm (6.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 229.4433 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 229.4433 Tm (All women who are thinking about becoming pregnant should have )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 217.9433 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 217.9433 Tm [(an intake of folic acid of at least 400 mcg daily)74.2(. )18.1(The addition of extra)]TJ ET EMC /P <>BDC BT 8 0 0 8 290.1755 217.9433 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 206.4433 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 206.4433 Tm (folic acid should be considered if the patient is at a high risk of )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 194.9433 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 194.9433 Tm (having a baby with a neural tube defect \(NTD\). )Tj ET EMC /P <>BDC BT 8 0 0 8 218.9931 194.9433 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.9931 177.774 Tm (7.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 177.774 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 177.774 Tm (Due to abdominal/pelvic/anal surgery/disease, there should be a )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 166.274 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 166.274 Tm -.02 Tc (discussion about the method of delivery \(vaginal or caesarean section\).)Tj ET EMC /P <>BDC BT 8 0 0 8 326.9931 166.274 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 38.9931 148.6046 Tm (Management of parenteral nutrition during pregnancy )Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 245.2353 148.6046 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.9931 134.2701 Tm (8.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 134.2701 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 134.2701 Tm (Patients should have 4-weekly clinical reviews during all three )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 122.7701 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 122.7701 Tm -.015 Tc (trimesters by their CIF multidisciplinary team \(MDT\) whilst maintaining)Tj ET EMC /P <>BDC BT 8 0 0 8 289.4253 122.7701 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 111.2701 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 111.2701 Tm (close dialogue with a high-risk obstetric service who will arrange )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 99.7701 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 99.7701 Tm (foetal scans as appropriate, and ensure women have individual )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 88.2701 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 88.2701 Tm (birth plans.)Tj ET EMC /P <>BDC BT 8 0 0 8 89.4645 88.2701 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.9931 71.1007 Tm -.015 Tc (9.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.229 71.1007 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 71.1007 Tm -.015 Tc (Any CIF complications are proactively identified and managed as risks)Tj ET EMC /P <>BDC BT 8 0 0 8 290.6145 71.1007 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 59.6006 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 59.6006 Tm (may be increased in pregnancy \(e.g. catheter-related blood stream )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 48.1006 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 48.1006 Tm (infection [CRBSI], central vein thrombosis or intestinal obstruction\). )Tj ET EMC /P <>BDC BT 8 0 0 8 291.7692 48.1006 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 488.1057 Tm -.09 Tc (10.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 488.1057 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 488.1057 Tm (At every visit the fluid, macro and micronutrients requirements )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 476.8557 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 476.8557 Tm (should be reviewed. Blood is taken for haematological profile, )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 465.6057 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 465.6057 Tm (urea and electrolytes, liver function, bone profile, magnesium )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 454.3557 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 454.3557 Tm [(and C-reactive protein. )55.2(At 3 monthly intervals, in addition, blood )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 443.1057 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 443.1057 Tm [(is taken for thyroid function, coagulation screen, vitamin )55.2(A, D, E, )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 431.8557 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 431.8557 Tm (B)Tj ET EMC /P <>BDC BT 4.8 0 0 4.8 320.8588 431.1807 Tm (12)Tj ET EMC /P <>BDC BT 8 0 0 8 326.1979 431.8557 Tm [(, folate, ferritin, selenium, manganese, zinc and copper)55.2(.)]TJ ET EMC /P <>BDC BT 8 0 0 8 522.3074 431.8557 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 414.9365 Tm -.1642 Tc [(11)-74.2(.)]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 414.9365 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 414.9365 Tm (Safety data on components of the PN regimen should be assessed. )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 403.6865 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 403.6865 Tm [(Essential fatty acid \(EF)55.2(A\) deficiency increases the risk of foetal )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 392.4365 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 392.4365 Tm (neurodevelopmental problems and may be more likely with the use )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 381.1865 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 381.1865 Tm (of fish oil emulsions. Olive oil and soya bean emulsions are not )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 369.9365 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 369.9365 Tm [(associated with this. Monitoring of EF)55.2(As should be considered.)]TJ ET EMC /P <>BDC BT 8 0 0 8 537.4214 369.9365 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 353.0172 Tm -.09 Tc (12.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 353.0172 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 353.0172 Tm [(During pregnancy too much vitamin )55.2(A)55.2( is toxic to the foetus and may )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 341.7672 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 341.7672 Tm -.005 Tc (cause physical deformities. Regular monitoring \(minimum 12 weekly\))Tj ET EMC /P <>BDC BT 8 0 0 8 556.5327 341.7672 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 330.5172 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 330.5172 Tm (is required. Over-the-counter pregnancy supplements should not )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 319.2672 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 319.2672 Tm [(be recommended if the patient is receiving intravenous vitamin )55.2(A. )]TJ ET EMC /P <>BDC BT 8 0 0 8 548.5346 319.2672 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 302.3479 Tm (13.)Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 302.3479 Tm (If the mother has a pre-pregnancy body mass index \(BMI\) )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 291.0979 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 291.0979 Tm (<18.5 kg/m, weight gain should be 0.5 kg/week in the second )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 279.8479 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 279.8479 Tm [(and third trimesters. If BMI is normal pre-pregnancy)74.2(, a weight gain )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 268.5979 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 268.5979 Tm (of 0.4 kg/week should be expected.)Tj ET EMC /P <>BDC BT 8 0 0 8 440.9408 268.5979 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 251.6786 Tm -.09 Tc (14.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 251.6786 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 251.6786 Tm (Most women will require an increase in their PN macronutrients )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 240.4286 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 240.4286 Tm (during pregnancy by increasing the energy in the PN infusions or )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 229.1786 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 229.1786 Tm [(having more nights of)18.1(f PN. Consider a modest increase in PN )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 217.9286 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 217.9286 Tm (energy by 200-400 kcals /day from pre-pregnancy amounts in the )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 206.6786 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 206.6786 Tm [(third trimester)55.2(.)]TJ ET EMC /P <>BDC BT 8 0 0 8 366.2026 206.6786 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 189.7593 Tm -.09 Tc (15.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 189.7593 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 189.7593 Tm (Intestinal failure \(IF\)/HPN centres should develop links with local )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 178.5093 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 178.5093 Tm (and regional high-risk obstetric services, so that there is a clear )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 167.2593 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 167.2593 Tm (pathway for women who want obstetric counselling, and for when )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 156.0093 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 156.0093 Tm (they become pregnant. )Tj ET EMC /P <>BDC BT 8 0 0 8 404.0229 156.0093 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 139.09 Tm -.09 Tc (16.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 139.09 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 139.09 Tm (If appropriate, the need and timing of a caesarean section should )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 127.84 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 127.84 Tm (be planned. )Tj ET EMC /P <>BDC BT 8 0 0 8 359.5619 127.84 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 110.9207 Tm -.09 Tc (17.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 110.9207 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 110.9207 Tm (Breastfeeding may be considered and, if so, the energy provision )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 99.6707 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 99.6707 Tm (in the PN will need to be increased and maintained until )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 88.4207 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 88.4207 Tm (breastfeeding stops.)Tj ET EMC /P <>BDC BT 8 0 0 8 387.5699 88.4207 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 71.1514 Tm -.09 Tc (18.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 71.1514 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 71.1514 Tm [(A)55.2( parenteral nutrition central vein catheter should not be used )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 59.5515 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 59.5515 Tm (for treatments during delivery unless no other venous access can )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 47.9514 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 47.9514 Tm (be obtained.)Tj ET EMC /P <>BDC BT 8 0 0 8 359.5619 47.9514 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 9 0 0 9 22.6772 814.1643 Tm 1 .15 0 0 k [(THE BRITISH INTESTINAL)18.1( F)55.2(AILURE )37.1(ALLIANCE \(BIF)55.2(A\) T)18.1(O)0(P)18.1( TIPS )37.1(ARTICLE SERIES)]TJ ET EMC /Artifact <>BDC 0 0 0 .6 k .015015 806.78 595.29 1.417 re f EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 22.6772 14.3571 Tm 0 0 0 0 k [(BIF)55.2(A)55.2( is a Specialist Interest Group of ϳԹ )]TJ ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 191.2006 14.3571 Tm [(www)37.1(.bapen.org.uk )]TJ ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 38.993 643.5861 Tm 0 0 0 .8 k [(Kirstine Farrer)55.2(, Simon Harrison, )55.2(Ashley Bond, )55.2(Antje )18.1(T)110.8(eubner)55.2(, )55.2(Alex Speakman, Jeremy Nightingale, Simon Lal and the BIF)55.2(A)55.2( Committe)]TJ 58.6221 0 TD (e)Tj ET EMC /P <>BDC BT 7 0 0 7 480.9973 15.0865 Tm 0 0 0 0 k (February 2024 | Page 1 of 3)Tj ET EMC Q endstream endobj 79 0 obj <>/ExtGState<>>> endobj 85 0 obj <> endobj 131 0 obj <>stream /Figure <>BDC q 1 i -16 794.836 625.344 -936.03 re 297.645 420.96 m W* n 0 841.89 595.276 -841.89 re 297.645 420.96 m W n .015015 841.89 595.29 -841.89 re W n /GS2 gs q 702.114 106.142 -80.977 535.654 11.868 -89.181 cm /Im1 Do Q EMC /P <>BDC Q q 1 i 0 841.89 595.276 -841.89 re 297.645 420.96 m W n .015015 841.89 595.29 -841.89 re W n /GS1 gs BT /TT4 1 Tf 9 0 0 9 22.6772 814.1656 Tm 1 .15 0 0 k 0 Tc 0 Tw [(THE BRITISH INTESTINAL)18.1( F)55.2(AILURE )37.1(ALLIANCE \(BIF)55.2(A\) T)18.1(O)0(P)18.1( TIPS )37.1(ARTICLE SERIES)]TJ ET EMC /Artifact <>BDC 0 0 0 .6 k .015015 806.781 595.29 1.4171 re f EMC /Artifact <>BDC 1 .1 0 .1 k .015015 0 595.29 31.482 re f EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 22.6772 14.3583 Tm 0 0 0 0 k [(BIF)55.2(A)55.2( is a Specialist Interest Group of ϳԹ )]TJ ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 191.2007 14.3583 Tm [(www)37.1(.bapen.org.uk )]TJ ET EMC /P <>BDC BT /TT2 1 Tf 7 0 0 7 480.444 15.0863 Tm (February 2024 | Page 2 of 3)Tj ET EMC /P <>BDC BT /TT4 1 Tf 12 0 0 12 36.8504 780.1547 Tm 1 .89 0 0 k (Explanations)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 111.534 780.1547 Tm 0 0 0 .8 k ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 762.8254 Tm (1.)Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 45.9663 762.8254 Tm ( )Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 48.189 762.8254 Tm (There are no data to provide a clear evidence base of fertility risk )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 751.1654 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 751.1654 Tm [(and pre-conception care in CIF)110.8(. )18.1(There are, however)55.2(, established )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 739.5054 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 739.5054 Tm [(guidelines on the management of conditions \(e.g. Crohn)18.1(s disease )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 727.8454 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 727.8454 Tm (in pregnancy which may be extrapolated to the HPN population\). )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 716.1854 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 716.1854 Tm (Although 54% of respondents in an international survey reported )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 704.5254 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 704.5254 Tm -.015 Tc [(they had experience of managing pregnancy in CIF)110.8(, 60% of healthcare)]TJ ET EMC /P <>BDC BT 8 0 0 8 289.6415 704.5254 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 692.8654 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 692.8654 Tm (professionals \(HCPs\) reported they did not feel it was their role to )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 681.2054 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 681.2054 Tm (discuss the topic of pregnancy with their patients with fewer than )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 669.5454 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 669.5454 Tm -.005 Tc [(10% stating they did it routinely)74.2(. )18.1(Thus, patients should be counselled)]TJ ET EMC /P <>BDC BT 8 0 0 8 287.4686 669.5454 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 46.0863 657.8854 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 657.8854 Tm -.015 Tc (on an individual basis by the CIF clinician and obstetric team regarding)Tj ET EMC /P <>BDC BT 8 0 0 8 289.9087 657.8854 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 646.2254 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 646.2254 Tm [(their fertility and potential risks of pregnancy)74.2(. In general, patients of )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 634.5654 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 634.5654 Tm (child-bearing age should be supported in their decision about a )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 622.9054 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 622.9054 Tm [(pregnancy)74.2(, providing it is felt that successful pregnancy is likely to )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 611.2454 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 611.2454 Tm [(be safe and feasible for the mother and baby)74.2(.)]TJ ET EMC /P <>BDC BT 8 0 0 8 208.5913 611.2454 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 593.9161 Tm -.01 Tc (2.)Tj ET EMC /P <>BDC BT 8 0 0 8 46.0463 593.9161 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 593.9161 Tm -.01 Tc (Active inflammation or malnutrition reduce the chances of conceiving.)Tj ET EMC /P <>BDC BT 8 0 0 8 288.129 593.9161 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 582.2561 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 582.2561 Tm (IVF may be possible if an ovum can be retrieved and implanted into )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 570.5961 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 570.5961 Tm [(the uterus. If dif)18.1(ficult to retrieve an ovum, an egg donor may be )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 558.9361 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 558.9361 Tm (considered. )Tj ET EMC /P <>BDC BT 8 0 0 8 91.771 558.9361 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 541.6068 Tm (3.)Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 541.6068 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 541.6068 Tm [(T)110.8(arget body weight should be achieved, and all micronutrient )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 529.9468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 529.9468 Tm (abnormalities should be corrected. Clinicians must determine and )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 518.2868 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 518.2868 Tm (hence advise about the feasibility and safety of a successful )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 506.6267 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 506.6267 Tm (pregnancy \(for the mother and baby\). Sometimes a patient may )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 494.9668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 494.9668 Tm (be advised not to become pregnant. )Tj ET EMC /P <>BDC BT 8 0 0 8 178.0561 494.9668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 477.6375 Tm -.01 Tc (4.)Tj ET EMC /P <>BDC BT 8 0 0 8 46.0463 477.6375 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 477.6375 Tm -.01 Tc [(Not all medicines are safe to take when planning/or during pregnancy)74.2(,)]TJ ET EMC /P <>BDC BT 8 0 0 8 289.7814 477.6375 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 465.9775 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 465.9775 Tm [(therefore a thorough review)55.2(, often involving the )18.1(T)37.1(rust medicines )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 454.3174 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 454.3174 Tm (information team, will allow HCPs and patients to receive accurate )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 442.6574 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 442.6574 Tm (information on any potential risks. Medications that are either )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 430.9974 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 430.9974 Tm (teratogenic or whose pharmacokinetics may be altered by a )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 419.3374 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 419.3374 Tm (pregnancy \(e.g. anti-coagulation, anti-epileptic, anti-hypertensive )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 407.6774 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 407.6774 Tm (or diabetic medication\) may require stopping, changing or needing )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 396.0174 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 396.0174 Tm [(additional monitoring during the pregnancy)74.2(.)]TJ ET EMC /P <>BDC BT 8 0 0 8 201.0288 396.0174 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 378.6881 Tm -.01 Tc (5.)Tj ET EMC /P <>BDC BT 8 0 0 8 46.0463 378.6881 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 378.6881 Tm -.01 Tc (Stopping smoking will reduce exposure to harmful gases \(e.g. carbon)Tj ET EMC /P <>BDC BT 8 0 0 8 287.8514 378.6881 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 367.0281 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 367.0281 Tm (monoxide, hydrogen cyanide, benzene, formaldehyde, nicotine, )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 355.3681 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 355.3681 Tm (phenol, polycyclic aromatic hydrocarbons and tobacco-specific )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 343.7081 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 343.7081 Tm -.015 Tc (nitrosamines\), which will reduce the risk of complications in pregnancy)Tj ET EMC /P <>BDC BT 8 0 0 8 288.2201 343.7081 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 332.0481 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 332.0481 Tm (and after birth. Smoking is associated with a risk of stillbirth and )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 320.3881 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 320.3881 Tm (premature birth. )Tj ET EMC /P <>BDC BT 8 0 0 8 106.8804 320.3881 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 46.0463 303.0588 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 303.0588 Tm (United Kingdom \(UK\) guidelines recommend that for those planning)Tj ET EMC /P <>BDC BT 8 0 0 8 45.3543 291.3988 Tm ( pregnancy and those who are pregnant, the safest option is to avoid)Tj ET EMC /P <>BDC BT 8 0 0 8 288.1824 291.3988 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 279.7388 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 279.7388 Tm [(alcohol. )55.2(Alcohol can increase the risk of miscarriage, and foetal )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 268.0788 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 268.0788 Tm (alcohol spectrum disorder which includes poor growth, and learning )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 256.4188 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 256.4188 Tm [(and behavioural dif)18.1(ficulties. )]TJ ET EMC /P <>BDC BT 8 0 0 8 146.771 256.4188 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 46.0463 239.0895 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 239.0895 Tm (Dietary advice includes avoiding foods such as soft cheeses and if )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 227.4295 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 227.4295 Tm [(eating cooked-chill ready meals, they must be well heated. )18.1(This is )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 215.7695 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 215.7695 Tm (to avoid the risk of acquiring a listeria infection which causes few )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 204.1095 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 204.1095 Tm (symptoms in a healthy adult but, by easily crossing the placenta, )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 192.4495 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 192.4495 Tm (may be fatal to a foetus \(miscarriage or stillbirth\) or a newborn )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 180.7895 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 180.7895 Tm (\(pneumonia and/or meningitis\).)Tj ET EMC /P <>BDC BT 8 0 0 8 158.4702 180.7895 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 160.6129 180.7895 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 163.4602 Tm -.015 Tc (6.)Tj ET EMC /P <>BDC BT 8 0 0 8 46.0863 163.4602 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 163.4602 Tm -.015 Tc (This is in line with the general population: patients should be receiving)Tj ET EMC /P <>BDC BT 8 0 0 8 287.1363 163.4602 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 151.8002 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 151.8002 Tm (400 mcg of folic acid daily prior to conception and for the first 12 )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 140.1402 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 140.1402 Tm (weeks of pregnancy to prevent NTD \(anencephaly and spina bifida\).)Tj ET EMC /P <>BDC BT 8 0 0 8 289.2163 140.1402 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 128.4801 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 128.4801 Tm (Cerenvit)Tj ET EMC /P <>BDC BT 4.8 0 0 4.8 77.978 130.8051 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 81.5148 128.4801 Tm (/Solivito)Tj ET EMC /P <>BDC BT 4.8 0 0 4.8 109.5265 130.8051 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 113.0632 128.4801 Tm (/Nutratain)Tj ET EMC /P <>BDC BT 4.8 0 0 4.8 147.7469 130.8051 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 151.2836 128.4801 Tm ( contain 414, 400, and 600 mcg )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 116.8202 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 116.8202 Tm (respectively of folic acid. Some patients may need more folic acid )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 105.1602 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 105.1602 Tm [(\(e.g. if a previous pregnancy af)18.1(fected by NTD, are taking epilepsy )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 93.5002 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 93.5002 Tm (medications, have coeliac disease, diabetes, sickle-cell anaemia, )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 81.8401 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 81.8401 Tm (thalassaemia or have a BMI is over 30 kg/m)Tj ET EMC /P <>BDC BT 4.8 0 0 4.8 203.814 84.1651 Tm (2)Tj ET EMC /P <>BDC BT 8 0 0 8 206.4835 81.8401 Tm (. )Tj ET EMC /P <>BDC BT 8 0 0 8 216.8504 81.8401 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 64.6709 Tm (7.)Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 64.6709 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 64.6709 Tm (Delivery may be vaginal or by caesarean section and the risks/)Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 53.1709 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 53.1709 Tm (benefits should be discussed with the high-risk obstetric team.)Tj ET EMC /P <>BDC BT 8 0 0 8 288.8504 53.1709 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 783.0668 Tm (8.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 783.0668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 783.0668 Tm [(In addition to the nutrition MDT)110.8(, patients should be referred to and )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 771.1868 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 771.1868 Tm [(followed by a high-risk)37.1( obstetric clinic which may include a high )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 759.3068 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 759.3068 Tm [(risk)37.1( foetal medicine team. )55.2(Access to such a clinic was reported by )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 747.4268 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 747.4268 Tm (80% of respondents in the paper published by Bond et al, while )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 735.5468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 735.5468 Tm (three-quarters of participants felt that a specialist IF-pregnancy )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 723.6667 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 723.6667 Tm (service improved the care and outcomes for pregnant patients with )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 711.7868 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 711.7868 Tm [(CIF)110.8(. Communication between these teams must be comprehensive.)]TJ ET EMC /P <>BDC BT 8 0 0 8 553.0364 711.7868 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 694.2375 Tm -.01 Tc (9.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.2256 694.2375 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 694.2375 Tm -.01 Tc (The management of the underlying disease and proactively observing)Tj ET EMC /P <>BDC BT 8 0 0 8 554.9077 694.2375 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 682.3575 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 682.3575 Tm (for HPN-related complications is imperative. In a French series, )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 670.4775 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 670.4775 Tm (maternal complications unrelated to pregnancy included intestinal )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 658.5975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 658.5975 Tm (obstruction in nine patients, cholestasis in one and CRBSI in five )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 646.7175 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 646.7175 Tm (patients, one of whom was subsequently treated with a taurolidine-)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 634.8375 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 634.8375 Tm -.015 Tc [(based lock. )18.1(The authors also highlighted severe complications in )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.2657 622.9575 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 622.9575 Tm -.015 Tc (patients with chronic intestinal pseudo-obstruction involving septic )Tj ET EMC /P <>BDC BT 8 0 0 8 311.2657 611.0775 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 611.0775 Tm -.015 Tc (episodes, obstruction)Tj ET EMC /P <>BDC BT 8 0 0 8 386.45 611.0775 Tm -.01 Tc ( and uterine rupture in one and obstructive)Tj ET EMC /P <>BDC BT 8 0 0 8 533.3322 611.0775 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 599.1975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 599.1975 Tm [(uropathy with renal failure in another)55.2(, which led them to suggest )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 587.3175 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 587.3175 Tm (that this group of patients warranted particularly close follow-up. )Tj ET EMC /P <>BDC BT 8 0 0 8 541.4855 587.3175 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 569.7682 Tm -.125 Tc (10)Tj ET EMC /P <>BDC BT 8 0 0 8 308.9283 569.7682 Tm 0 Tc (.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 569.7682 Tm (Monitoring vitamins and trace elements is important. Iron deficiency )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 557.8882 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 557.8882 Tm (is very common, and an intravenous iron infusion may be required )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 546.0082 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 546.0082 Tm [(from the second trimester onwards. V)18.1(itamin K deficiency \(suggested)]TJ ET EMC /P <>BDC BT 8 0 0 8 554.6653 546.0082 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 534.1281 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 534.1281 Tm (by prolonged coagulation tests\), in addition to causing bleeding, )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 522.2481 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 522.2481 Tm [(may cause foetal skeletal abnormalities. )55.2(Although iodine deficiency )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 510.3681 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 510.3681 Tm (may be common worldwide screening for it is not commonly )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 498.4881 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 498.4881 Tm (performed in the UK. )Tj ET EMC /P <>BDC BT 8 0 0 8 389.4035 498.4881 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 480.9388 Tm -.1642 Tc [(11)-74.2(.)]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 480.9388 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 480.9388 Tm -.005 Tc (In the French series, all patients received lipid with a mixture of olive )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 469.0588 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 469.0588 Tm -.005 Tc (oil and soybean-based emulsions, with no patients solely receiving )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 457.1788 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 457.1788 Tm [(a fish oil-based emulsion. Similarly)74.2(, in the UK series reporting five )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 445.2988 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 445.2988 Tm (pregnancies, all mothers received a combination of lipid \(less than)Tj ET EMC /P <>BDC BT 8 0 0 8 547.2708 445.2988 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 433.4188 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 433.4188 Tm -.015 Tc (20% Intralipid)Tj ET EMC /P <>BDC BT 4.8 0 0 4.8 360.1611 435.7438 Tm 0 Tc ()Tj ET EMC /P <>BDC BT 8 0 0 8 363.5778 433.4188 Tm -.015 Tc ( or Clinoleic)Tj ET EMC /P <>BDC BT 4.8 0 0 4.8 403.8107 435.7438 Tm 0 Tc ()Tj ET EMC /P <>BDC BT 8 0 0 8 407.2277 433.4188 Tm -.015 Tc [(\). )18.1(Theilla et al. also note that their pregnant)]TJ ET EMC /P <>BDC BT 8 0 0 8 553.5333 433.4188 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.2256 421.5388 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 421.5388 Tm -.005 Tc (patients all received lipid based PN \(Intralipid)Tj ET EMC /P <>BDC BT 4.8 0 0 4.8 471.0901 423.8638 Tm 0 Tc ()Tj ET EMC /P <>BDC BT 8 0 0 8 474.5869 421.5388 Tm -.005 Tc ( or Clinoleic)Tj ET EMC /P <>BDC BT 4.8 0 0 4.8 515.8602 423.8638 Tm 0 Tc ()Tj ET EMC /P <>BDC BT 8 0 0 8 519.3568 421.5388 Tm -.005 Tc (\) without )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 409.6588 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 409.6588 Tm [(significant complications. )18.1(Thus, close clinical and dietetic overview )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 397.7788 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 397.7788 Tm (is required during pregnancy to ensure nutritional requirements are )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 385.8988 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 385.8988 Tm (met, particularly since oral intake may diminish in the second and)Tj ET EMC /P <>BDC BT 8 0 0 8 544.1457 385.8988 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 374.0188 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 374.0188 Tm (third trimesters.)Tj ET EMC /P <>BDC BT 8 0 0 8 374.0298 374.0188 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 356.4495 Tm -.09 Tc (12.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 356.4495 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 356.4495 Tm -.005 Tc [(V)18.1(itamin )55.2(A)55.2( can be harmful to the unborn foetus. Over-exposure can )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1857 344.5495 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 344.5495 Tm -.005 Tc (cause a range of malformations including spina bifida, cleft palate, )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 332.6495 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 332.6495 Tm -.005 Tc [(deformities of the eye, ear)55.2(, limb, heart and kidneys. However)55.2(, vitamin)]TJ ET EMC /P <>BDC BT 8 0 0 8 554.6872 332.6495 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 320.7495 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 320.7495 Tm -.005 Tc [(A)55.2( is vital to health and development of a healthy foetus. Due to the )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1857 308.8495 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 308.8495 Tm -.005 Tc [(wide range of oral intake and absorption of patients with CIF)110.8(, a )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1857 296.9495 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 296.9495 Tm -.005 Tc (review of current dietary intake is important, and a decision made )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 285.0495 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 285.0495 Tm -.005 Tc [(for an appropriate route for vitamin )55.2(A)55.2( supplementation. )18.1(The W)18.1(orld )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1857 273.1496 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 273.1496 Tm -.03 Tc [(Health Organization \(WHO\) recommends that vitamin )55.2(A)55.2( supplementation)]TJ ET EMC /P <>BDC BT 8 0 0 8 554.293 273.1496 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 261.2495 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 261.2495 Tm -.005 Tc (should only be given to pregnant women to prevent night-blindness )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 249.3495 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 249.3495 Tm -.005 Tc [(in areas where vitamin )55.2(A)55.2( deficiency is severe \(not within the UK\). )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1857 237.4496 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 237.4496 Tm -.005 Tc [(The European food safety agency \(ESF)55.2(A\) have set a tolerable upper)]TJ ET EMC /P <>BDC BT 8 0 0 8 553.5862 237.4496 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 225.5496 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 225.5496 Tm -.005 Tc [(intake level for V)18.1(itamin )55.2(A)55.2( as 3000 mcg \(10,000 IU\). However)55.2(, due to )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1857 213.6496 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 213.6496 Tm -.005 Tc [(CIF)110.8(, where oral intake and absorption varies greatly)74.2(, provision of )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1857 201.7495 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 201.7495 Tm -.005 Tc [(vitamin )55.2(A)55.2( supplementation may be required depending on dietary )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1857 189.8496 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 189.8496 Tm -.005 Tc [(intake. Use of V)18.1(itlipid)]TJ ET EMC /P <>BDC BT 4.8 0 0 4.8 387.0074 192.1745 Tm 0 Tc ()Tj ET EMC /P <>BDC BT 8 0 0 8 390.5042 189.8496 Tm -.005 Tc ( \(3300 IU per vial\) Nutratain)Tj ET EMC /P <>BDC BT 4.8 0 0 4.8 487.6105 192.1745 Tm 0 Tc ()Tj ET EMC /P <>BDC BT 8 0 0 8 491.1074 189.8496 Tm -.005 Tc ( \(3300 IU per vial\))Tj ET EMC /P <>BDC BT 8 0 0 8 553.9297 189.8496 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 177.9496 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 177.9496 Tm -.005 Tc (or Cernevit)Tj ET EMC /P <>BDC BT 4.8 0 0 4.8 352.0536 180.2746 Tm 0 Tc ()Tj ET EMC /P <>BDC BT 8 0 0 8 355.5503 177.9496 Tm -.005 Tc ( \(3500 IU per vial\) within HPN needs to be closely )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 166.0496 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 166.0496 Tm -.005 Tc (monitored to provide adequate but not excessive supplementation. )Tj ET EMC /P <>BDC BT 8 0 0 8 548.6995 166.0496 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 148.5003 Tm -.09 Tc (13.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 148.5003 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 148.5003 Tm -.005 Tc (Currently there are no UK guidelines on appropriate weight gain )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 136.6203 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 136.6203 Tm -.005 Tc [(during pregnancy)74.2(. )18.1(The United States Institute of Medicine \(IOM\) )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1857 124.7403 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 124.7403 Tm -.005 Tc (can be used as a guide and if the patient has a normal BMI prior )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 112.8603 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 112.8603 Tm -.005 Tc (to pregnancy weight gain should not exceed more than 0.4 kg/week )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 100.9803 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 100.9803 Tm -.005 Tc (in )Tj ET EMC /P <>BDC BT 8 0 0 8 321.8723 100.9803 Tm [(the second and third trimesters. W)18.1(eight gain in a pregnancy in a )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1857 89.1003 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 89.1003 Tm -.005 Tc (woman of a normal starting weight is 10-12.5 kg; most weight is put )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 77.2202 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 77.2202 Tm -.005 Tc [(on after week 20. )18.1(The publication by Billiauws et al. reported median )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1857 65.3401 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 65.3401 Tm -.005 Tc (BMI pre-pregnancy of 19.4 kg/m, with a median weight gain of 10 kg)Tj ET EMC /P <>BDC BT 8 0 0 8 554.8187 65.3401 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 53.4601 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 53.4601 Tm -.005 Tc (\(IQR: 5\) with 33% gaining > 12 kg. )Tj ET EMC /P <>BDC BT 8 0 0 8 438.437 53.4601 Tm 0 Tc ( )Tj ET EMC Q endstream endobj 132 0 obj <>/XObject<>/ExtGState<>>> endobj 136 0 obj <> endobj 182 0 obj <>stream /Figure <>BDC q 1 i -16 794.836 625.344 -936.03 re 297.645 420.96 m W* n 0 841.89 595.276 -841.89 re 297.645 420.96 m W n .015015 841.89 595.29 -841.89 re W n /GS2 gs q 702.114 106.142 -80.977 535.654 11.868 -89.181 cm /Im1 Do Q EMC /P <>BDC Q q 1 i 0 841.89 595.276 -841.89 re 297.645 420.96 m W n .015015 841.89 595.29 -841.89 re W n /GS1 gs BT /TT4 1 Tf 9 0 0 9 22.6772 814.1656 Tm 1 .15 0 0 k 0 Tc 0 Tw [(THE BRITISH INTESTINAL)18.1( F)55.2(AILURE )37.1(ALLIANCE \(BIF)55.2(A\) T)18.1(O)0(P)18.1( TIPS )37.1(ARTICLE SERIES)]TJ ET EMC /Artifact <>BDC 0 0 0 .6 k .015015 806.781 595.29 1.4171 re f EMC /Artifact <>BDC 1 .1 0 .1 k .015015 0 595.29 31.482 re f EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 22.6772 14.3583 Tm 0 0 0 0 k [(BIF)55.2(A)55.2( is a Specialist Interest Group of ϳԹ )]TJ ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 191.2007 14.3583 Tm [(www)37.1(.bapen.org.uk )]TJ ET EMC /Artifact <>BDC 0 0 0 .08 k 36.85 434.945 520.425 222.924 re f EMC /P <>BDC BT 9 0 0 9 57.286 631.3123 Tm 1 .89 0 0 k (Suggested reading)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 165.286 631.3123 Tm 0 0 0 .8 k ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 57.286 615.9777 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 65.79 615.9777 Tm (Billiauws L, et al. \(2017\). Pregnancy is possible on long-term home parenteral nutrition in patients with chronic intestinal fa)Tj 53.917 0 TD (ilure: )Tj ET EMC /P <>BDC BT 8 0 0 8 65.79 603.4777 Tm [(Results of a long-term retrospective observational study)74.2(. Clin Nutr)55.2(.; 36\(4\): 1)74.2(165-1)74.2(169.)]TJ ET EMC /P <>BDC BT 8 0 0 8 366.8252 603.4777 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 57.286 590.9777 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 65.79 590.9777 Tm [(Bond )55.2(A, et al. \(2017\). Managing Successful Pregnancies in Patients with Chronic Intestinal Failure on Home Parenteral Nutrition)]TJ 56.5854 0 TD (: )Tj ET EMC /P <>BDC BT 8 0 0 8 65.79 578.4777 Tm (Experience from a UK National Intestinal Failure Unit. J Gastrointestin Liver Dis.; 26\(4\): 375-379.)Tj ET EMC /P <>BDC BT 8 0 0 8 407.7198 578.4777 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 57.286 565.9777 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 65.79 565.9777 Tm [(Theilla M, et al. \(2017\). Safety of home parenteral nutrition during pregnancy)74.2(. Clin Nutr)55.2(.; 36\(1\): 288-292.)]TJ ET EMC /P <>BDC BT 8 0 0 8 432.5049 565.9777 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 57.286 553.4777 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 65.79 553.4777 Tm [(Bond )55.2(A, et al. \(2023\). Experience and opinions relating to pregnancy in patients with chronic intestinal failure: an internatio)]TJ 53.9219 0 TD [(nal survey)74.2(. )]TJ ET EMC /P <>BDC BT 8 0 0 8 65.79 540.9777 Tm (Frontline Gastroenterol.; 14\(5\): 377-383.)Tj ET EMC /P <>BDC BT 8 0 0 8 208.9775 540.9777 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 57.286 528.4777 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 65.79 528.4777 Tm [(Pironi L, et al. \(2023\). ESPEN guideline on chronic intestinal failure in adults - Update 2023. Clin Nutr)55.2(.; 42\(10\): 1940-2021.)]TJ ET EMC /P <>BDC BT 8 0 0 8 497.5947 528.4777 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 57.286 515.9777 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 65.79 515.9777 Tm [(British Dietetic )55.2(Association. Healthy Eating During Pregnancy)74.2(. )55.2(Accessible online: www)55.2(.bda.uk.com/resource/pregnancy-diet.html )]TJ ET EMC /P <>BDC BT 8 0 0 8 65.79 503.4777 Tm (\(Jan 2024\).)Tj ET EMC /P <>BDC BT 8 0 0 8 106.2587 503.4777 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 57.286 490.9777 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 65.79 490.9777 Tm [(Food Standards )55.2(Agency \(2022\). Lay Summary of the Statement on the ef)18.1(fects of excess V)18.1(itamin )55.2(A)55.2( on maternal health. )55.2(Accessible )]TJ ET EMC /P <>BDC BT 8 0 0 8 65.79 478.4777 Tm [(online: https://cot.food.gov)74.2(.uk/Lay%20Summary%20of%20the%20Statement%20on%20the%20ef)18.1(fects%20of%20excess%20)]TJ ET EMC /P <>BDC BT 8 0 0 8 65.79 465.9777 Tm [(V)18.1(itamin%20A%20on%20maternal%20health#:~:text=T)110.8(oo%20much%20vitamin%20A%20can,heart%2C%20thyroid%20gland%20and)]TJ ET EMC /P <>BDC BT 8 0 0 8 65.79 453.4777 Tm (%20skeleton \(Jan 2024\).)Tj ET EMC /P <>BDC BT 8 0 0 8 154.29 453.4777 Tm ( )Tj ET EMC /P <>BDC BT 7 0 0 7 480.444 15.0863 Tm 0 0 0 0 k (February 2024 | Page 3 of 3)Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 782.0668 Tm 0 0 0 .8 k -.055 Tc (14.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 782.0668 Tm 0 Tc (In the Billiauws publication parenteral energy needs increased from )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 769.5668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 769.5668 Tm (5 to 7 nights; 70% of energy needs were met by PN at conception )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 757.0668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 757.0668 Tm (and this increased to 135 % by the end of pregnancy \(note median )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 744.5668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 744.5668 Tm (lipid provision/week was 230 g at conception and this increased to )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 732.0668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 732.0668 Tm [(a median of 350 g by the end of the pregnancy)74.2(.)]TJ ET EMC /P <>BDC BT 8 0 0 8 215.271 732.0668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 713.8975 Tm -.055 Tc (15.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 713.8975 Tm 0 Tc (Integrated care between obstetrics, foetal medicine and the )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 701.3975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 701.3975 Tm [(multidisciplinary NST)18.1( are vital for providing support.)]TJ ET EMC /P <>BDC BT 8 0 0 8 230.3374 701.3975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 683.2281 Tm -.065 Tc (16.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 683.2281 Tm 0 Tc [(A)55.2( date for expected delivery needs to be set and if appropriate )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 670.7282 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 670.7282 Tm (an elective caesarean section date booked.)Tj ET EMC /P <>BDC BT 8 0 0 8 202.0717 670.7282 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 782.0668 Tm -.09 Tc (17.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 782.0668 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 782.0668 Tm (Breastfeeding is an energy-demanding activity and has to contain )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 770.2668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 770.2668 Tm [(enough energy to supply the needs of the growing infant. )18.1(Therefore,)]TJ ET EMC /P <>BDC BT 8 0 0 8 553.8293 770.2668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 758.4668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 758.4668 Tm (additional energy intake, over and above pre-pregnancy levels,)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 746.6667 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 746.6667 Tm (is required \(approximately 300-500 additional kcal per day\) )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 734.8668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 734.8668 Tm (especially during the first 6 months of lactation.)Tj ET EMC /P <>BDC BT 8 0 0 8 479.677 734.8668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 717.3975 Tm -.09 Tc (18.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 717.3975 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 717.3975 Tm (During labour and post-delivery the HPN catheter should not be )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 705.5975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 705.5975 Tm (used for the administration of anything \(fluids or medication\) except )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 693.7975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 693.7975 Tm (PN. If used for routine or emergency treatment especially by those )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 681.9974 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 681.9974 Tm (not familiar with handling these central lines using an aseptic )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 670.1975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 670.1975 Tm [(non-touch technique, a CRBSI is likely to occur)55.2(.)]TJ ET EMC /P <>BDC BT /TT4 1 Tf 6 0 0 6 36.8504 420.1299 Tm (Disclaimer:)Tj ET EMC /P <>BDC BT /TT2 1 Tf 6 0 0 6 69.2 420.1299 Tm ( ϳԹ Position Statements/Guidelines have been prepared as guidance only to assist qualified healthcare professionals in the d)Tj 57.4793 0 TD (ecision-making processes surrounding nutritional)Tj ET EMC /P <>BDC BT 6 0 0 6 544.1434 420.1299 Tm ( )Tj ET EMC /P <>BDC BT 6 0 0 6 36.8504 412.1299 Tm (care. Users of these materials may only do so on the condition that they exercise their own professional knowledge and skills w)Tj 56.1952 0 TD [(hen applying such guidance to specific circumstances. )55.2(Anyone )]TJ ET EMC /P <>BDC BT 6 0 0 6 36.8504 404.1299 Tm (without the appropriate qualifications must seek the advice of a qualified healthcare professional before taking, or refraining)Tj 54.4212 0 TD ( from, any action on the basis of the policies or guidance. ϳԹ does)Tj ET EMC /P <>BDC BT 6 0 0 6 551.4852 404.1299 Tm ( )Tj ET EMC /P <>BDC BT 6 0 0 6 36.8504 396.1299 Tm (not \(i\) owe a duty of care to users of the policies, guidance or practice tips who are not qualified healthcare professionals; )Tj 53.8075 0 TD (and \(ii\) cannot accept liability to anyone using these policies, guidance)Tj ET EMC /P <>BDC BT 6 0 0 6 576.8504 396.1299 Tm ( )Tj ET EMC /P <>BDC BT 6 0 0 6 36.8504 388.1299 Tm (or practice tips.)Tj ET EMC Q endstream endobj 183 0 obj <>/XObject<>/ExtGState<>>> endobj 6 0 obj <> endobj 5 0 obj <> endobj 133 0 obj <>stream Adobed         #"""#''''''''''     !! !!''''''''''Z""  s!1AQa"q2B#R3b$r%C4Scs5D'6Tdt& EFVU(eufv7GWgw8HXhx)9IYiy*:JZjzm!1AQa"q2#BRbr3$4CS%cs5DT &6E'dtU7()󄔤euFVfvGWgw8HXhx9IYiy*:JZjz? a8թ8S@z@}x9$pT7ڥS?vlٛ؏g0hcL2׀1ٳZE~\[%>39>!V3ǖwwl乔i9)ӿ+?0@ V,MB 8#tTQTbi]^.NˏU<'͞X{K!er$v7 C$OԽ<Bf{;e_f?sp1k8d{u[TavhË?iAuqnuByMw:Y`)/1K004!iF}4i~,kM Ȟ`}V}gYw9TQce9[ڽ΋#'͏q\v&I8P:mw.-E #E|wgFr2"I>g6lٳfȫf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͛6lثf͋Zmn"TŜHۉG2礿.ð%ck۠!AN'SOfj-p)4 DZ;ٚ-FO\Y!2CzC|fny&-%}:pO¸[q y0vVbr~0*ϺiIBkv>h:zkv&{եfKKWh.2 q>`Ȏxf3)/8㇔S $ ToR(O|!iTy['+7G=)O~b{<[ep-_*Pv*~y˳`OFYc7hbxuG9O$L%d8d*6j6lٳdٳf͛6lUٳf͛6lUٳf͛6lUٳf͛>U\ٳf͛(uvlٲd~m>H.Xਪ/O>"_ffY.wWJ)mٛN$Ҽ;I,^Iff5,I9{ 7M@C|q>Sc0^mJ][[kveTtHl;g˓,,s&R#̒ylٳf͛+Wf͛6lٱWf͛6ls*7?Uto\P;i_DOpϒ8cYaG#r͛, 6.K6H FFUsWq>^p37S=#Gt?->Zc?wC$݉?qzCy +YiLgH0heL|a58`|ϪϬ3;>q f˗&\˖Fs))JG'$f͛6lZ6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6lٳf͊6l;GQմnqJ T; 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