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Offsite Patient Education & Support

Enteral (NG/PEG) Nutrition

In recent years, research has increased on the use of feedings by either a nasogastric (NG), or a percutaneous endoscopic gastrostomy (PEG) tube as an alternative to parenteral (intravenous) nutrition in mothers with HG. This is mostly attributed to decreasing the cost of medical care, and increasing safety. Other benefits include the stomach and intestines not atrophying from lack of use, and the nutrients being better absorbed and utilized by the body. It is generally easier on the body than IV nutrition. A NG tube is passed through the nose, down the throat, to the stomach or jejunum, and the PEG requires an outpatient surgical procedure to implant it through the abdomen into the stomach. Sometimes, the tube will be advanced into the jejunum for added safety and tolerance. Both procedures are somewhat uncomfortable, but steps are typically taken to decrease any discomfort.

However, it should not be assumed that the metabolic complications of parenteral (IV) nutrition will avoided by use of enteral nutrition, nor is it without risk. The most common risks include tube displacement, pulmonary (lung) aspiration and poor tolerance. Aspiration is one of the most concerning complications because it can cause pneumonia or other problems in the lungs. Many women with HG have slow emptying of their stomachs, reflux, extremely sensitive gag reflexes, and frequent vomiting which make NG feedings intolerable and somewhat risky. The smell of formula also may cause vomiting in some women. Some of these women report repeated tube dislodgements due to vomiting. Further, many women benefit greatly from a period of gut rest, yet require nutritional support due to weeks of vomiting and limited intake. Intravenous (IV) nutrition is preferred initially in these women.

Risk Factors and Potential Complications

A few research studies have demonstrated that enteral nutrition may be a safe and effective alternative to TPN in selected pregnant women with HG who have failed conventional treatment. However, these studies have only a few patients of varying severity, and thus should be interpreted cautiously. It is not yet clear as to which women with HG are the best candidates. It should be noted that women with HG have several risk factors for aspiration, as well as Refeeding Syndrome, both potential complications of enteral nutrition. (See list below.) In women who continue to vomit, more aggressive antiemetics should be considered, and/or an alternative mode of nutritional support.

If your health professional suggests this therapy, be informed of the risks and discuss them. If you try this route of nutritional support, make sure you are educated in the care of a gastric tube and able to identify signs of aspiration or other potential complications. Online resources are listed to the right for your reference. A second opinion may be needed if this therapy is not tolerated or desired, and the mother continues to vomit and become more nutritionally depleted.

See our Referral Network for more assistance. Remember, chronic dehydration and nutrient depletion make vomiting and nausea worse. So assist her in getting the help she needs so she will improve and recover faster.

Risk Factors for Aspiration:

  • Decreased level of consciousness (sedative medication)
  • Diminished gag reflex
  • Gastric (stomach) reflux
  • Supine position (laying down)
  • Use of large diameter tubes
  • Delayed gastric (stomach) emptying
  • Vomiting or retching
 

Risk Factors for Refeeding Syndrome:

  • Prolonged fasting
  • Repeated IV hydration
  • Significant stress
  • Nutrient depletion

 

Potential Complications of Enteral Nutrition:
Metabolic complications:
Electrolyte imbalances (K+, Na+) Due to fluid imbalance, renal impairment, diarrhea, Refeeding syndrome.
Hyperglycemia Too many calories or lack of adequate insulin.
Dehydration
 
Tube clogging
 
Tube malposition
 
Aspiration
 
Nausea and vomiting
 
Diarrhea
 
Constipation
 
Malabsorption/maldigestion  
Refeeding syndrome The metabolic cascade of events that takes place when a malnourished patient is refed.

Adapted from www.rxkinetics.com, www.medscape.com, and other sources.

Updated on: Apr. 18, 2013

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