The outcome of pregnancies in women with cystic fibrosis—single centre experience 1998–2011

Abstract

Objective To describe the maternal and fetal outcomes of pregnancies in women with cystic fibrosis.Design Retrospective study.Setting Single obstetric hospital and adult cystic fibrosis centre.Methods Retrospective case-note review of pregnant women with cystic fibrosis referred for antenatal care and delivery.Main outcome measures Maternal and fetal outcomes, mode of delivery, lung function and pregnancy complications.Results Forty-eight pregnancies were studied in 41 women. There were two miscarriages, 44 singleton pregnancies and two sets of twins. All babies were liveborn and survived. The mean gestational age at delivery was 35.9 ± 3.3 weeks. There were no fetal abnormalities or terminations of pregnancy. The median birthweight centile was 31.9 (interquartile range 14.9-55.6). Twentyfive (52.1%) of the women had pancreatic insufficiency and 17 (35.4%) required insulin. There was a positive correlation between booking predicted forced expiratory volume in 1 second (FEV 1 ) and gestational age at delivery (P < 0.01). Women with FEV 1 60% were more likely to deliver earlier and by caesarean section compared with women with FEV 1 >60% (35.0 ± 3.2 weeks versus 37.1 ± 3.0 weeks; P = 0.02 and 75.0% versus 25.0%; P = 0.01). Three of the seven women with an FEV 1 <40% died within 18 months of delivery. Four of the eight women with FEV 1 40-50% died between 2 and 8 years after delivery.Conclusion Pregnancy for women with cystic fibrosis is possible and results in favourable maternal and fetal outcomes, but the incidence of preterm delivery and caesarean section is increased. Women with pre-existing poor lung function should be counselled antenatally to ensure that they understand the implications of their shortened life-expectancy and parenthood.

Pregnancy outcomes in cystic fibrosis: a 10-year experience from a UK centre

“…21 We reported high rates of preterm (46.7%) and CS (46.15%) deliveries. This is in keeping with data from most other studies, 11,12 although differs from a recent report from Burden et al 21 of 100% vaginal deliveries, reflecting the multifactorial indications for CS.…”

“…8 Poor lung function is commonly cited as the most significant single predictor of maternal morbidity, prematurity and fetal complications. [11][12][13][14][15][16][17][18][19][20] Pregnancy is not recommended in significant lung disease (forced expiratory volume in one second (FEV1) 550% predicted) with a low body mass index (BMI), whilst cor pulmonale and pulmonary hypertension are considered absolute contraindications. 6,8,11 Current understanding and antenatal counseling is limited by a paucity of published series.…”

Pregnancy and cystic fibrosis: Approach to contemporary management

“…18,22,23,28,29 Increased rates of low birth weight (52.5 kg) have been reported in some studies but not all. 18,22,23,28 For most infants, Apgar scores will be normal, 29 rates of congenital malformations do not appear to be increased and perinatal death is rare.…”

“…18,22,23,28 For most infants, Apgar scores will be normal, 29 rates of congenital malformations do not appear to be increased and perinatal death is rare. 12,18,22,23,28,29 Short-term neurological and cognitive development appears to be normal, although subtle sequelae of CF pregnancy on the child have not been comprehensively studied to date. 22 …”

Nutrition for Pregnant Women Who Have Cystic Fibrosis

“…Case reports and epidemiological studies showed that the A. OVERVIEW OF NUTRITION AND DIETS IN CYSTIC FIBROSIS long-term outcome of women with CF who become pregnant was not worse than that of CF women who did not become pregnant [2,[10][11][12][13][14][15]. Case reports and epidemiological studies showed that the A. OVERVIEW OF NUTRITION AND DIETS IN CYSTIC FIBROSIS long-term outcome of women with CF who become pregnant was not worse than that of CF women who did not become pregnant [2,[10][11][12][13][14][15].…”