Cystic fibrosis in pregnancy

Pregnancy after Lung Transplant

The purpose of this study was to analyze pregnancy outcomes in female lung transplant recipients. Data were collected from the National Transplantation Pregnancy Registry via questionnaires, interviews, and hospital records. Twenty-one female lung recipients reported 30 pregnancies with 32 outcomes (1 triplet pregnancy). Outcomes included 18 live births, 5 therapeutic abortions, and 9 spontaneous abortions. No stillbirths or ectopic pregnancies were reported. Mean (SD) interval from transplant to conception was 3.6 (3.3) years (range, 0.1–11.3 years). Comorbid conditions during pregnancy included hypertension in 16, infections in 7, diabetes in 7, preeclampsia in 1, and rejection in 5 women. Ten of the 21 recipients received a transplant because of cystic fibrosis and accounted for 12 pregnancy outcomes (7 live births, 3 spontaneous abortions, and 2 therapeutic abortions). At last recipient contact, 13 had adequate function, 2 had reduced function, 5 recipients had died (2 with cystic fibrosis), and 1 recipient had a nonfunctioning transplant. Mean gestational age of the newborn was 33.9 (SD, 5.2) weeks, and 11 were born preterm (<37 weeks). Mean birthweight was 2206 (SD, 936) g and 11 were low birthweight (<2500 g). Two neonatal deaths were associated with a triplet pregnancy; one fetus spontaneously aborted at 14 weeks and 2 died after preterm birth at 22 weeks. At last follow-up, all 16 surviving children were reported healthy and developing well. Successful pregnancy is possible after lung transplant, even among recipients with a diagnosis of cystic fibrosis.

Caesarean section in a patient with cystic fibrosis

Severely impaired pulmonary function due to cystic fibrosis is associated with a poor pregnancy outcome. A 19-year-old primigravida with cystic fibrosis had a forced expiratory volume in one second 34% of predicted and a low body mass index of 17.1 kg/m(2) before pregnancy. During pregnancy she required several admissions to hospital for deteriorating pulmonary function due to infection. She also developed gestational diabetes and required overnight feeding via a gastrostomy tube throughout pregnancy to improve her nutritional status. With close medical attention, pulmonary function tests remained stable. A joint decision was made to deliver the baby by caesarean section at 33 weeks' gestation as this was considered optimal time for mother and baby and to avoid potential catastrophic pulmonary deterioration later in pregnancy. A combined spinal-epidural technique provided adequate anaesthesia. Pulmonary function tests were performed in theatre before and after the spinal injection, as well as two and five hours postoperatively. Despite a spinal anaesthetic block to T5 bilaterally, lung function tests remained stable. An epidural infusion provided good postoperative analgesia. The outcome was successful for mother and fetus.

Fertility issues in cystic fibrosis

With increasing survival in cystic fibrosis (CF) there is an increasing need to deal with the desires of CF patients to become parents. In the context of 98% male infertility in CF, new techniques offer the prospect of successful parenthood. For females, successful pregnancy is possible but careful planning is required. The practical and ethical aspects of reproductive health in CF are discussed.

Cystic fibrosis and pregnancy. Report from French data (1980-1999)

OBJECTIVE

To study the consequences of pregnancy on women affected by cystic fibrosis and to clarify the impact of the disease on maternal and newborn health.

DESIGN

Retrospective study.

SETTING

Pregnancy survey from the French Cystic Fibrosis Registry.

POPULATION

Women with cystic fibrosis having a pregnancy between 1980 and 1999.

METHODS

During the 1980-1999 period, 90 pregnancies in 80 French female patients were registered in the pregnancy survey of the French Cystic Fibrosis Registry. General and clinical data before pregnancy were noted. Outcome of the pregnancy was described. Variations of pulmonary function and body weight during pregnancy were evaluated. Comparison between a group of pregnant women and a group of non-pregnant cystic fibrotic women of same age and genotype, followed in the same care centre network, was made.

MAIN OUTCOME MEASURES

Spirometric and nutritional parameters, vital status and perinatal health indicators.

RESULTS

The outcome was identified for 75 cases: 64 delivered babies (45 at term and 10 prematurely, prematurity rate: 18%), 10 abortions (five spontaneous and five therapeutic or medical), and one maternal death during pregnancy. The proportion of newborns with low weight was 29.8%. Mean maternal weight gain during pregnancy was 5.5 kg. Four affected children were diagnosed after birth. A decline in the forced expiratory volume in one second (FEV1) and forced vital capacity was observed between the beginning of pregnancy and the year following the delivery. However, no significant difference was found when comparing the variation in the pulmonary function during pregnancy between cases and controls. Moreover, the pulmonary status before pregnancy was better than the status of non-pregnant women. Among 12 deaths recorded after pregnancy, only three happened in the year following the pregnancy. All three women had an FEV1 < 50% before pregnancy.

CONCLUSION

Pregnancy only has a slight adverse effect on maternal health if the women are in good general condition before starting pregnancy. Women with a better health status are more inclined to initiate and successfully complete a pregnancy. Complete collaboration between cystic fibrosis practitioners and obstetricians should be observed to allow women to deliver children in the best conditions.

The outcome of 72 pregnancies in 55 women with cystic fibrosis in the United Kingdom 1977-1996

OBJECTIVE

To identify pregnancies in women with cystic fibrosis and describe obstetric, infant and maternal medical outcomes in relation to the severity of maternal disease.

DESIGN

Retrospective study, based on casenotes.

SETTING

Eleven cystic fibrosis centres in the United Kingdom.

POPULATION

Pregnant women with cystic fibrosis.

METHODS

Single observer medical and obstetric casenote review categorising maternal cystic fibrosis (e.g. genotype, pancreatic, hepatic and diabetic status) and pre-pregnant severity (e.g. weight and lung function) and noting fetal outcome and maternal morbidity.

MAIN OUTCOME MEASURES

Completed pregnancies and pregnancy losses, fetal outcome and complications, maternal morbidity, such as changes in weight, lung function, pulmonary infections during and after pregnancy. Relation of outcomes to severity of maternal cystic fibrosis.

RESULTS

From 72 pregnancies identified, the outcomes were known for 69; there were 48 live births (70%) of which 22 were premature (46%); 14 therapeutic abortions (20%); and 7 miscarriages (10%). There were no stillbirths, neonatal or early maternal deaths. Three major fetal anomalies were seen, but no infant had cystic fibrosis. At the conclusion of our study three pregnancies were still continuing. Prematurity with increased fetal complications and maternal morbidity with infection, declining lung function and poor weight gain were associated with poor pre-partum lung function.

CONCLUSION

Pregnancy occurs in women with cystic fibrosis of all degrees of severity. Outcomes for the infant are generally good but are variable for the mother. Predicting outcome on the basis of maternal severity is difficult but lung function appears to be the most significant determining factor. Pregnancy may be normal in women with normal lung function (forced expiratory volume > 80%). However, it may adversely affect mild and moderate lung disease due to cystic fibrosis and should be avoided in pulmonary hypertension, cor pulmonale and when forced expiratory volume < 50% predicted. Ideally, all pregnancies should be planned with prior counselling and monitored by dedicated cystic fibrosis teams, including obstetricians who are experienced in managing high risk pregnancies.