Impact of pregnancy on women with cystic fibrosis

Background: Improvements in the health and survival of patients with cystic fibrosis (CF) have led to increasingly normal lifestyles, including successful pregnancies in women with CF. Concern exists among care providers about the impact of pregnancy on the health of women with CF. Study objectives: We examined data from a large longitudinal observational study, the Epidemiologic Study of Cystic Fibrosis (ESCF), to characterize health outcomes and CF-related therapies in women who became pregnant. Design: This analysis was conducted using ESCF data from 1995 to 2003. Patients: A total of 216 women, aged 15 to 38 years, who met the criteria for a qualifying pregnancy, were compared with a matched group of never-pregnant women during three time periods (ie, baseline, during pregnancy, and follow-up). Interventions: None. Results: The baseline pulmonary function (FEV1) values were 74.5% and 66.4% predicted, respectively, in the pregnant and nonpregnant women. Declines in FEV1 values of 6.8% and 4.7%, respectively, were observed from baseline to follow-up in the pregnant and nonpregnant women (p = 0.61). During pregnancy, outpatient visits were 33% more frequent compared to baseline and 62% more frequent than in the nonpregnant group (7.19 vs 4.45, respectively, visits annually). Annual rates of respiratory exacerbation and hospitalization were similar at baseline but increased during pregnancy. The prevalence of treatment for diabetes more than doubled, from 9.3% at baseline to 20.6% during pregnancy, and was 14.4% at follow-up. In contrast, 18.7% of the never-pregnant women were being treated for diabetes at baseline, rising to 25.2% at follow-up. Conclusions: These findings suggest that, over the same time period, women with CF who become pregnant experienced similar respiratory and health trends as nonpregnant women. However, pregnant women use a greater number of therapies and receive more intense monitoring of their health. These findings have implications for clinicians providing prepregnancy counseling for women with CF.