Chest
Clinical Investigations: Cystic FibrosisPregnancy in Cystic Fibrosis: Fetal and Maternal Outcome
Section snippets
Materials and Methods
All women with CF who attended the CF program from 1960 to 1998 at the Hospital for Sick Children or at St. Michael's/Wellesley Hospital (from 1992) were eligible for the study. Demographic and clinical follow-up data were abstracted from the patient database. In general, patients were seen one to four times per year, and the following pertinent data were recorded: height; weight; pancreatic function; and pulmonary function, as assessed by spirometry.11 Information on gestational age, birth
Statistical Analysis
Pregnancies with gestational lengths of > 26 weeks were included in the statistical analysis.
Data were presented as mean ± SD or median with range, as appropriate. Paired data (pre- and postpregnancy) were analyzed using a two-tailed t test. Subgroups were compared using a two-tailed t test or the Mann-Whitney test. The significance level was set at p ≤ 0.05.
Kaplan-Meier estimates of survival were computed, using data from the first completed pregnancy for each woman. Survival was determined
Outcomes of Pregnancies
For prepregnancy characteristics see Table 1.
From 1963 to 1998, there were 92 pregnancies in 54 women, with 74 births in 49 women (range, 1 to 3 births [no multiple births]). There were 11 miscarriages and 7 medical terminations. Terminations were for psychosocial reasons in three patients and poor health in four patients (PS, 1 patient; PI, 3 patients). In the latter group, one patient carried a pregnancy to term 4 years later, but she deteriorated during and after the pregnancy and died 4
Discussion
The fetal outcome was good for this population, with a mean gestational age and birth weight comparable to data for Ontario from 1973 to 1993.12 A higher percentage of pregnancies resulting in live births in women < 25 years of age was seen compared with the whole Ontario population (42% vs 32%, respectively).12 The number of infants who were small for gestational age did not substantially differ from the numbers reported for Canada.16 Hilman et al7 reported a higher percentage of preterm
Conclusion
Pregnancy was well-tolerated in our population of CF women. Most patients carrying a pregnancy to term had mild to moderate disease. The risk factors for deteriorating health and early death after pregnancy are the same as for the whole adult female CF population, with the presence of B cepacia being the most important risk factor for early death. Pregnancy did not affect the rate of yearly decline in FEV1. Follow-up studies of pregnant women with poor lung function and of women with diabetes
ACKNOWLEDGMENT
The authors thank Anna Tsang and Sandi Peroff for their assistance in contacting patients, and the Ottawa CF clinics for follow-up information.
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2020, Journal of Cystic FibrosisCitation Excerpt :Compared to the general non-CF population, pregnancy in CF is associated with an increased risk of perinatal complications including maternal deterioration, preterm labor, low birth weight, Caesarian delivery, respiratory failure, and death, with most studies showing higher risks in those with ACFLD [93-95]. The associated maternal complications may be a function of the lung disease itself, as outcomes in pregnant women with CF do not appear to differ from outcomes in non-pregnant women with CF who have similar lung disease characteristics [96-99]. International guidelines regarding pregnancy in CF note that pregnancy can occur regardless of severity of pulmonary disease, with outcomes (for mother and infant) being closely linked to lung function and stability.
Supported in part by the Canadian Cystic Fibrosis Foundation (M.G.).