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Pregnancy in Cystic Fibrosis^*

Fetal and Maternal Outcome

Marita Gilljam, MD; Maria Antoniou, MD; Janey Shin, MSc; Annie Dupuis, MSc; Mary Corey, PhD and D. Elizabeth Tullis, MD, FCCP

^* From the Department of Respiratory Medicine and Allergology (Dr. Gilljam), Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden; Adult Cystic Fibrosis Program (Drs. Antoniou and Tullis), St. Michael’s Hospital, Department of Medicine, University of Toronto, Toronto, Canada; and Department of Public Health Sciences (Mss. Shin and Dupuis and Dr. Corey), University of Toronto and Research Institute, Hospital for Sick Children, Toronto, Canada. At the time of the study, Dr. Gilljam was a clinical fellow at the Adult Cystic Fibrosis Program, St. Michael’s Hospital, Toronto, Canada, where the study was undertaken.

Correspondence to: D. Elizabeth Tullis, MD, FCCP, Room 6–045, Bond Wing, St. Michael’s Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8 Canada; e-mail: tullise{at}smh.toronto.on.ca

Objective: To assess the effect of pregnancy on pulmonary function and survival in women with cystic fibrosis (CF) and to assess the fetal outcome.

Design: Cohort study. The data analyzed were collected from the Toronto CF database, chart review, and patient questionnaire.

Setting: Tertiary-care center.

Patients: All women with CF who, at the time of diagnosis or pregnancy, attended the Toronto Cystic Fibrosis Clinics between 1961 and 1998.

Results: From 1963 to 1998, there were 92 pregnancies in 54 women. There were 11 miscarriages and 7 therapeutic abortions. Forty-nine women gave birth to 74 children. The mean follow-up time was 11 ± 8 years. One patient was lost to follow-up shortly after delivery, and one was lost after 12 years. The overall mortality rate was 19% (9 of 48 patients). Absence of Burkholderia cepacia (p < 0.001), pancreatic sufficiency (p = 0.01), and prepregnancy FEV₁ > 50% predicted (p = 0.03) were associated with better survival rates. When adjusted for the same parameters, pregnancy did not affect survival compared to the entire adult female CF population. The decline in FEV₁ was comparable to that in the total CF population. Three women had diabetes mellitus, and seven developed gestational diabetes. There were six preterm infants and one neonatal death. CF was diagnosed in two children.

Conclusions: The maternal and fetal outcome is good for most women with CF. Risk factors for mortality are similar to those for the nonpregnant CF population. Pregnancies should be planned so that there is opportunity for counseling and optimization of the medical condition. Good communication between the CF team and the obstetrician is important.

Key Words: cystic fibrosis • diabetes mellitus • fertility • outcome • pregnancy

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