We noted an increase in the use of nutritional therapies during and after pregnancy. This finding is consistent with the increasing caloric needs associated with pregnancy and breastfeeding; recommendations for these therapies are supported by both obstetric and CF caregivers.
The increased frequency of CF clinic visits is likely due to the perceived need for increased monitoring of disease status as well as the need to closely monitor for complications of the pregnancy. The most frequently documented complication was the need for the management of diabetes. Almost one pregnant woman in five was treated with either insulin or an oral hypoglycemic agent during pregnancy. Click Here
The detection of diabetes during pregnancy might have been higher because of ascertainment bias; that is, women are routinely screened for diabetes during pregnancy, whereas not all CF centers routinely screen for diabetes in adolescents and adults. In this study, at least half of the women who were first identified as diabetic during pregnancy continued to require diabetes therapy following the pregnancy. Diabetes in CF patients has been associated with a higher risk of pulmonary decline, and it is appropriate to communicate these risks to a woman with CF who is contemplating pregnancy. Nonpregnant women also had an increase in the use of antidiabetic medications during the same period, although at a slightly lower rate of increase.
These analyses were limited by the available variables in the ESCF database. All women who were pregnant were alive for the 18-month follow-up period; however, long-term outcomes for these women, including survival, were not examined. Because the database did not include the date of conception, we had to estimate the actual time of pregnancy. Our use of a 1-year period was designed to ensure that we included the entire pregnancy. No data on associated infant outcomes are available from the ESCF database, and we are unable to comment on whether the mother was breastfeeding following delivery, which might represent an added nutritional burden after pregnancy.
Analyses of data from this large cohort demonstrate that women with CF can experience a pregnancy with the impact on their overall respiratory and nutritional health being similar to nonpregnant women. Pregnant women with CF will likely require increased use of various therapies and more hospitalizations, and receive more intensive monitoring of their health. In addition, these women will have an increased chance of requiring treatment for diabetes both during and after pregnancy. There is also some suggestion that, with the demands of pregnancy and motherhood, women with CF may not maintain their previous levels of adherence to maintenance therapies, which may contribute to the observed decline in lung function in this group. Recognition and communication of these realities should be a part of prepregnancy counseling for women with CF.