Impact of Pregnancy on Women With Cystic Fibrosis: Discussion

To further test the reliability of the differences that we observed, we examined the same variables for the 18 to 36 months before the index visit and for the 18 to 36 months following the pregnancy period in a subgroup of patients with available data (n = 83). Group differences remained similar across all five time periods of comparison, indicating a constant difference between the pregnant and control groups. Additionally, results did not change when multiple pregnancies were excluded from the analysis.
Because of improved health outcomes in patients with CF, an increasing number of affected women are interested in bearing children. Investigators have previously reported that the outcomes associated with these pregnancies include healthy infants, a slight deterioration in maternal pulmonary function, and uncompromised long-term survival. Our findings are consistent with these reports and, in addition, show a substantial increase in therapy both during and after the pregnancy in women with CF. Women with CF who become pregnant generally have better pulmonary function than women who do not become pregnant; women in the former group generally have only mild-to-moderate lung disease (average FEV1, 74.5% predicted). During the baseline period, they received more therapy than women who did not become pregnant.

This finding is perhaps related to the patients’ expressed desire to become pregnant and an associated motivation to improve and maintain their health, as well as to the clinician’s goal of maximizing lung health prior to pregnancy. In addition, women who become pregnant have a better nutritional status, and there is little evidence that fertility is reduced in healthy women with CF except by the mechanical barrier of cervical mucus plugging. These observations may also correlate with the general finding in CF care that better outcomes are associated with more aggressive therapy.
Because the ESCF is an encounter-based study, we were able to assess the use of specific therapies before, during, and after pregnancy. Despite an increase in hospital admissions during pregnancy, the use of IV antibiotics for respiratory exacerbations did not increase during this time. This suggests that hospitalizations occurred for other than respiratory indications, such as obstetric complications. The increased hospitalization rate may also indicate that the clinician is less comfortable treating the pregnant woman at home during a respiratory exacerbation. During pregnancy, there was a significant decrease in the use of both oral quinolones and inhaled dornase alfa, while inhaled antibiotic use remained constant. The decreased use of quinolone antibiotics is probably the result of pulmonologists’ concerns about the effect of these drugs on fetal cartilage development. The decreased use of dornase alfa is more difficult to rationalize. Perhaps other airway clearance therapies are being substituted. In addition, the demands of pregnancy and child rearing may reduce the patient’s adherence to routine therapies. This issue is of concern, since reduction in airway clearance could be contributing to the observed decrease in lung function associated with pregnancy.

This entry was posted in Cystic Fibrosis and tagged cystic fibrosis, Pregnancy, therapy.