| (There is a large difference between having a high-risk pregnancy and having a high-risk birth. You need not necessarily be treated for one simply because you have the other and CF alone is NOT a reason for being regarded as high-risk--ed.) Even after adjusting for differences in various prognostic indices, pregnant women have longer survival than non-pregnant women. Overall the data show no decreased survival following pregnancy. Maternal health post-partum is directly related to nutritional status during pregnancy. Click www.cysticfibrosismedicine.com/htmldocs/CFText/pregnancy.htm to view the article in entirety. Women with good lung health usually have no problems with pregnancy, while those with ongoing lung infection often do poorly. Click www.healthatoz.com/healthatoz/Atoz/ency/cystic_fibrosis.jsp to view the article in entirety. Cystic fibrosis, in all degrees of severity, is not a strict contraindication for pregnancy, especially if disease is mild; pregnancy by itself does not appear to adversely affect patients with CF. Pregnancy could proceed normally in women with normal lung function, but could adversely affect mild and moderate lung disease due to CF and should be avoided when patients have pulmonary hypertension or cor pulmonale, and when reduced lung function is predicted. Ideally, all pregnancies should be planned with prior counseling and be monitored by dedicated CF teams. http://pediatrics.aappublications.org/cgi/content/abstract/67/5/664 Weight gain in normal pregnancy is in the order of 10-12 kg and requires up to 300 kcal/day in addition to the recommended daily requirements. Hormonal and mechanical factors increase the prevalence of dyspepsia, reflux, nausea and vomiting, while gut transit time is reduced and constipation is common. They suggested that the rate of decline of lung function may be more important as a prognostic indicator than absolute values Ahmed�compared 13 cases with age and %FVC matched controls, with no differences between groups with respect to genotype, pancreatic status, diabetic status, BMI, or sputum microbiology before pregnancy and found no difference in the change in %FVC, %FEV1, %FEF25-75 or peak flow at 1 or 2 years after delivery. The authors concluded that certain individuals were adversely affected by pregnancy. Frangolias�matched seven patients for age, height, weight, lung function, and sputum bacteriology. The pregnant group had a significant decrease in both %FEV1 and %FVC during pregnancy but the rate of decline was equal to the controls at 1 and 2 years thereafter and hospitalisation rates were similar. In a study from the UK�55 women were matched for age�and best recorded %FEV1� in the 3 months before conception. There were no differences in age at diagnosis of CF, genotype, prevalence of pancreatic insufficiency, liver disease, diabetes mellitus, or prepregnant age, sputum microbiology or BMI (body mass index). As a group, the women who were pregnant showed no significant changes in lung function during pregnancy or in lung function or weight afterwards. Those delivering prematurely (<37 weeks)�experienced a significant loss of lung function. The group delivering prematurely differed from those delivering at term only in having a significantly reduced prepregnant lung function. These data confirm lung function to be the most significant predictor of pregnancy outcome and suggest that pregnancy may directly affect women with poor lung function, leading to a further decline which impacts on long term prognosis. Conversely, those with good lung function were unaffected by pregnancy. 1990�North American CF Foundation database. At 1 year before pregnancy they (the women) were matched with up to four controls for age, %FEV1, and weight percentile. Preliminary data were presented in 1996 on 258 women who had live births compared with 889 controls, and 67 women who had therapeutic termination with 253 controls. No differences were noted between cases and controls in rates of decline of %FEV1, nor in the frequency of haemoptysis, pneumothorax, infective exacerbations during pregnancy or during the subsequent 2 years. Pregnancy was not an independent risk factor for survival, which was equal in cases and controls but was worse for those with poor lung function, low body weight, or diabetes in both cases and controls. Similar results were found by a retrospective cohort analysis of all women who had pregnancies since 1961 compared with women who had not been pregnant in the Toronto clinic. Pancreatic insufficiency, Burkholderia cepacia colonisation, and poor pulmonary function were associated with reduced survival but, when these factors were corrected for, pregnancy had no independent effect on survival. Pregnancy outcomes were excellent in this group. Click http://thorax/bmjjournals/cgi/content/full/56/8/649 to view the article in entirety. Pulmonary function impairment has been suggested as the most important predictor of maternal and fetal outcome. Other factors that may affect long-term survival are nutritional status, the existence of diabetes mellitus, the presence of Burkholderia cepacia, and frequent infectious exacerbations. Five infants had immediate but not serious medical problems, two requiring an incubator, one who was small for gestational age, one with transient respiratory problems, and one with hypoglycemia. There was a significant decrease in FEV1 from a mean of 68% of predicted before pregnancy to 65% of predicted after delivery. The calculated yearly rate of decline in FEV1 was 1.6% predicted per year, which is comparable to the rate of decline in the whole CF population attending the Toronto clinics. The average BMI before pregnancy was 21 � 2.6, which was not different from the average BMI after pregnancy. Prior to pregnancy, three women had diabetes mellitus requiring insulin, and seven women developed gestational diabetes, with five requiring insulin. 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. A higher percentage of pregnancies resulting in live births in women < 25 years of age was seen compared with the whole Ontario population. Pregnancy does not appear to have a detrimental effect on maternal health. Some women experienced their best health during pregnancy, while others described the onset of deteriorating health. This reflects the variable nature of CF, with stability over years in some patients and acute deterioration in others. Click http://www.chestjournal.org/cgi/content/full/118/1/85 to view the article in entirety. Many antibiotics have been shown to be safe during pregnancy and breastfeeding and can be used by patients with CF as required. Generally, gestation age has to be considered in choosing antibiotics, and dosage might need to be adjusted for a changed volume of distribution and clearance rate during pregnancy. Pregnancy does not appear to affect the rate of early decline of FEV1. When adjusted for the same parameters, pregnant CF patients have the same survival rates as the entire population of female patients with CF. Click http://www.cfpc.ca/cfp/2002/Mar/vol48-mar-clinical-1.asp to view the article in entirety. Preliminary results of a study in which the 258 women with CF who had babies between 1986 and 1994 were compared with matched controls (women with CF who were not pregnant) suggest that pregnancy does not afftect the rate at which pulmonary function deteriorates. Women who were doing well prior to pregnancy continued to do well after childbirth. However, all women who had poor pulmonary function at the start of the study, regardless of pregnancy status, had faster progression of disease. (Fiel SB. Pulmonary function during pregnancy in cystic fibrosis: implications for counseling. Curr Opin Pulm Med. 1996;2:462-465) Safety of Medications in Pregnancy Click http://www.perinatology.com/exposures/druglist.htm to view medication list in entirety. Suggested Reading and Resources The Naturally Healthy Pregnancy by Shonda Parker The Pregnancy Book by Dr. and Mrs. Sears The Home Court Advantage and The Home Birth Advantage by Mayer Eisenstein, M.D. Most Midwives, Chiropracters and Doctors of Osteopathy are knowledgeable about how to have a naturally healthy pregnancy and avoid the need for prescription drugs--ed. Bradley Method Childbirth Classes - These classes are recommended to take early in pregnancy as they stress not only knowledge for birth but prenatal nutrition. The earlier you can go, the more time you will have to practice relaxation and learning to communicate your needs to your birth partner and your attendants. www.bradleybirth.com La Leche League International - Whether or not you are considering breastfeeding your baby, during your pregnancy is a great time to go to some LLL meetings. You can get practical information for mothering as well as see mothers breastfeeding and begin buildnig a support network, which is of infinite advantage to the success of your own mothering experience. LLL meetings can also benefit Dads, as they are their wives primary source of support and decision making assistance. www.llli.org Homefirst - Practicing scientifically sound medicine, Homefirst is physician run and has a wealth of information and resources for making healthy decisions for your family regarding pregnancy, birth and breastfeeding. They have a 94% success rate for home birth without complication and an 87% success rate for home birth after cesarean (HBAC). They are located in Chicago, Illinois, USA www.homefirst.com |
| Excerpts from various sources detailing the issues and safety of pregnancy for women with CF |
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| For You have formed my inward parts; You have covered me in my mother's womb. I praise You for I am fearfully and wonderfully made; Marvelous are Your works, and that my sould knows very well. My frame was not hidden from You, when I was made in secret, and skillfully wrought in the lowest parts of the earth. Your eyes saw my substance, being yet unformed. And in Your book they were all written, the days fashioned for me, when as yet there were none of them. How precious are Your thoughts to me, O God! How great is the sum of them! Psalm 139:13-17 |