| (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.) After Lung Transplant Three cases have been reported in women following lung transplantation for CF who became pregnant 22 months after transplantation at a mean age of 27 with two live premature deliveries of infants both requiring ventilation but going on to do well. Both pregnancies were complicated but neither experienced rejection and pulmonary function is adequate 15 months after delivery. One woman with chronic rejection prior to conception was terminated at 16 weeks. It is recommended that pregnancy be delayed for at least 2 years after transplantation and that rejection and infection are treated conventionally with little to indicate increased risk of pregnancy induced rejection, organ failure, or drug induced fetal anomalies. Click thorax.bmjjournals.com/cgi/content/full/56/8/649 to view the article in entirety. (Of 8 post-transplant pregnancies followed�)Five recipients had drug-treated hypertension before and during pregnancy. Recipient 1 reported infections during her pregnancy, which included an upper respiratory infection, Pneumocystis carinii pneumonia at 5 months, and Aspergillus pneumonia at 7 months. All were successfully treated with antibiotics. Three women had rejection episodes during pregnancy. Two of the recipients required insulin: recipient 2 had been diagnosed with diabetes before her pregnancy, and recipient 1 required insulin secondary to high-dose steroids during treatment of pneumonia. Of the 8 recipients, all reported some complication during pregnancy, including shortness of breath, rejection, and infection. Recipient 8 received a lung transplant at age 21 for cystic fibrosis and became pregnant 1.2 years after her transplant. No prepregnancy rejections were reported. She experienced decreased lung function during pregnancy, and a biopsy revealed grade II rejection, which was treated with methylprednisolone. She gave birth to a live female (see child 4 outcomes). Her lung function remained reduced, and obliterative bronchiolitis was diagnosed 1 year after delivery (and she died approx. 6 months later--ed.). Three (of the 4) neonates experienced complications of prematurity, including low birth weight and hyaline membrane disease. The follow-up for these 4 children, at ages ranging from 1.7 years to 3.4 years, showed that all were developing well, with no residual problems. Lung transplantation can restore patients�to a normal and active life, including the potential for fertility and pregnancy. As reported for other types of organ recipients, female lung recipients have a high incidence of premature and low birth weight newborns. However, in contrast to other recipient populations reported, there appear to be both more significant and a greater incidence of complications reported by female lung recipients. All 3 recipients who reported rejection during pregnancy continued to have decreased graft function after delivery or after termination of their pregnancies, and they subsequently died. Analyses of larger numbers of cases may help to identify prepregnancy factors that are predictive of adverse outcomes. (Only two of these women had CF--ed.) Click www.medscape.com/viewarticle/409284 to view the article in entirety. The worldwide experience of pregnancy after lung or heart-lung transplantation is limited, with a suggested worse outcome compared to other solid organ transplantation. Click www.chestjournal.org/cgi/content/full/118/1/85 to view the article in entirety. Colonization with B. cepacia, MRSA, and Stenotrophomonas maltophilia B. cepacia is associated with unpredictable rapid decline. The published UK experience is of three terminations and three premature deliveries, including a woman who required nasal ventilation and parenteral nutrition during pregnancy and died 10 days after delivery. There is currently no consensus on advising patients infected with this organism, but these data suggest a very real risk and it has been suggested that colonisation with B. cepacia is a relative contraindication. The position regarding multiresistant P. aeruginosa is moot. Other multiresistant organisms including methicillin resistant Staphylococcus aureus (MRSA) and Stenotrophomonas maltophilia seem unlikely to be of concern. Click thorax.bmjjournals.com/cgi/content/full/56/8/649 to view the article in entirety. Better outcomes were seen for those who were negative for B cepacia (n = 36) than for those who were positive for B cepacia. Click www.chestjournal.org/cgi/content/full/118/1/85 to view the article in entirety. Diabetes Poorly controlled diabetes has been associated with an increased rate of fetal cardiovascular, renal, and neural tube defects. In particular double outlet right ventricle , truncus arteriosus, and caudal regression syndrome are seen with higher frequency than expected. Click www.perinatology.com/exposures/Maternal/endocrinology.htm#Diabetes to view the article in entirety. Of infants born to mothers with prepregnancy diabetes, two of three were preterm with low birth weight. One child of a mother with gestational diabetes was small for the gestational age. The prevalence of gestational diabetes was 14% (7 of 49 patients), which is higher than in the general population and is consistent with the high prevalence of diabetes mellitus in the adult CF population. Screening for diabetes is recommended at 20 weeks� gestation. Click www.chestjournal.org/cgi/content/full/118/1/85 to view the article in entirety. Until fairly recently, pregnancy was risky for women with diabetes. Fortunately, today with good medical care and rigorous self-management, most women with diabetes have a successful pregnancy and a healthy baby - provided that they pay close attention to glucose levels and work hard to keep them as close to normal as possible. Click www.lifeclinic.com/focus/diabetes/pregnancy_main.asp to view article in entirety. H. pylori & Hyperemesis of Pregnancy (HG) H. pylori infection may be an important factor in exacerbating HG (hyperemesis gravidarum), [but] it may not represent the sole cause of the disease. Click www.medscimonit.com/pub/vol_9/no_1/3315.pdf#search='h%20pylori%20pregnancy' to view the article in entirety. |
| back to Pregnancy |
| Excepts from various sources detailing the issues of preexisting or complicating conditions for people with CF |
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| And Sarah said, "God has made me laugh, so that all who hear will laugh with me." She also said, "Who would have said to Abraham that Sarah would nurse children? For I have borne him a son in his old age." Genesis 21:6-7 |