Background: Advancement in medical care for patients with CF has led to an increased life expectancy for the CF population. A growing number of women with CF are reaching reproductive age and having successful pregnancies. There are increased risks associated with pregnancy in this population, and concern remains regarding the effect that pregnancy in the woman with CF may have on maternal and infant health.
Objectives: To determine the relationship between CF disease and maternal and infant outcomes and describe the nutritional interventions provided to women with CF during pregnancy.
Methods: Retrospective chart review including all women with CF who had successful pregnancies between 1996 and 2011 who still attended the CF Center at a Midwestern Hospital. Measures collected include age, BMI, FEV1, weight gain during pregnancy, pre-existing CFRD, diagnosis of gestational diabetes, hospitalizations during pregnancy, need for IV antibiotic therapy, type of delivery, infant weight, gestational age, decision to breastfeed infant, and nutrition topics discussed during counseling with the CF dietitian.
Results: Eighteen women in the study had 23 successful pregnancies. Mean pre-pregnancy BMI was 20.6kg/m2 with a mean weight gain of 26.2lbs during pregnancy. Mean FEV1 was 81.7% for the 12 months prior to pregnancy. Pre-pregnancy weight and FEV1 were shown to be strong predictors of weight and FEV1 status postpartum. Women with pre-pregnancy FEV1 greater than 60% experienced significantly greater weight gain during pregnancy than women with pre-pregnancy FEV1 <60%.Women who gained at least 25lbs during pregnancy were shown to have significantly greater FEV1 measures before, during, and after pregnancy, compared to women who gained less. Women with a BMI <22 had mean increase in BMI of 0.5 after pregnancy, compared to women with an initial BMI >22 who experienced a mean decrease in BMI of 1.5. Infant weight and gestational age did not differ based on maternal factors, however there was a 40% rate of premature births, and 30% rate of low birth weight infants in this study.
Conclusions: Maternal and infant outcomes are positive for most women with cystic fibrosis who have sub-optimal body max index. Pre-pregnancy maternal BMI and FEV1 remain strong predictors of these measures 6 months after delivery. Women with milder pulmonary disease may be more successful in gaining the recommended amount of weight during pregnancy, however all women are likely to return to their pre-pregnancy BMI status. Women with CF who chose to breastfeed are likely able to return to and maintain their pre-pregnancy BMI just as successfully as women who do not breastfeed. There is much variability in the health outcomes during pregnancy regardless of weight and pulmonary status, suggesting that all women with CF remain at risk for adverse health outcomes due to pregnancy and should be monitored closely and frequently during this time. Nutrition interventions to promote adequate weight gain and overall optimal nutritional status for pregnancy should begin in the prenatal period, and continue throughout the patient’s pregnancy.