CYSTIC-FIBROSIS AND PREGNANCY

The case records of 11 patients with cystic fibrosis (CF) who had 13 c ompleted pregnancies between 1975 and 1995 were retrospectively review ed to assess: (1) the changes in spirometry and body mass index (BMI) during pregnancy; and (2) maternal and neonatal complications and outc omes. Prepregnancy the mean age of the group was 24 (range 17-27) year s. Two patients were exsmokers, 7 had pancreatic insufficiency and 7 h ad chest X-ray evidence of bronchiectasis. None of the patients had di abetes mellitus but 3 developed gestational diabetes. The mean +/- SEM (% predicted) forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) prepregnancy were 2.3 +/- 1.0 (83%) litres and 3. 0 +/- 0.9 (85%) litres respectively. Five patients had normal spiromet ry (FEV1 and FVC >80% predicted) prior to 6 pregnancies. The mean body mass index (kg/height(m)(2)) for the group was 20.5 +/- 2.0. There wa s a significant decline in spirometry during pregnancy (FEV1 15.5 +/- 6.6% p<0.01; FVC 14.0 +/- 8.3% p<0.5). However, FVC but not FEV1 recov ered to prepregnancy values by 12 months postpartum. There was a signi ficant increase in both weight (7.1 kg) and BMI (2.6 kg/height(m)(2)) at the time of delivery compared with prepregnancy (p = 0.0003). Howev er, postpregnancy both weight and BMI had returned to their prepregnan cy values (p<0.2). Mothers with an FEV1 >80% had less decline in FEV1 related to pregnancy, better outcomes, fewer operative and instrumenta l deliveries, fewer preterm infants and fewer neonatal complications. Suggestions for the planning and management of pregnancy in women with CF are discussed.