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Pulmonary exacerbations worse after unplanned pregnancy

U.S. study examines the association in cystic fibrosis patients after giving birth

Among women with cystic fibrosis (CF) who experienced a pregnancy, those that were unplanned were associated with an increased frequency of pulmonary exacerbations after giving birth, according to a recent study.

Regardless of whether the pregnancy was planned or unplanned, women experienced declines in lung function after delivery compared with the pre-pregnancy period.

Some infant complications, including preterm birth, intensive care unit stays, and low scores on an infant’s health test, were more likely to occur among babies born from an unplanned pregnancy compared with planned ones. However, that analysis was not adjusted for other potentially influential factors and requires further investigation.

“As more people become pregnant and female fertility is potentially improved with highly effective CFTR modulator therapy, future studies on long-term outcomes in this population are needed to define the best approach for care,” the authors wrote.

Infertility is common in CF patients, occurring in up to 35% of women, for reasons including malnutrition, hormonal changes, or mucus buildup in the reproductive organs. But as new and effective CFTR modulator therapies have emerged, patients have better health and prolonged survival, making pregnancy in CF more possible.

Indeed, pregnancy rates among CF patients are on the rise. According to data from the CF Foundation Patient Registry (CFFPR), they almost doubled in 2o2o relative to the five years prior.

While that could be due, in part, to improved health leading to more planned conceptions, it also is possible that patients are facing fewer fertility issues, and unplanned pregnancies are coming about more often.

In the general population, unplanned pregnancies have been linked to a higher likelihood of certain adverse outcomes, including preterm labor and low infant birthweight, compared with planned ones.

Some data suggest that pulmonary exacerbations — acute bouts of worsening lung symptoms in CF — become more frequent during pregnancy, but it is not known whether these or other CF symptoms are worse for women who did not plan their pregnancy.

Analyzing pregnancy data

To learn more, the team retrospectively analyzed pregnancy data from women with CF who were seen at any of 11 adult CF centers in the U.S. Medical data were collected every three months in the year before pregnancy, during pregnancy, and in the year after delivery.

Of 226 pregnancies among 163 patients, 136 (60.2%) were planned and 90 were unplanned (39.8%) — a similar rate to those observed in the general population.

Women in the planned pregnancy group had a higher educational status and were significantly older at conception than those in the unplanned group, with a mean age of 30.9 compared with 27.6. Their health status also seemed to be better, with significantly higher lung function and higher body mass index (BMI, a measure of body fat) during the pre-pregnancy period.

Results showed that lung function declined significantly from pre- to post-pregnancy, with no differences between the planned and unplanned groups.

The number of pulmonary exacerbations was increased significantly by 26% from pre- to post-pregnancy among women with an unplanned pregnancy, whereas the exacerbation rate decreased by 16% in the planned pregnancy group — reflecting a significant difference between the two groups of women.

That difference remained even after adjusting for other potentially influential factors, including health status, insurance status, race and education.

A ‘critical’ difference

The researchers noted this difference “is critical,” given the fact that such exacerbations are associated with “more rapid lung function decline, decreased quality of life, and shortened survival.”

No significant changes in BMI were observed after pregnancy in either group.

Among patients with available infant data, babies born from unplanned pregnancies were more likely to be born preterm (earlier than 37 weeks of pregnancy), require a stay in the neonatal intensive care unit, or have a low APGAR score, a measure of a baby’s health right after birth.

Notably, those analyses were not adjusted for other potentially influential factors and thus must be taken with caution.

While more studies are still needed, “pregnancy intention may serve as a useful prognostic indicator for clinicians to identify which patients may need closer surveillance and provide more support during pregnancy and the post-partum period,” the researchers wrote.

“It is now more important than ever for clinicians to have early conversations about family planning and contraceptive use, the potential impact of unplanned pregnancy, and referral to reproductive health services in people with chronic illnesses such as CF,” the team concluded.

More detailed data on pregnancy in CF and infant outcomes are now being collected in the U.S. MAYFLOWERS study (NCT04828382), which is recruiting up to 285 women in their first trimester of pregnancy who receive regular care at any of 40 U.S. sites.



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