Dr Maleeka Ladhani1,2, A/Prof Judith Morton3, Ms Tina Bode4, Dr Peter Muller4, Dr Laura Slade4, Dr Emily Hopkins3, Dr Sally Chapman2,3, Dr Mark Morton5
1Dept of Renal Medicine, Lyell McEwin Hospital, Elizabeth Vale, Australia, 2University of Adelaide, Adelaide, Australia, 3Department of Respiratory and Sleep Medicine, Royal Adelaide Hospital, Adelaide, Australia, 4Department of Maternal Fetal Medicine, Women’s and Children’s Hospital, North Adelaide, Australia, 5Department of Obstetric Medicine, Women’s and Children’s Hospital, North Adelaide, Adelaide
Biography:
Dr Ladhani is a nephrologist practicing at Lyell McEwin Hospital. As part of her endeavour to empower women and provide patient centred care in the north she completed a Fellow year at the Women's and Children's Hospital to train in Obstetric Medicine.
Abstract:
Background: Pregnancy with cystic fibrosis (CF) prior to CFTR (CF transmembrane regulator) modulator availability was more difficult to achieve and higher risk. Numbers of pregnancies with the advent of CFTR modulator therapy are increasing.
Methods: We describe a retrospective cohort of pregnant women with CF from 2014 to 2023, managed through the Women’s and Children’s and Royal Adelaide Hospitals in South Australia.
Results: There was a total of 31 pregnancies in 22 women. The mean age was 28 years, mean BMI was 23.0kg/m2 and the mean baseline FEV1 was 71.4%. Of the 31 pregnancies, 23 delivered live infants, 4 had terminations of pregnancy, 2 were miscarriages with 2 pregnancies continuing at study end. Eight women were delta F508 homozygotes and had 12 pregnancies. Most of the pregnancies occurred later with 12 pregnancies in the 2014-2018 period and 19 in the 2019-2023 period. CFTR modulator therapy was continued (or ceased then restarted) in 11 pregnancies, all of which were in the 2019-2023 time period. Twelve pregnancies required 26 hospital admissions (not including delivery), 15 of which were for respiratory causes. Additionally, each woman had a mean of 18.1 outpatient health encounters, largely with respiratory health services (8.6) followed by maternal fetal medicine (6) and obstetric physicians (3.5). The difference in FEV1 change related to CFTR modulator therapy (baseline to end of pregnancy) was not significant at -1%(95%CI -6.9 to 4.9%) for those on treatment compared with -4%(95%CI -15.1 to 7.1%) for those not on treatment. Women delivered at a mean gestational age of 36+6 days and the average birthweight was 2.87kg. The median length of stay for delivery was 4.5 days.
Conclusion: People with CF can have positive maternal and fetal outcomes however require significant health resources. Further research into the effect of CFTR modulator therapy on outcomes is required.
Keywords
cystic fibrosis, pregnancy, outcomes