Having a baby despite Cystic Fibrosis

Ερώτηση

Hello dear experts,

I am 25 years old and have Cystic Fibrosis. Currently, I live together with my boyfriend and our little dog, but we would like to expand our family somewhen.

I find it very difficult to find out in which way a pregnancy would have an effect on me and the course of the disease and which possibilities for treatment with medicaments exist during the pregnancy.

Currently, I am taking pancreatic enzymes, Dornase alpha, NaCl, Ipratropiumbromide, Salbutamol, Acetylcystein and several vitamins. Infections are usually treated with Ciprofloxacin in my case.

How is an infection treated during the pregnancy? And finally, how can I prepare myself in the best possible way for the pregnancy?

Many greetings and thank you for your effort,
Tonja & Sven

Απάντηση

Dear Tonja,
Dear Sven,

It is very good to deal with these questions at an early stage and to be prepared – as much as possible – for your family planning. Regarding your question how you can prepare yourself in the best possible way for the pregnancy I like to recommend you make use of three consulting talks together with your boyfriend:

- with the CF doctor of a/of your CF adult ambulance
- with a gynecologist you trust
- with the Human Genetics department (at a university hospital)

It is not possible to give a really personalized advice over the internet. For that, a personal conversation, the knowledge of relevant findings, and the current medication are required among others. However, I like to give you some general answers to your questions:

1) You ask which effect a pregnancy could have on the course of the disease. Generally speaking it always depends on the general condition, the weight, the lung function and existing accompanying diseases of the CF patient if she becomes pregnant and can carry a child to term. In general, CF women with a good lung function and a good weight have less problems in fulfilling their desire for having a child and carrying a child to term. However, when a CF patient becomes pregnant this always has to be considered being a high-risk pregnancy.

2) You like to know how the medical treatment could look like during the pregnancy.
During the pregnancy efforts are made to reduce the therapy to an essential minimum and in each single case the medical therapy has to be adjusted to the patient's needs. Especially the use of antibiotics (in tablet form or intravenously) has to (and also can) be adjusted accordingly (e.g. as a rule, one would have to avoid Ciprofloxacin). Inhalative antibiotics are no problem. According to the SMPC [Summary of medicinal product characteristics] of Dornase alpha and Acetylcystein it has not been proven that using these drugs during pregnancy is harmless. Studies based on animal tests do not suggest direct or indirect untoward effects on the pregnancy or embryonic/fetal development. When using Dornase alpha during pregnancy caution is needed. It is disadvised to take Acetylcystein during pregnancy.
Salbutamol and/or Ipratropiumbromide is used during the first three months and at the end of the pregnancy with extraordinary caution. For pancreatic enzymes there is no sufficient data available either concerning the harmless usage during pregnancy or lactation , however for patients with exocrine pancreatic insufficiency (like in Cystic Fibrosis) it is allowed.

3) You ask how infections during pregnancy can be treated. Let me say that the treatment does not differ much from the therapy you already know. However, in every single case it has to be decided very carefully which drug can be taken while bearing the pregnancy in mind.

I wish you all the best!

Many kind regards,
Dr. C. Smaczny

08.07.2008