Start Out Right

If you are considering pregnancy, it is important to receive counseling, which your CF care team can help arrange. This will allow your obstetrician to give you advice on improving lung function and nutrition before you start trying to get pregnant. If you have CF-related diabetes (CFRD), it is important to have good control of your sugars before you become pregnant.

It is recommended that women with CF have a body mass index (BMI) of 22 or higher. A lower BMI before pregnancy is associated with more hospitalizations later and a greater need for intravenous (IV) antibiotics. If your BMI is below 18, it is important to improve your diet before you get pregnant. Your CF care team can help you with this.

Focus on Weight, Vitamins, and Minerals

There is no standard nutrition plan for women with CF who are pregnant. You must be assessed individually by your CF care team before, during, and after your pregnancy.

In general, your dietitian will follow recommendations for pregnant women without CF and modify them on the basis of your individual needs. All pregnant women are advised to:

• Avoid alcohol and caffeine.
• Monitor intake of fish that may contain high levels of mercury or other toxins.
• Increase intake of folic acid, calcium, and iron.

Normal weight gain for pregnant women without CF is between 25 and 35 pounds. Women with CF are at risk for inadequate weight gain or weight loss during pregnancy because of the increased nutritional demands. Weight is more important than pancreatic status in achieving the best outcomes for you and your baby. Therefore, if you maintain an adequate weight, you are more likely to have a successful pregnancy.

Many women are advised to drink supplements and aim for higher-calorie diets. IV feeding — called total parenteral nutrition — may be necessary if a woman has inadequate weight gain, weight loss, nausea, and vomiting. IV feeding also may be required for women who are pancreatic sufficient and develop an inflamed pancreas (pancreatitis).

If you are pancreatic insufficient, you must continue to use pancreatic enzymes with all meals, snacks, and drinks containing fat and protein. Since 2009, potentially harmful phthalates have been removed from pancreatic enzymes. No research has shown that hypromellose phthalate, which is used to coat some enzymes, is harmful.¹

Handling Complications

Constipation: This is very common for all women during pregnancy, but CF puts you at higher risk for constipation. If you notice a decrease in the number or amount of your normal stools, call your doctor. To prevent this, you can try to drink more water, eat more vegetables and fruits, and add fiber to your diet. Your CF care team may recommend the use of stool softeners or laxatives while you are pregnant.

Gestational diabetes: You will need to be closely monitored for gestational diabetes, a condition that can occur in all women. Diabetes can increase your risk for a worse outcome during pregnancy. If you already have CFRD, monitoring and controlling your blood sugars is critical. If you are taking insulin to control your diabetes, your insulin requirements may change when you are pregnant.

Vitamin A (retinol) toxicity: High levels of vitamin A, especially in the first three months of your pregnancy, can be associated with abnormal development of your baby. If you are taking extra vitamin A supplements, your obstetrician will have you stop taking them during your pregnancy. Discuss your CF vitamins with your care team and your obstetrician.

Can I Breastfeed?

You can breastfeed your baby, but it can be tiring so you may have to find a compromise that works for you and your baby. Talk to your doctor to make sure the medication you are on is safe because your baby will consume some of it during breastfeeding.

Maintaining good nutrition and hydration is important if you are breastfeeding. Women who are breastfeeding are advised to drink an extra 4 cups (1 liter) of fluid and consume 500 additional calories per day.

REFERENCES

¹ Michel, Suzanne H, Mueller, Donna H. Nutrition for pregnant women who have cystic fibrosis. Diet and Exercise in Cystic Fibrosis. San Diego, CA: Academic Press; 2015:3-10.