Partnering With Your CF Care Team
Working closely with your cystic fibrosis care team is one of the most important things you can do to ensure the best possible outcome for both you and your baby throughout your pregnancy. This means carefully monitoring your weight, nutrition, lung function, and blood glucose to maximize the chance of a safe pregnancy and lower the risk of complications.
Because pregnancy comes with certain respiratory, cardiovascular, and metabolic changes, pregnant women with CF will be monitored more closely than women without CF. Your CF dietitian will pay close attention to your nutritional status and weight gain, and may suggest nutritional supplementation or tube feeding since common pregnancy symptoms can make it even more difficult to maintain food intake — let alone increase calorie consumption to meet the extra requirements of pregnancy. Your team will also keep a close eye on your pulmonary function, as well as consistently monitor your glucose levels and test for diabetes.
Coordinating Care With Your CF and Obstetric Teams
Many women with CF are capable of getting pregnant and having a successful pregnancy. Others may determine that, for them, the risks outweigh the benefits. To help you evaluate your options and the implications to your health, invite your care and obstetric teams to be part of the discussion, including an obstetrician (OB) who specializes in high-risk pregnancies.
This high-risk OB — also known as a Maternal-Fetal Medicine (MFM) physician — can play an active role as a member of your multidisciplinary care team and work closely alongside them to provide you with individualized care.
No two cases of CF or pregnancy are exactly alike, so making sure that your care team and OB are openly communicating with one another is crucial for keeping both you and your baby as healthy as possible throughout your pregnancy.
“Maintain good communication with your OB and CF care teams throughout your pregnancy, and request that they talk to each other, if necessary. When I was diagnosed with gestational diabetes, I occasionally felt like the 'middleman' between my CF doctor and my OB in managing how to treat it. I had to be firm with my doctors and request that they discuss the details together before they offered me their suggestions and recommendations.” — Anna Ward, adult with CF
Ideally, your OB should practice at the same hospital or facility as your CF care center. This way, your care team will be close by if you face any CF-related complications, and the proximity will make it easier for your care team and OB to maintain a line of communication.
If your obstetrician is at a different institution than your care team, keep in mind that you will need to give explicit permission to transfer your information. However, ensuring that your care team and obstetric team are working together and are aware of all your treatments and medical history is key to encouraging continuity of care.
Treatments and Medications
For the most part, it is important that you continue with your treatments and therapies as prescribed during pregnancy. However, you will first need to carefully weigh the risks and benefits of your treatment plan against the trimester of your pregnancy and your health with your CF care team and obstetrician. For example, there are some medications that you may not be able to take while pregnant, such as antibiotics or oral medications for Pseudomonas aeruginosa. In addition, talk to your care team about important considerations if you are taking CFTR modulator and are planning to get pregnant.
You and your care team will work together to review your current treatment routine and update it to account for duration, timing of treatments, choice and use of inhalation devices, physiotherapy, and exercises. Your care team will also assess your airway clearance techniques (ACTs) and work with you to adapt them to your individual needs and the trimester of your pregnancy.