(123) Cystic fibrosis during pregnancy and severe maternal morbidity: Nationally representative data from 2006 to 2019

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective:
Introduction of transmembrane conductance regulator modulator therapy in 2012 revolutionized the treatment of cystic fibrosis (CF). These therapies are now used in pregnancy. We previously demonstrated that prevalence of CF in pregnancy has increased and shifted toward older age groups, however, the effect on pregnancy outcomes is understudied. Using a large, nationally representative database, we aimed to estimate the association between pregnancies affected by CF and severe maternal morbidity (SMM) during a 14-year period in the United States.

Study Design:
We conducted a serial cross-sectional analysis of delivery hospitalizations from the 2006 to 2019 National Inpatient Sample. In addition to sociodemographic data, ICD-9 and ICD-10 codes were used to capture diagnosis of CF during delivery hospitalizations, the presence of obstetric comorbidities, and the study’s primary outcome, SMM. We used survey-weighted logistic regression to generate odds ratios (OR) and 95% confidence intervals (CI) reflective of the association between CF and SMM.

Results:
Of nearly 54 million delivery hospitalizations, 4,785 occurred to patients with CF, or 8.8 cases per 100,000 deliveries. The rate of CF increased from 5.3 to 10.4 per 100,000 during the 14-year study period. Pregnancies with CF had a higher mean obstetric comorbidity index score compared to unaffected pregnancies (15.9 vs 8.6), as well as higher prevalence of diabetes (10-fold), asthma (7-fold), and gastrointestinal disease (4-fold). The rate of SMM among CF-affected deliveries was 3.4%. Mean rate of SMM among CF-affected deliveries decreased from 4.1% from 2006-2012 to 2.8% from 2013-2019. There was a two-fold increased odds of SMM for pregnancies affected by CF compared to unaffected pregnancies (OR=2.12; 95% CI: 1.50, 3.00). After adjusting for obstetric comorbidities, there remained a 31% increased likelihood of SMM for patients with CF.

Conclusion:
The prevalence of CF in pregnancy is increasing in the era of CF transmembrane conductance regulator modulator therapy. Despite increased deliveries in patients with CF, morbidity has not increased.

Primary & Presenting Author(s)

Anthony Kendle, MD (he/him/his)
Fellow Maternal Fetal Medicine
Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine
Tampa, Florida, United States

Coauthor(s)

JS
Jason L. Salemi, MPH, PhD
Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine
Tampa, Florida, United States
Judette M. Louis, MD, MPH
Department Chair
Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine
Tampa, Florida, United States