Maternal and fetal outcomes in multiparous women with Cystic Fibrosis.

Autor:	Cohen-Cymberknoh M; Pediatric Pulmonary Unit and Cystic Fibrosis Center, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Israel. Electronic address: malena@hadassah.org.il., Ariel Dabby M; Faculty of Medicine, Hebrew University of Jerusalem, Israel., Gindi Reiss B; Safra Sheba Medical Center, Ramat-Gan, Israel., Melo Tanner J; Instituto Nacional del Tórax, Santiago, Chile., Pérez G; Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Exequiel González Cortés, Chile., Lechtzin N; Johns Hopkins University School of Medicine, Baltimore, MD, USA., Polverino E; Hospital Universitari Vall d'Hebron, Barcelona, Spain., Perez Miranda J; Hospital Universitari Vall d'Hebron, Barcelona, Spain., Gramegna A; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Center, Italy; Department Pathophysiology and Transplantation University of Milan, Italy., Aliberti S; Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy., Levine H; Graub CF Center, Schneider Children's Medical Center, Petach-Tikva and Sackler School of Medicine, Tel-Aviv University, Israel., Mussaffi H; Graub CF Center, Schneider Children's Medical Center, Petach-Tikva and Sackler School of Medicine, Tel-Aviv University, Israel., Blau H; Graub CF Center, Schneider Children's Medical Center, Petach-Tikva and Sackler School of Medicine, Tel-Aviv University, Israel., Prais D; Graub CF Center, Schneider Children's Medical Center, Petach-Tikva and Sackler School of Medicine, Tel-Aviv University, Israel., Mei-Zahav M; Graub CF Center, Schneider Children's Medical Center, Petach-Tikva and Sackler School of Medicine, Tel-Aviv University, Israel., Shteinberg M; Pulmonology Institute and CF Center, Carmel Medical Center and the Technion- Israel Institute of Technology, Haifa, Israel., Livnat G; Pulmonology Institute and CF Center, Carmel Medical Center and the Technion- Israel Institute of Technology, Haifa, Israel., Gur M; Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children's Hospital, Rambam Medical Center and the Technion- Israel Institute of Technology, Haifa, Israel., Bentur L; Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children's Hospital, Rambam Medical Center and the Technion- Israel Institute of Technology, Haifa, Israel., Downey DG; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, Ireland., Dagan A; Safra Sheba Medical Center, Ramat-Gan, Israel., Golan-Tripto I; Pediatric Pulmonary Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel., Aviram M; Pediatric Pulmonary Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel., Mondejar-Lopez P; Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain., Picard E; Pediatric Pulmonary Unit, Shaare Zedek Medical Center, Jerusalem, Israel., Schwarz C; Charite Hospital, Berlin, Germany., Jakubec P; CF Center, University Hospital Olomouc and Faculty of Medicine, Palacky University, Olomouc, Czech Republic., Kazmerski TM; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, USA; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, USA., Amsalem H; Department of Obstetrics and Gynecology, Mount Scopus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel., Hochner Celnikier D; Department of Obstetrics and Gynecology, Mount Scopus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel., Kerem E; Pediatric Pulmonary Unit and Cystic Fibrosis Center, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Israel., Reiter J; Pediatric Pulmonary Unit and Cystic Fibrosis Center, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Israel.
Jazyk:	angličtina
Zdroj:	Respiratory medicine [Respir Med] 2024 Jul; Vol. 228, pp. 107654. Date of Electronic Publication: 2024 May 11.
DOI:	10.1016/j.rmed.2024.107654
Abstrakt:	Background: Quality of life and survival in Cystic Fibrosis (CF) have improved dramatically, making family planning a feasible option. Maternal and perinatal outcomes in women with CF (wwCF) are similar to those seen in the general population. However, the effect of undergoing multiple pregnancies is unknown. Methods: A multinational-multicenter retrospective cohort study. Data was obtained from 18 centers worldwide, anonymously, on wwCF 18-45 years old, including disease severity and outcome, as well as obstetric and newborn complications. Data were analyzed, within each individual patient to compare the outcomes of an initial pregnancy (1st or 2nd) with a multigravid pregnancy (≥3) as well as secondary analysis of grouped data to identify risk factors for disease progression or adverse neonatal outcomes. Three time periods were assessed - before, during, and after pregnancy. Results: The study population included 141 wwCF of whom 41 (29%) had ≥3 pregnancies, "multiparous". Data were collected on 246 pregnancies, between 1973 and 2020, 69 (28%) were multiparous. A greater decline in ppFEV 1 was seen in multiparous women, primarily in pancreatic insufficient (PI) wwCF and those with two severe (class I-III) mutations. Multigravid pregnancies were shorter, especially in wwCF over 30 years old, who had high rates of prematurity and newborn complications. There was no effect on pulmonary exacerbations or disease-related complications. Conclusions: Multiple pregnancies in wwCF are associated with accelerated respiratory deterioration and higher rates of preterm births. Therefore, strict follow-up by a multidisciplinary CF and obstetric team is needed in women who desire to carry multiple pregnancies. Competing Interests: Declaration of competing interest MCC received honoraria for lectures from Vertex. EP received a grant from Grifols; consulting fees from Moderna, Pfizer, Insmed and Chiesi; honoraria for lectures from Moderna, Pfizer, Vertex, GSK, TEVA, Chiesi and Insmed; payment for expert testimony from Chiesi; and support for attending meetings from Moderna, Pfizer, Vertex, GSK and Insmed. AG received consuting fees (personal) from Vertex, Menarini and Zambon; honoraria for lectures (personal) from Insmed and Vertex; support for attending meetings from Neupharma and Zambon; and payment (personal) for participation on a Data Safety Monitoring (DSM) Board or Advisory Board from Vertex. She is also an Associate Editor for Respiratory Research, Managment board member at IRENE NTM network and ERS chair Adult CF group-assembly 10. DP received consulting fees from Vertex. MMZ received support from the ECFS to attend the European CF meeting 2023. MS received grants from GSK and Trudell pharma; consulting fees (personal) from AstraZeneca, Boehringer Ingelheim, Dexel, Kamada, Synchrony medical, Trumed and Zambon; honoraria for lectures (personal) from AstraZeneca, Boehringer Ingelheim, Kamada and Sanofi; support for attending meetings from Boehringer Ingelheim, AstraZeneca and Kamada; payment (personal) for participating on DSM Board or Advisory Board from Bonus Biotherapeutics, Boehringer Ingelheim and AstraZeneca; and received oPEP devices for clinical trial from Trudell Medical International. She is also an Associate Editor at AJRCCM; Management board member at the Israeli Pulmonology society, Israeli society for Tuberculosis and mycobacterial diseases; and Editorial board member: Chest ERJ taskforce-bronchiectasis guidelines. DGD received grants from Chiesi; consulting fees from Vertex, Proteostasis and Insmed; honoraria for lectures from Chiesi and Gilead. He is also the current Director of the European CF Society Clinical Trials Network. PML received grant (institution) and payment for testimony (personal) from Vertex; consulting fees and honoraria for lectures (personal) from Vertex and Chiesi; support for attending meetings (personal) from Chiesi, Pari and AstraZeneca; and participation on a DSM Board or Advisory Board for Vertex and AstraZeneca. PJ received consulting fees from Centrum hydraulického výzkumu spol. s.r.o.; honoraria for lectures from MSD and Vertex; support for attending meetings, and participation on a DSM Board or Advisory Board from Chiesi: and leadership or fiduciary role in Vertex. TMK received a grant from the Cystic Fibrosis Foundation and the National Institutes of Health; consulting fees from the Cystic Fibrosis Foundation; and honoraria for lectures from the Johns Hopkins Institute. All other authors declare no competing interests. (Copyright © 2024 Elsevier Ltd. All rights reserved.)
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