Safety of Drugs during Pregnancy and Breastfeeding in Cystic Fibrosis Patients

Panchaud, Alice; Paolo, Ermindo R. Di; Koutsokera, Angela; Winterfeld, Ursula; Weisskopf, Etienne; Baud, David; Sauty, Alain; Csajka, Chantal

doi:10.1159/000444088

Cited by 11 publications

(5 citation statements)

References 129 publications

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“…Acute airway infection is treated, taking into consideration that some antibiotics may be contraindicated during pregnancy. Generally, inhaled antibiotics are considered safe throughout pregnancy because of limited systemic absorption [68]. Ursodeoxycholic acid is discontinued before and during pregnancy, and vitamins are adjusted according to current guidelines for the general population.…”

Section: Pregnancymentioning

confidence: 99%

Close monitoring and early intervention: management principles for cystic fibrosis in Denmark

Qvist,

Nielsen,

Olesen

et al. 2024

APMIS

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Cystic fibrosis (CF) care in Denmark has been characterized by close monitoring and pre‐emptive treatment of lung disease and other CF‐related complications. Continuous evaluation through data collection and commitment to clinical research has incrementally improved outcomes. This approach has been in line with best practices set forth by European Standards of Care but has also gone beyond Society standards particularly pertaining to early treatment with high‐dose combination antimicrobial therapy. Despite a high prevalence of severe CF variants, lung function has been among the best in Europe. In this review, the Danish approach to management of CF prior to the introduction of new CF modulator treatment is explained and benchmarked. Downsides to the Danish approach are discussed and include increased burden of treatment, risk of antimicrobial resistance, side‐effects and costs.

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Section: Pregnancymentioning

confidence: 99%

Close monitoring and early intervention: management principles for cystic fibrosis in Denmark

Qvist,

Nielsen,

Olesen

et al. 2024

APMIS

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“…Should a pulmonary exacerbation during pregnancy prompt consideration of antibiotics, a multidisciplinary approach is necessary. Consultation among the CF and obstetrics physicians, a CF pharmacist, a genetic counselor with expertise in teratogen assessment and counseling, and the adult patient can facilitate shared decision-making that addresses the health needs of the mother and minimizes teratogenic risks to the fetus [80].…”

Section: Medication Uses During Pregnancymentioning

confidence: 99%

Reproductive Counseling and Care in Cystic Fibrosis: A Multidisciplinary Approach for a New Therapeutic Era

McGlynn

DeCelie-Germana

Kier

et al. 2023

Life

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With the advent of highly effective modulator therapies, many people with cystic fibrosis (CF) are living longer, healthier lives. Pregnancy rates for women with CF more than doubled between 2019 and 2021, reflecting increases in both planned and unplanned pregnancies. For men with CF, CF-associated infertility can be mitigated with assistive reproductive technology, yet patient knowledge of these challenges and options is variable. Preconception and prenatal counseling for individuals with CF and for parents of children with CF who wish to expand their families requires nuanced discussions to promote informed reproductive decisions, drawing from a combination of standard practice recommendations and CF-specific assessments. This review article synthesizes the current literature and practice recommendations regarding reproductive counseling and care in CF, outlining the role of genetic counseling, carrier screening, teratogen counseling, in vitro fertilization and pre-implantation genetic diagnosis, and careful assessment and management of cystic fibrosis-related diabetes when present. Via a multidisciplinary, patient-centered approach, clinicians can support adults with CF and parents of children with CF as they make informed reproductive decisions and embark on family planning.

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“…As with safety of medication use in pregnancy, reviews and recommendations for medications frequently used in lactating women with CF are published [ 50 , 51 , 63 ]. However, these recommendations are not guided by methodical studies and data collection.…”

Section: Lactationmentioning

confidence: 99%

“…Thus, in counseling women with CF who are considering pregnancy or who are pregnant, as with every drug that pregnant women with CF use to maintain their health, the health benefits to the mother of continuing the drug must be weighed against both the risk to her health if she discontinues the therapy and the known and unknown risks to the developing fetus if she continues the therapy. While there is adequate experience during pregnancy with many of the drugs used in the treatment of CF [50,51], to date, all information regarding use of CFTR modulators in pregnancy has been generated from case reports, case series and two surveys of CF providers [32,33,35,49,[52][53][54][55][56].…”

Section: Data In Pregnant Women Exposed To Cftr Modulators During Pregnancymentioning

confidence: 99%

Fertility, Pregnancy and Lactation Considerations for Women with CF in the CFTR Modulator Era

Jain

Taylor‐Cousar

2021

JPM

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Cystic fibrosis (CF) is an autosomal recessive genetic disorder impacting approximately 80,000 people of all races and ethnicities world-wide. CF is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene which encodes a protein of the same name. Protein dysfunction results in abnormal chloride and bicarbonate transport in mucus membranes, including those in the respiratory, gastrointestinal and reproductive tracts. Abnormal anion transport causes viscous secretions at the site of involvement. The majority of people with CF succumb to respiratory failure following recurrent cycles of infection and inflammation in the airways. Historically, providers treated the signs and symptoms of CF, but since 2012, have been able to impact the basic defect for the subset of people with CF who have mutations that respond to the new class of drugs, CFTR protein modulators. With the improved health and longevity afforded by CFTR modulators, more women are interested in parenthood and are becoming pregnant. Furthermore, this class of drugs likely increases fertility in women with CF. However, the safety of CFTR modulators in pregnancy and lactation is only beginning to be established. We summarize available data on the impact of CFTR modulators on fertility, pregnancy and lactation in women with CF.

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Safety of Drugs during Pregnancy and Breastfeeding in Cystic Fibrosis Patients

Cited by 11 publications

References 129 publications

Close monitoring and early intervention: management principles for cystic fibrosis in Denmark

Close monitoring and early intervention: management principles for cystic fibrosis in Denmark

Reproductive Counseling and Care in Cystic Fibrosis: A Multidisciplinary Approach for a New Therapeutic Era

Fertility, Pregnancy and Lactation Considerations for Women with CF in the CFTR Modulator Era

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