What to Know About Cystic Fibrosis and Pregnancy

Careful planning is the key to a successful pregnancy with cystic fibrosis

Cystic fibrosis (CF) is a disease that causes thick mucus to build up in your body, which leads to problems with breathing and digestion and makes you susceptible to bacterial infections.

While most people with CF can get pregnant and have healthy babies, the condition can cause problems with fertility, complicate pregnancy, and lead to the birth of premature or small babies.

Although it doesn’t appear to take a long-term toll, the demands of pregnancy on your body can temporarily make your CF worse. Planning your pregnancy for a time when your cystic fibrosis is well controlled can help you avoid many of the potential problems. 

A pregnant woman discusses trouble breathing with her doctor.

DjelicS / Getty Images

Planning Your Pregnancy

If possible, you should make sure to get your CF and any related illnesses under control before you get pregnant. The ideal situation includes:

  • Good lung function: Forced expiratory volume (FEV1) of 50% or higher reduces your risk of respiratory complications.
  • Normal body mass index (BMI): An indicator of good nutritional status, your BMI shouldn’t be abnormally low or your baby may not grow properly or could be born prematurely.
  • Controlled blood sugars: If you have diabetes that’s related to your CF, it should be well managed. (Expect that your insulin needs to change during pregnancy as well.)
  • Lung transplant planning: If you may need a lung transplant soon or you’ve had one in the past three years, you have a higher risk of complications for both you and the baby, including the possibility of lung rejection.
  • No active liver disease: Liver disease or cirrhosis can lead to pregnancy complications. If you suspect you have liver disease, ask your doctor to check for it before you try to conceive.

Of course, not all pregnancies are planned. If you have CF and realize you’re pregnant, talk to your healthcare provider right away and ask if they can recommend an obstetrician who’s experienced with CF or other high-risk pregnancies.

Compared with women without CF, women with CF have higher risks of serious complications during pregnancy (including preterm birth, cesarean delivery, pneumonia, requirement for mechanical ventilation, and death), but these events are rare and the absolute risk is low.

Cystic Fibrosis Drugs and Pregnancy

Some cystic fibrosis drugs are believed to be unsafe for a developing baby, so you may need to change your medication regimen before conceiving or as soon as you realize you’re pregnant.

Researchers have established which classes of drugs—and in some cases, which specific drugs—should be considered first-line or second-line treatments and which ones should be used only if there’s no safer alternative.

First-Line CF Drugs: Pregnancy and Breastfeeding

DRUG CLASS PREFERRED
Penicillins Any
Cephalosporins Any
Macrolides Azithromycin, clarithromycin, erythromycin

Second-Line CF Drugs: Pregnancy and Breastfeeding

DRUG CLASS  PREFERRED/NOTES
Carbapenems Imipenem
Monobactam Use caution with aztreonam
Quinolones Ciprofloxacin
Sulfonamides Cotrimoxazole: Discontinuation in late pregnancy preferred
Clindamycin Any

CF Drugs Uses With Caution: Pregnancy and Breastfeeding

DRUG CLASS WHEN USED NOTES
Aminoglycosides Life-threatening situations only Second line for breastfeeding
Tetracyclines Short-term use preferred; only until week 15 of pregnancy Doxycycline preferred
Colistin Life-threatening situations only Second line for breastfeeding
Source: Panchaud, et al.

Post-Transplant Considerations

Pregnancy planning is especially important if you’ve had a lung transplant. Additional concerns you should talk to your medical team about include:

Immunosuppressants that absolutely should not be used during pregnancy are:

Immunosuppressive drugs regarded as safest, based on animal studies, include:

With other drugs, you and your doctor should discuss whether the benefits outweigh the risks or you should switch to a different medication.

Cystic Fibrosis Doctor Discussion Guide

Doctor Discussion Guide Old Man

Cystic Fibrosis and Fertility

Cystic fibrosis can make it hard for you to get pregnant. It doesn’t always—in fact, it’s possible to have an unplanned pregnancy even if you have CF. Because of the potential that you and your baby could face complications due to your illness, it’s especially important that you use some form of birth control until you’re ready to become a parent.

Your CF can cause physical barriers to conception, including thick cervical mucus and obstructions of the fallopian tubes (which allow your eggs to travel to the uterus).

Nutritional problems, which are common in CF, may keep you from ovulating normally, which can also make it difficult to conceive. The good news is that several fertility treatments have helped people with CF get pregnant, including:

  • Follicular stimulation, such as with the drug Clomid (clomiphene)
  • In vitro fertilization (IVF), in which a fertilized egg is placed in your uterus
  • Intrauterine insemination (IUI), when sperm are placed inside your uterus

People with CF have also had healthy babies using surrogacy involving their egg and a partner’s or donor’s sperm. Surrogacy using a donated egg and adoption are other options for becoming a parent.

Genetic Counseling

If you have CF, any child you conceive will automatically be at least a carrier of the CF gene. For them to have CF itself, your partner would need to contribute a second CF gene.

If you and your partner are both CF carriers, your baby could end up in one of three situations:

  • The baby could receive two CF genes and have CF (25% chance).
  • The baby could receive one CF gene and be a carrier (50% chance).
  • The baby could receive no CF genes, meaning they don’t have CF and aren’t a carrier (25% chance).

You can have your baby tested for CF as early as the tenth week of your pregnancy with chorionic villus sampling (CVS). Amniocentesis can also detect it and is generally done between weeks 15 and 20.

Cystic Fibrosis and Gestation

All pregnancies come with some risks. However, when you have a chronic condition like CF, you are at higher risk of having pregnancy-related complications. 

Your medical team should monitor you closely for early signs of these complications. It’s also important that you communicate any symptoms or changes to your medical team. 

Pulmonary Exacerbations

Your CF may get worse during pregnancy, meaning you’ll have more pulmonary (lung) exacerbations. Continuing with your respiratory therapies can help you avoid them. Symptoms to watch for include:

Some antibiotics aren’t safe for your baby, so you may need different ones than in the past.

If your lung function is deteriorating late in pregnancy, your doctor may want to induce labor once you hit 37 weeks of gestation, which is considered full term, to keep it from getting worse.

Gestational Diabetes

Possibly because CF is linked to impaired glucose (sugar) tolerance, gestational diabetes is more common in people with CF. You should be screened for this regularly since it can lead to:

  • Preeclampsia, which can be life-threatening to your and your baby
  • Premature birth, which may mean your baby’s organs aren’t sufficiently developed
  • Macrosomia, an abnormally large baby, which can complicate delivery
  • Neonatal hypoglycemia, which is dangerously low blood sugar in your baby after delivery

Gestational diabetes often has no symptoms and is diagnosed through screening. You may develop symptoms if your blood sugar levels are extremely high, including:

  • Excessive thirst or hunger
  • Excessive urination
  • Nausea and vomiting
  • Unexplained weight loss
  • Blurred vision

If you develop gestational diabetes, you may need to check your blood sugar levels regularly, follow a special diet, increase your exercise, and give yourself insulin injections.

Nutritional Deficiency

Especially if CF makes it hard for you to maintain your weight, you may have trouble gaining enough weight during pregnancy. Gaining too little can cause your baby to be especially small, which is linked to:

  • Breastfeeding difficulties
  • Developmental delays
  • Increased risk of illness

You may not have any symptoms of a nutritional deficiency, and even if you do, it may be hard to distinguish them from symptoms of pregnancy, such as fatigue or trouble sleeping. 

However, your weight gain (or lack thereof) may be a helpful indicator of how well you’re meeting your body’s current needs. Your doctor may also want to perform regular blood tests to check your vitamin and mineral levels.

You may need to increase how many calories you eat and start taking nutritional supplements. Talk to your doctor and nutritionist about what can help you with this healthy weight gain.

Constipation

Common in pregnancy overall, CF increases your risk of constipation. Not only can constipation be uncomfortable or even painful on its own, it can lead to:

Constipation symptoms to watch for include:

  • Three or fewer bowel movements per week
  • Dry, lumpy, or hard stools
  • Difficulty or pain with passing stools
  • Nausea, bloating, cramping, or stomach aches
  • Feeling like you can’t fully empty your bowels

Drinking more water and adding fruits, vegetables, and possibly fiber supplements to your diet can prevent constipation or relieve the symptoms of constipation. Physical activity may help as well.

If you need more than this, talk to your doctor about medical options such as stool softeners and laxatives that are safe during pregnancy.

Hypertension

With CF, your risk of hypertension (high blood pressure) during pregnancy is elevated, so your medical team will keep a close eye on it. You may also want to monitor it at home. This is important because hypertension usually doesn’t cause any symptoms.

Severely high blood pressure during pregnancy can lead to:

Your doctors can work with you on the best medications to control your blood pressure during pregnancy, if needed.

Cystic Fibrosis and Postpartum

Risks to your health continue even after you’ve given birth. You should be monitored closely, especially during the first week after giving birth. 

Impact on Recovery

Complications during the early postpartum period may stem from combinations of problems that may have developed during pregnancy, such as:

  • Lung disease
  • Diabetes
  • Preeclampsia

If you have poor lung function, a long labor, or a cesarean section, expect chest physiotherapy to begin as soon as possible. It’s important for your pain to be well managed for this, so be sure to communicate with the hospital staff about your pain levels.

Even when lung function is poor before conception, pregnancy does not appear to have a negative long-term impact on respiratory health or life expectancy.

As a new parent, you may find it difficult to manage your CF because so much of your energy is now focused on your child. However, researchers have found that most parents are able to make adjustments over time and get back into a good CF management routine.

For the first days your baby is home, though, it may help to pre-arrange help from friends and family members to make sure you’re able to take care of yourself as well as your baby.

Breastfeeding

Breastfeeding is usually possible with CF—at least for a while. You have a lot of CF-related factors to consider when deciding whether to breastfeed your baby, including:

  • Whether your body can accommodate the extra caloric and nutritional demands, which are actually greater than during pregnancy
  • The potential impact of losing sleep for overnight feedings, which someone else may be able to do if you’re not breastfeeding
  • Whether your health would be improved by going back on medications you went off of during pregnancy

You may be able to address some of your concerns by taking a short-term or part-time approach to breastfeeding, depending on what your needs are.

For example, if you’re concerned about the demands on your body, you can breastfeed sometimes while using formula other times. That way you can get more rest. Either formula or pumped breast milk may solve that problem. 

If your doctor wants you to go back on a drug that’s unsafe for your baby, you may want to discuss the possibility of delaying the drug for a few weeks so your child can reap the early benefits of breastfeeding.

Summary

Having cystic fibrosis can make it harder for you to conceive, but not impossible. If you are planning on getting pregnant, be sure to check with your healthcare provider to see what changes you need to make to your treatment plan. These changes need to be followed through after your baby’s birth. It’s important to find a doctor who specializes in high-risk pregnancies for the best care.

A Word From Verywell

Cystic fibrosis certainly can complicate conception, pregnancy, delivery, and the postpartum period. However, the medical community knows significantly more about pregnancy with CF than it used to, and all of that knowledge can be put to work to benefit you and your baby. 

What that means is that it’s more likely than ever that you’ll be able to get pregnant, carry a child to term, and deliver a healthy baby, while also protecting your own health. Planning, learning, and working closely with your medical team are all important parts of the process.

Frequently Asked Questions

What happens if someone with cystic fibrosis gets pregnant?

If your pregnancy is unplanned, you should contact your doctor immediately so they can review your medications, supplements, overall health, and risk factors. You may need to make some changes to your treatment regimen. If your pregnancy is planned, hopefully you’ve made these adjustments already. Either way, you should try to find an obstetrician who has experience with cystic fibrosis or high-risk pregnancies.

Do you get tested for cystic fibrosis when pregnant?

You can get tested for cystic fibrosis when you’re pregnant. However, probably the most common reason for testing during pregnancy isn’t to see whether you have the disease, but to see if you’re a carrier. If both biological parents carry the gene, it’s possible that the baby will inherit the disease. You can have your baby tested for cystic fibrosis during pregnancy as early as the tenth week of gestation.

Why does being a male cystic fibrosis carrier keep a female from getting pregnant?

Some male carriers of the CF gene are missing a duct called the vas deferens in their reproductive organs. The vas deferens carries sperm from the testicles to the penis. When it’s not there, sperm can’t get into the ejaculate, and the ejaculate, therefore, can’t get someone pregnant without medical assistance.

How do you get pregnant when your husband has cystic fibrosis?

Even if your male partner is infertile due to cystic fibrosis and a blocked or missing vas deferens, they’re 90% more likely to create sperm that remain trapped in their testicles. In these cases, a doctor may be able to extract their sperm and use it to impregnate you with assisted reproductive technology.

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14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Girault A, Blanc J, Gayet V, Goffinet F, Hubert D. Maternal and perinatal outcomes of pregnancies in women with cystic fibrosis—a single centre case-control studyRespir Med. 2016;113:22-27. doi:10.1016/j.rmed.2016.02.010

  2. Ashcroft A, Chapman SJ, Mackillop L. The outcome of pregnancy in women with cystic fibrosis: a UK population-based descriptive studyBJOG. 2020;127(13):1696-1703. doi:10.1111/1471-0528.16423

  3. Kim SC, Hernandez-Diaz S. Editorial: safety of immunosuppressive drugs in pregnant women with systemic inflammatory diseases. Arthritis Rheumatol. 2014;66(2):246-249. doi:10.1002/art.38258

  4. MedlinePlus. Gestational diabetes. Updated August 18, 2020.

  5. Stanford Children’s Health. Gestational diabetes.

  6. Centers for Disease Control and Prevention. Reproductive health: weight gain during pregnancy. Updated May 26, 2021.

  7. Cleveland Clinic. Constipation. Updated November 7, 2019.

  8. Centers for Disease Control and Prevention. High blood pressure. Updated May 18, 2021.

  9. Cancer Therapy Advisor. Obstetrics and gynecology: cystic fibrosis.

  10. Cammidge SL, Duff AJ, Latchford GJ, Etherington C. When women with cystic fibrosis become mothers: psychosocial impact and adjustments. Pulm Med. 2016;2016:9458980. doi:10.1155/2016/9458980

  11. Cystic Fibrosis Foundation. Breastfeeding with CF.

  12. Centers for Disease Control and Prevention. Maternal diet. Updated October 8, 2020.

  13. Miller AC, Comellas AP, Hornick DB, et al. Cystic fibrosis carriers are at increased risk for a wide range of cystic fibrosis-related conditions. Proc Natl Acad Sci U S A. 2020;117(3):1621-1627. doi:10.1073/pnas.1914912117

  14. Cystic Fibrosis Foundation. Fertility in men with CF.

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