IMPACT OF LACTATION ON WOMEN WITH CYSTIC-FIBROSIS AND THEIR INFANTS - A REVIEW OF 5 CASES

Objective To evaluate the impact of lactation on the health status of women with cystic fibrosis and their infants. Design Data were acquired through a retrospective review of pulmonary, obstetric, and pediatric medical records. Setting A medical school-based Pediatric Cystic Fibrosis Center in Philadelphia, Pa. Subjects Five women with cystic fibrosis and their respective infants. Main outcome measures For the women, measures of pregravid, gravid, and postpartum height, weight, pulmonary function test results, and energy intake were determined. For the infants, birth Apgar scores were obtained, as were measures of growth and development. Statistical analyses performed Means and standard deviations were calculated. Data were compared with published standardized references. Results Mean maternal age at conception was 25.41+/-4.1 years. Mean pregravid weight was 60.0+/-10.7 kg of standard body weight for height (range = 50.8 to 76.7 kg; median = 58 kg). Two women consumed up to two enteric-coated supplemental enzyme capsules per meal, three women consumed none. Pulmonary disease was mild in four of the five women. Mean weight gain during pregnancy was 10.2+/-7.4 kg. Mean gestation was 37.4+/-1.5 weeks; mean birth weight was 3.0+/-0.5 kg. Sweat tests performed on all infants were negative. Duration of breast-feeding was 3 to 30 weeks. Four of the five infants maintained appropriate growth velocity during breast-feeding. Mean maternal energy intake during lactation was above the Recommended Dietary Allowance for lactating women. Four of the five women were at or above their standard body weight during lactation. Conclusions/applications We conclude that women with the clinical diagnosis of mild cystic fibrosis disease can maintain a normal pregnancy with appropriate weight gain and can deliver infants of normal weight for gestational age. During lactation, women with mild cystic fibrosis disease can maintain their own weight and support growth in healthy infants. The dietitian needs to be an integral member of the health care team in assessing, monitoring, and managing women with cystic fibrosis during their child-bearing years.