Submitted to: American Journal of Obstetrics and Gynecology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/20/2005
Publication Date: 8/20/2005
Citation: Hardin, D.S., Rice, J., Cohen, R.C., Ellis, K.J., Nick, J.A. 2005. The metabolic effects of pregnancy in cystic fibrosis. American Journal of Obstetrics and Gynecology. 106(2):367-375. Interpretive Summary: The survival of patients with cystic fibrosis (CF) has dramatically improved, and some women with CF have become pregnant, and of these some have developed complications that are serious. A series of tests to determine pregnancy-induced diabetes were performed on 8 CF women and 9 non-CF women during their pregnancies. Differences in how the body responds to changes in dietary intakes were found between the CF and non-CF women. It was concluded that pregnant CF women are at increased risk of early development of diabetes and have poor weight gain. It is recommended that these women should be screened throughout pregnancy, and should receive careful nutritional follow-up after pregnancy.
Technical Abstract: Our purpose was to determine glucose tolerance in pregnant women with cystic fibrosis (CF) and to relate glucose tolerance to insulin sensitivity, hepatic glucose production, and protein turnover. We studied 8 CF women during pregnancy (CFPreg). Results were compared with those from 9 pregnant controls (PregCont) and 8 nonpregnant CF women (CFCont). The following metabolic studies were conducted: oral glucose tolerance test (OGTT), hyperinsulinemic euglycemic clamp, stable isotope infusion of [1-13C]leucine and [6,6-2H2]glucose for measurement of whole body protein turnover and hepatic glucose production (HGP), respectively. Indirect calorimetry was used to measure resting energy expenditure (REE), and food intake was measured by 3-day food journals. Fat-free mass was measured by total body potassium 40K scan. All but one CFPreg developed diabetes by the end of the second trimester and had significantly lower insulin secretion and more insulin resistance than PregCont. Hepatic glucose production was significantly higher and suppression by insulin was less in CF subjects, and protein breakdown was significantly higher. Insulin resistance and HGP increased during pregnancy similarly in CFPreg and PregCont groups. Pregnancy in CF is associated with decreased insulin sensitivity and high HGP, in addition to inherent decreased insulin secretion. Pregnancy in CF is also associated with increased protein turnover and less response to insulin's anticatabolic effect. These changes appear to predispose the pregnant CF women to early development of diabetes and poor weight gain.