*3.3.1. Lung function*

FEV1% predicted, PO2, and PCO2 are important predictors of pregnancy outcomes. In 1995, Edenborough et al. [28] reported that a pregravid FEV1 <60% caused greater pulmonary function decrease, a higher frequency of preterm infants, and also a higher mortality. However, successful pregnancies have been reported also in CF patients with compromised lung function (FEV1 < 50% of that predicted), and most patients seem to return to baseline pulmo‐ nary status after pregnancy.

The only absolute contraindication to pregnancy in CF is represented by pulmonary hyper‐ tension, which is correlated with higher rates of mortality in pregnancy. An echocardiogram performed before pregnancy can be useful to individuate underlying pulmonary hypertension and cor pulmonale, in order to advise the patient about the high mortality risk in case of pregnancy [24].

### *3.3.2. Pancreatic insufficiency and diabetes mellitus*

In old literature, pancreatic insufficiency was considered as a major risk factor in pregnancy outcomes. Actually, with the modern pancreatic enzymes supplementations, it is a nonsigni‐ ficant issue in CF pregnancies.

CF women planning pregnancy have to be tested for glucose intolerance before conception and the test has to be repeated at 20 weeks of gestational age. Insulin therapy is indicated in case of abnormalities in blood glucose monitoring.

### *3.3.3. Nutritional status*

Clinician should advise to reach a pregravid weight before conception up to 90% of the ideal body weight. Poor nutritional status is without any doubt one of the most relevant risk factor for pregnancy outcomes in CF, and a severe malnutrition (BMI <18 kg/m2 ) is a relative contraindication to pregnancy. A weight gain of 11–12 kg during pregnancy is recommended [29]; poor outcome is particularly associated with a maternal gain less than 4.5 Kg. A high caloric intake should be maintained and a poor weight gain is an indication for aggressive nutritional intervention (dietary supplementation, nasogastric, or gastrostomy feeding).
