*3.4.6. Diabetes care*

A pre-pregnancy diagnosis of CF-related diabetes and gestational diabetes are associated with a poorer prognosis; in literature, it is reported that an unsatisfactory glycemic control in the first trimester is associated with an increased risk of teratogenesis. During preconceptional counselling an OGTT is recommended, if not already performed, and blood sugars have to be monitored during lung exacerbations. Usually, OGTT is repeated at 20 weeks gestation and glycaemia should be measured at every visit: if random values are high, another OGTT could be repeated at 28 weeks.

Insulin is the recommended treatment for diabetes in CF also during pregnancy. A high calorie intake should also be assessed in diabetic patients.

### *3.4.7. Termination of pregnancy*

Guidelines about when to terminate pregnancy in a woman with advanced CF remain fluid. The indications may be psychosocial (in order to prevent serious injury to the mental health of the pregnant woman) or medical.

The only absolute contraindication to pregnancy is a pre-existing pulmonary hypertension with cor pulmonale; also chronic hypoxia could be considered a contraindication to pregnancy. There are no clear indications about the FEV1 cut-off to recommend pregnancy termination.

There are also some relative contraindications to pregnancy in CF women:


### *3.4.8. Delivery*

Most pregnancies in CF end in spontaneous vaginal delivery. Caesarean section is indicated only in case of maternal or fetal sufferance, preferably with spinal anesthesia. In CF, a high proportion (26–46%) of pregnancies end up with a spontaneous or therapeutic preterm delivery, and the usual indication is represented by maternal conditions. Usually, failing lung function and hypoxia occur in patients with a significant low pre-pregnant lung function; persisting hypoxia and onset of headache are in these cases severe signs and could request oxygen support or non-invasive ventilation.

In peripartum, pain and anxiety can lead to hyperventilation and decrease in alveolar gas exchanges; hypoxia, hypercarbia, and respiratory acidosis occur rapidly in patients with compromised lung function. An adequate analgesia should be performed, because it reduces pain, fear, and fatigue; oxygen support can be useful in case of desaturations.
