The introduction of mutation-specific therapy led to a revolution in cystic fibrosis (CF) care. These advances in CF therapies have changed the disease profile from a severe incurable disease with limited survival to a treatable disease with improved quality of life and survival into adulthood. CF patients are now able to plan their future, including marriage and parenthood. Side by side with the optimism, new issues and concerns are arising, including fertility and preparation for pregnancy, maternal and fetal care during pregnancy, and post-partum care. While cystic fibrosis transmembrane regulator (CFTR) modulators show promising results for improving CF lung disease, data on their safety in pregnancy are still limited. We performed a literature review on pregnancy in CF from the past, with the first described pregnancy in 1960, through the current fascinating changes in the era of CFTR modulators, to ongoing studies and future directions. Current advances in knowledge give hope for improved outcomes of pregnancy, towards the best possible prognosis for the mother and for the baby.

Background: Elexacaftor/tezacaftor/ivacaftor (ETI) has improved outcomes for people with cystic fibrosis (pwCF). This study evaluated changes in airway microbiological infection status after initiating ETI. Methods: Using the European Cystic Fibrosis Society registry, pwCF who started ETI between 2019 and 2021 were identified. The changes in microbiological status from 1 year before to 1 year after ETI initiation, were compared with the changes seen from 3 to 1 years before starting ETI. Mixed-effect regression models were used to analyse changes. Data from 2 years after initiation were examined for those starting ETI in 2019–2020. Results: Included were 15 739 pwCF from 30 countries. In the year before ETI, 38.4% were positive for Pseudomonas aeruginosa (PsA) and 36.4% for methicillin-sensitive Staphylococcus aureus (MSSA). After ETI, 38.7% of PsA-positive and 47.2% of MSSA-positive patients transitioned to negative status, compared with 14.8% and 29.1%, respectively, in the previous years. The adjusted difference in transitioning to negative was 14.6% (PsA) and 17.1% (MSSA), both p<0.001. Similar improvements were seen for Burkholderia cepacia complex and Stenotrophomonas maltophilia. For those starting ETI in 2019–2020, PsA positivity remained low over 2 years, decreasing from 46.8% pre-ETI to 30.4% and 27.7% at 1 and 2 years after ETI treatment. Conclusion: One year after starting ETI, many pwCF who were initially positive for various CF-related pathogens, shifted to a negative status, a change less common before ETI. These findings suggest that ETI reduces airway infections, with benefits extending into the second year of treatment, although some pwCF continue to carry these pathogens despite treatment.

Elexacaftor/tezacaftor/ivacaftor (ETI) therapy reduces airway infection rates with Pseudomonas aeruginosa (PsA). This study assessed factors associated with sustained chronic PsA infection and evaluated clinical outcomes after one year of ETI, stratified by PsA status. Using the European Cystic Fibrosis Society Patient Registry (ECFSPR), we identified people with cystic fibrosis (pwCF) who initiated ETI between 2019 and 2022. Multivariable logistic regression was used to identify clinical and demographic predictors of persistent chronic PsA. Changes in clinical outcomes from one year before to one year after ETI were analyzed using semiparametric models. Among 8188 pwCF with chronic PsA prior to ETI, 4908 (59.9 %) remained chronically infected after one year, while 3280 (40.1 %) transitioned to non-chronic PsA. Older age (OR 1.63, 95 %CI: 1.49-1.78) and lower baseline ppFEV₁ (OR 0.64, 95 %CI: 0.58-0.70) were the strongest predictors of persistent chronic PsA. The improvement in ppFEV₁ was similar between those who remained chronic (12.5 %, 95 %CI: 11.8-13.3) and those who shifted to non-chronic status (13.0 %, 95 %CI: 12.2-13.8; p = 0.074). BMI z-score improvements did not differ significantly between groups (p = 0.086). However, the mean hospital admission days was lower in those who shifted to non-chronic PsA (1.2 vs. 1.9 days; p < 0.001). Risk factors for sustained PsA infection post-ETI are associated with older age and lower ppFEV₁. Nonetheless, improvements in lung function and nutritional status were comparable, regardless of PsA status. Further research is required to better understand how PsA affects CF lung disease in the era of ETI treatment.

Cystic Fibrosis (a genetic recessive disease) is caused by a mutant cystic fibrosis transmembrane conductance regulator (CFTR) gene that causes an absence of, or impaired CFTR activity