Pregnancy outcomes for females with cystic fibrosis in the CFTR modulator era according to airways infection status with Pseudomonas aeruginosa

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Background The introduction of CFTR modulator therapy has resulted in dramatic health improvements for people with cystic fibrosis (CF) and responsive CFTR mutations, including reduction in pulmonary infective exacerbations, as well as an associated increase in pregnancies among females with CF (FwCF). Historically, pregnancies in FwCF were medically ‘high-risk’, with both chronic airways infection and more severe CF-lung disease shown to correlate with poorer obstetric and neonatal outcomes. Given overall trends of improved CF-health stability, these conclusions warrant re-evaluation in the modern CF therapeutic era. Methods A single-centre, retrospective electronic medical records review was performed of all pregnancies at a large adult CF centre between September 2020 and March 2026. Maternal CF outcomes including spirometry, nutritional status, antibiotic use and hospitalisations for infective pulmonary exacerbations in the year pre-pregnancy and during pregnancy, in addition to obstetric and neonatal outcomes were reviewed for FwCF with lower airways infection with Pseudomonas aeruginosa ( Pa ) compared to those without evidence of Pa infection. Results 78 pregnancies completed by 60 FwCF were reviewed. 48 pregnancies were recorded in FwCF who were clinically categorised with lower airways Pa infection. FwCF who were Pa infected had significantly lower pre-conception lung function (mean ppFEV 1 (SD) Pa infected 72.7% (23.7) vs. non-Pa infected 85% (19.9), p = 0.013). There were no other significant differences in pre-conception clinical CF-health characteristics between the two infection cohorts. Although there was a non-significant increase in antibiotic use during pregnancy overall, compared to pre-pregnancy, this did not correlate with Pa airways infection status. There was no statistically significant difference in maternal-CF, obstetric or neonatal outcomes associated with maternal Pa airways infection status. Conclusion Despite substantially lower baseline lung function among women with Pa infection in this centre, they did not experience a statistically significantly increase in adverse maternal, respiratory, obstetric, or neonatal outcomes. Clinical trial number Not applicable.