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Case Reports
. 2022 Jul;21(4):721-724.
doi: 10.1016/j.jcf.2022.04.005. Epub 2022 Apr 11.

A case report of CFTR modulator administration via carrier mother to treat meconium ileus in a F508del homozygous fetus

Sylvia Szentpetery  1 , Kimberly Foil  2 , Sara Hendrix  2 , Sue Gray  2 , Christina Mingora  2 , Barbara Head  2 , Donna Johnson  2 , Patrick A Flume  2
Affiliations
Case Reports

A case report of CFTR modulator administration via carrier mother to treat meconium ileus in a F508del homozygous fetus

Sylvia Szentpetery et al. J Cyst Fibros. 2022 Jul.

Abstract

We report elexacaftor-tezacaftor-ivacaftor (ETI) treatment of a F508del carrier who was pregnant with a F508del homozygous fetus. At 23-weeks gestation meconium ileus (MI) was evident on ultrasound including dilated, hyperechoic bowel, which persisted on subsequent imaging. Through shared decision-making, the mother began ETI at 32 weeks with intent to treat fetal MI. The ultrasound findings persisted at treatment day 13, but bowel dilation had resolved by imaging on treatment day 27. A female infant was delivered vaginally at 36 weeks with no complications. The mother continued ETI while breastfeeding. Stool elastase at age 2 weeks was 240 mcg/g. Sweat chloride measurement was 64 and 62 mEq/L. Maternal and infant liver function testing have been normal. Maternal ETI treatment likely led to resolution of the MI and there is evidence supporting continued infant benefit through breastmilk. Logistical and ethical considerations regarding treatment of a carrier mother for infant benefit are discussed.

Keywords: CFTR modulators; Cystic fibrosis; Pregnancy.

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Conflict of interest statement

Declaration of Competing Interest Patrick Flume receives research support and consultation fees from Vertex Pharmaceuticals. All other authors declare no conflict of interest.

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