Background: People with CF (pwCF) frequently have gastrointestinal symptoms (GI), including abdominal pain and irregular bowel movements. These are often embarrassing, difficult to report, and frequently missed. Thus, a GI Symptom Tracker was created and validated in the US and translated and validated in Dutch. This questionnaire consists of four subscales: Eating Challenges, Stools, Adherence Challenges and Abdominal Symptoms. Aim of this study was to investigate the relationship between GI symptoms, anxiety/depression and health-related quality of life (HRQoL) in Dutch pwCF. Methods: In this prospective, cross-sectional single-center pilot study, pwCF completed the Dutch GI Symptom Tracker, GAD-7 (anxiety), PHQ-9 (depression), and CFQ-R (HRQoL) from Sept 2021-June 2022. Regression analyses were used to analyze the univariable associations between GI symptoms, anxiety/depression and HRQoL. Results: 51 pwCF were enrolled consecutively ( n= 41 adults, 66% female, mean age (y) [range]= 32.7 [19-71] & n=10 adolescents, 70% female, mean age (y) [range]= 14.2 [12-17]). Elevated levels of anxiety (scores ≥10 on GAD-7) were found in 17% of adults and 0% of adolescents. Elevated depression scores ( ≥10 on PHQ-9) were found in 9% of adults and 20% of adolescents. GI scales ‘Eating Challenges’ and ‘Stools’ were significantly, positively associated with elevated symptoms of anxiety and depression. Most GI scales were associated with lower HRQoL. Conclusion: This is the first study investigating the link between GI symptoms assessed by the Dutch GI Symptom Tracker and anxiety/depression and HRQoL in Dutch pwCF. More GI symptoms were associated with higher anxiety and depression scores and worse health-related quality of life. Additional research is needed to better understand how mental and physical health are linked in CF.

Objective: Prediction of preterm birth is currently not feasible, resulting in maternal and fetal overexposure to prenatal corticosteroids and unnecessary hospital admittance. Novel biomarkers seem to hold potential for predictive applicability, including non-invasive volatile organic compounds. In this study, we aimed to assess the potential of urinary volatile organic compound profiles (VOCs) in the identification of pregnant women at risk for preterm birth. Design, setting, population: We prospectively collected urine of women admitted for imminent preterm birth (≧ 24+0 weeks until 36+6 weeks), collected data on maternal characteristics, including urine cultures, time between admission and delivery and mode of delivery. Methods and main outcome measures: Urine samples were analyzed using gas chromatography coupled to an ion mobility spectrometer (GC-IMS). VOCs of women delivering preterm and term were compared. Results: Urinary VOCs differed between women delivering between 28+0 until 36+6 weeks compared to women admitted for imminent preterm birth but delivering at term (area under the curve: 0.70). We identified women with either chorioamnionitis (area under the curve: 0.72) and positive bacterial cultures (area under the curve: 0.97) based on their urinary VOCs. Conclusions: Urinary VOCs hold potential for non-invasive prediction of preterm birth. Furthermore, they may allow for detection of chorioamnionitis and urinary tract infections in the investigated population. These observations need to be validated in a larger population prior to clinical implementation. Funding: This study was funded by the Department of Obstetrics and Prenatal diagnosis. Keywords: preterm birth, premature delivery, volatile organic compounds, chorioamnionitis, urinary tract infection, infection