Fetal myelomeningocele diagnosed in the antenatal period: Maternal-fetal characteristics and their relationship with pregnancy decision-making

Article type: Research Article

Authors: Munoz, J.L.^{a; *} | Bishop CNM, E.^a | Reider, M.^a | Radeva, M.^b | Hsich, G.^c | Singh, K.^a

Affiliations: [a] OB/GYN and Women’s Health Institute, Cleveland Clinic, OH, USA | [b] Department of Quantitative Health Sciences, Cleveland Clinic, OH, USA | [c] Department of Pediatric Neurology, Cleveland Clinic, Cleveland, OH, USA

Correspondence: [*] Address for correspondence: Jessian Munoz, MD, PhD, 9500 Euclid Ave. Desk A81 Cleveland, Ohio 44195, USA. Tel.: +1 216 210 0756; E-mail: [email protected].

Abstract: BACKGROUND:Spina bifida is the most common fetal anomaly of the central nervous system, which affects approximately 1:1000 live births in the United States. Myelomeningocele (MMC) is the most common presentation of spina bifida, representing half of these cases. Given the deformation to the spinal cord and the nerve roots, this defect may result in significant morbidity to infants and major life-long disabilities. In this study we aimed to identify maternal and fetal characteristics associated with expectant management or termination of pregnancy in the setting of antenatally diagnosed MMC. We hypothesized that the level of the defect would correlate with patient’s decision to continue the pregnancy. METHODS:A retrospective cohort analysis was performed with patients who had presented to the Cleveland Clinic Fetal Care Center between 2005–2017. RESULTS:Our data showed 36% of patients with antenatal diagnosis of MMC elected for second trimester terminations versus 64% who chose to continue their pregnancy and deliver either by cesarean section or vaginal delivery. Based on ultrasound findings, there were no significant differences between these two groups. Maternal body mass index was significantly higher in those who continued pregnancies (p = 0.036). In addition, the fetal diagnostic methods chosen by patients were significantly different. Those who elected to terminate were more likely to pursue amniocentesis (p = 0.03) and less likely to opt for MRI characterization of the fetus (p = 0.007). CONCLUSION:We conclude, in the setting of fetal MMC diagnosed during pregnancy, patients often rely less on the associated ultrasonographic findings. Personal decisions likely influence the choice of other fetal diagnostic modalities. Other than BMI, we did not see an association between maternal factors and decisions regarding second trimester pregnancy termination.

Keywords: Spina bifida, termination, expectant management, fetal medicine, maternal care

DOI: 10.3233/NPM-180208

Journal: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 4, pp. 399-403, 2019