Fetal Myelomeningocele Closure in the Setting of Maternal Body Mass Index 35 to 40
Year: 2025
Type: article
Abstract: BACKGROUND AND OBJECTIVES: The Management of Myelomeningocele Study established a role for maternal-fetal surgery for myelomeningocele (MMC) but was limited to patients with a maternal body mass index (BMI) less than 35 kg/m 2 . However, as the rate of obesity has increased globally, some centers have extended the Management of Myelomeningocele Study criteria to include patients with a BMI of 35 to 40 kg/m 2 . We used the Fetal MMC Consortium registry to analyze the complications associated with maternal-fetal surgery in patients with a maternal BMI < 35 kg/m 2 compared with 35 to 40 kg/m 2 . METHODS: The prospective observational Fetal MMC Consortium registry sponsored by the North American Fetal Therapy Network was used to extract deidentified "maternal complication" and "fetal/neonatal complication" data sets, corresponding to patients with complete entries related to maternal or fetal/neonatal complications, respectively. Demographics, clinical characteristics, and complications were recorded. Propensity score matching was conducted with a 2:1 algorithm, and outcomes were compared between patients with BMI < 35 kg/m 2 and those with BMI 35 to 40 kg/m 2 . RESULTS: Propensity score matching resulted in 156 patients with BMI < 35 kg/m 2 and 78 patients with BMI 35 to 40 kg/m 2 in the "maternal complication" data set, and 130 patients with BMI < 35 kg/m 2 and 65 patients with BMI 35 to 40 kg/m 2 in the "fetal/neonatal complication" data set. No significant differences in the median number of maternal (2.0 vs 2.0; P = .257) or median number of fetal/neonatal (1.0 vs 1.0; P = .409) complications were observed between the 2 cohorts. Furthermore, prematurity rates did not differ significantly between the BMI < 35 and BMI 35 to 40 cohorts. CONCLUSION: Maternal-fetal surgery for open neural tube defect closure is not associated with increased risks among patients with a maternal BMI of 35 to 40 kg/m 2 . Extending the initial inclusion criteria for prenatal MMC closure has the potential to expand access to patients with a higher risk for open neural tube defects.
Source: Neurosurgery
Authors: David S. Hersh, Amirul Anuar, Kelly A. Bennett, Caitlin M. Clifford, Samer K. Elbabaa, Stephen P. Emery, William H. Goodnight, Shinjiro Hirose, Alekhya Jampa, Joseph B. Lillegard, Foong-Yen Lim, Francois I. Luks, Jena L. Miller, Ueli Moehrlen, Julie S. Moldenhauer, Mauro H. Schenone, Aimen F. Shaaban, KuoJen Tsao, Michael V. Zaretsky, Timothy M. Crombleholme
Institutions: University of Connecticut, Connecticut Children's Medical Center, UConn Health, Vanderbilt University, Vanderbilt University Medical Center, University of Michigan, Arnold Palmer Hospital for Children, University of Pittsburgh, Magee-Womens Hospital, University of Pittsburgh Medical Center, University of North Carolina at Chapel Hill, University of California Davis Medical Center, Children's Hospital of Philadelphia, Mayo Clinic, Children's Minnesota, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Brown University, Rhode Island Hospital, Hasbro Children's Hospital, Johns Hopkins University, Johns Hopkins Medicine, University of Zurich, University Children's Hospital Zurich, Northwestern University, Lurie Children's Hospital, The University of Texas Health Science Center at Houston, Children's Hospital Colorado, University of Colorado Anschutz
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4415281708