(366) Factors associated with abortion completion among people with a fetus affected with myelomeningocele

Data on individuals who undergo abortion after consultation at a fetal therapy center (FTC) for prenatal or postnatal management of fetal myelomeningocele (MMC) have yet to be elucidated. Thus, we aimed to evaluate factors associated with completion of abortion in this population.


Study Design:

We performed a retrospective cohort analysis of all fetal MMC consultations at the Chicago Institute for Fetal Health from 2018 to 2022. Severity of MMC was defined a priori as size of the lesion, grade of Chiari II malformation, upper level of the lesion, presence of talipes equinovarus, and presence of genetic and/or other structural abnormalities. Sociodemographic and biomedical variables were evaluated using chi-squared or Fisher’s tests for categorical variables and t-tests or Wilcoxon rank-sum tests for continuous variables, as indicated. Multivariable logistic regression was used to control for confounding covariates, which were selected using backwards elimination with p< 0.10 for retention. P < 0.05 was used to indicate statistical significance.


Results:

A total of 106 individuals were available for analysis, of whom 25 (23.6%) underwent abortion after consultation at a FTC. On bivariate analysis, higher maternal age and lower gestational age (GA) at initial consultation were associated with abortion completion. Nulliparity was more prevalent in those who continued pregnancy (Table). On regression modeling, after controlling for GA at presentation, consideration of abortion prior to presentation at a FTC was independently associated with subsequent abortion (aOR 3.65, 95% CI 1.07–12.42).


Conclusion: Almost 1 in 4 people with a pregnancy affected by MMC presenting to a FTC in an abortion-expanded state underwent an abortion after comprehensive counseling. Consideration of abortion prior to consultation at a FTC was independently associated with abortion completion. These data emphasize the importance of rigorous assessment of consideration of abortion and comprehensive reproductive counseling at FTCs.