52 - Mode of delivery and motor function in infants with myelomeningocele without in-utero repair

Friday, February 10, 2023

1:45 PM – 2:00 PM

Location: Room 3022, Moscone West, Level 3

Objective: To assess the impact of mode of delivery on two-year motor function in infants with prenatal diagnosis of myelomeningocele (MMC) who did not undergo in-utero repair.

Study Design: A multisite retrospective cohort study of 14 North American Fetal Therapy Network (NAFTNet) centers. De-identified data of all 2007-2020 MMC births were collected. Inclusion criteria were live singleton gestation with MMC at ≥24 weeks at birth and follow-up neurologic assessment available at two years of age (2y). Exclusion criteria were in-utero MMC repair, postnatal MMC diagnosis, abnormal karyotype, and obstetric contraindications to labor. The primary outcome was the difference between the anatomic level of the spinal lesion and functional motor level in the child at 2y (Figure), with a lower functional than anatomic level indicating improved motor function. Secondary outcomes were ambulation (independent, with assistance, or none), shunt-related outcomes (placement/infection/revision), seizures, and neurogenic bladder. A general linear model was used to determine the effect of mode of delivery on the primary outcome. Presence of labor, gestational age at birth, lesion width, length, and origin level, and presence of hydrocephalus were included as potential confounders for the multivariable analyses.

Results: Of 566 infants with MMC during the study period, 305 met inclusion criteria, with 216 (70.8%) delivering by cesarean and 89 (29.2%) vaginally. Infants delivered by cesarean had a mean (±standard error) level of motor function 0.07 ± 0.21 segments below the anatomic level at 2y, compared to 0.57 ± 0.32 for infants delivered vaginally (p=0.19). After controlling for potential confounders, both groups improved in motor function by 2y compared to anatomic level (p=0.01); however, the difference in motor improvement (0.37 segments) between two modes of delivery was not significant (p=0.62). Secondary outcomes did not differ by mode of delivery (Table).

Conclusion:

In this multisite NAFTNet cohort, mode of delivery was not associated with motor outcomes at 2y in infants with MMC.

Primary & Presenting Author(s)

Anna Palatnik, MD

Medical College of Wisconsin
Milwaukee, Wisconsin, United States

Slides

Coauthor(s)

AP

Amy Y. Pan, PhD

Medical College of Wisconsin
Milwaukee, Wisconsin, United States
SE

Stephen P. Emery, MD

UPMC Magee-Womens Hospital
Pittsburgh, PA, United States
SG

Stephanie Greene, MD

Children's Hospital of Pittsburgh
Pittsburgh, PA, United States
NM

Nallammai Muthiah, BA

Children's Hospital of Pittsburgh
Pittsburgh, PA, United States
DB

Deborah R. Berman, MD

Associate Professor
University of Michigan
Ann Arbor, MI, United States
TB

Terry Buchmiller, MD

Boston Children’s Hospital
Boston, MA, United States
Juliana S. Gebb, MD (she/her/hers)

Assistant Professor
Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
JL

Jospeh Lillegard, MD, PhD

Children’s Minnesota
Rochester, MN, United States
Jena L. Miller, MD (she/her/hers)

Assistant Professor
Johns Hopkins Center for Fetal Therapy
Baltimore, Maryland, United States
JN

J. Michael M. Netwon, MD, PhD

Vanderbilt University Medical Center
Nashville, TN, United States
PS

Patrick Schneider, MD

The Ohio State University
Columbus, OH, United States
Yair J. Blumenfeld, MD

Stanford University
Stanford, California, United States
AP

Amy Powne, MSN, RN

UC Davis Fetal Care and Treatment Center
Sacramento, CA, United States
CC

Catherine Cibulskis, MD

Saint Louis University School of Medicine
St. Louis, MO, United States
KD

Kathryn Drennan, MD

Assistant Professor - Department of Obstetrics and Gynecology
University of Rochester Medical Center
Rochester, NY, United States
Ramesha Papanna, MD, MPH

Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States