Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
Fetal Diagn Ther. 2020;47(12):889-893. doi: 10.1159/000511781. Epub 2020 Nov 9.
Open maternal-fetal surgery for in utero closure of myelomeningocele (MMC) has become an accepted treatment option for prenatally diagnosed open neural tube defects. Historically, this option has been limited to women with BMI < 35 due to concern for increasing complications in patients with obesity.
The aim of this study was to evaluate maternal, obstetric, and fetal/neonatal outcomes stratified by maternal BMI classification in women who undergo open maternal-fetal surgery for fetal myelomeningocele (fMMC) closure.
A single-center fMMC closure registry was queried for maternal demographics, preoperative factors, fetal surgery outcomes, delivery outcomes, and neonatal outcomes. Data were stratified based on maternal BMI: <30, 30-34.99, and ≥35-40, corresponding to normal weight/overweight, obesity class I, and obesity class II. Statistical analysis was performed using statistical software SAS v.9.4 (SAS Institute Inc., Cary, NC, USA).
A total of 264 patients were analyzed, including 196 (74.2%) with BMI <30, 54 (20.5%) with BMI 30-34.99, and 14 (5.3%) with BMI ≥ 35-40. Maternal demographics and preoperative characteristics were similar among the groups. Operative time increased with increasing BMI; otherwise, perioperative outcomes were similar among the groups. Obstetric and neonatal outcomes were similar among the groups.
Increasing maternal BMI did not result in a negative impact on maternal, obstetric, and fetal/neonatal outcomes in a large cohort of patients undergoing open maternal-fetal surgery for fMMC closure. Further study is warranted to determine the generalizability of these results.
开放性胎儿手术治疗胎儿脊髓脊膜膨出（MMC）已成为一种被广泛接受的治疗方法，适用于产前诊断为开放性神经管缺陷的病例。历史上，由于担心肥胖患者的并发症增加，该方法仅限于 BMI<35 的女性。
本研究旨在评估在接受开放性胎儿手术治疗胎儿脊髓脊膜膨出（fMMC）闭合的患者中，按照母体 BMI 分类，评估母体、产科和胎儿/新生儿结局。
对单中心 fMMC 闭合登记处的产妇人口统计学、术前因素、胎儿手术结果、分娩结果和新生儿结局进行了检索。根据产妇 BMI 进行数据分层：<30、30-34.99 和≥35-40，分别对应于正常体重/超重、肥胖 I 级和肥胖 II 级。使用统计软件 SAS v.9.4（SAS Institute Inc.，Cary，NC，USA）进行统计分析。
共分析了 264 例患者，其中 196 例（74.2%）的 BMI<30，54 例（20.5%）的 BMI 为 30-34.99，14 例（5.3%）的 BMI≥35-40。各组间产妇人口统计学和术前特征相似。手术时间随 BMI 增加而增加；否则，各组间围手术期结局相似。各组间产科和新生儿结局相似。
在接受开放性胎儿手术治疗胎儿脊髓脊膜膨出闭合的大型患者队列中，随着母体 BMI 的增加，母体、产科和胎儿/新生儿结局并未受到负面影响。需要进一步研究以确定这些结果的普遍性。
