肥胖母亲胎儿脊柱裂修复术：母婴安全性是否受到影响？

Fetal Spina Bifida Repair in Obese Mothers: Is Maternal and Fetal Safety Compromised?

机构信息

Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.

The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland.

出版信息

Fetal Diagn Ther. 2024;51(2):175-183. doi: 10.1159/000536071. Epub 2024 Jan 8.

DOI:10.1159/000536071

PMID:38190813

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10994580/

Abstract

INTRODUCTION

The Management of Myelomeningocele Study (MOMS) eligibility criteria preclude in utero surgery for fetal spina bifida (fSB) when the maternal body mass index (BMI) is ≥35 kg/m2. Some centers still respect this criterion, while others, like ours, do not. This study aimed to assess whether maternal and fetal safety is compromised with higher maternal BMIs.

METHODS

Data of 192 patients with open fSB repair at our center were retrospectively analyzed. According to their BMI, patients were divided into three groups: group 1 (BMI <30 kg/m2), group 2 (BMI 30-35 kg/m2), and group 3 (BMI >35 kg/m2). Subgroup analysis was performed to assess differences in maternal and fetal outcomes. Additionally, complications were divided into grades 1 to 5 according to their severity and outcome consequences and compared among groups.

RESULTS

Out of 192 patients, 146 (76.0%) had a BMI <30 kg/m2, 28 (14.6%) had a BMI 30-35 kg/m2, and 18 (9.4%) had a BMI >35 kg/m2. Significant differences occurring more often in either group 2 or 3 compared to group 1 were maternal wound seroma (50% or 56% vs. 32%, p = 0.04), amniotic fluid leakage (14% or 6% vs. 2%, p = 0.01) as well as vaginal bleeding (11% or 35% vs. 9%, p = 0.01). On the contrary, duration of tocolysis with atosiban was shorter in patients with BMI >30 kg/m2 (4 or 5 vs. 6 days, p = 0.01). When comparing severity of maternal or fetal complications, grade 1 intervention-related complications occurred significantly more often in group 3 compared to group 1 or 2 (78% vs. 45% or 57%, p = 0.02). Gestational age at delivery was around 36 weeks in all groups without significant differences.

CONCLUSION

This investigation did not identify clinically relevant maternal and/or fetal outcome problems related to BMIs >35 kg/m2. Additional studies are however needed to confirm our results.

摘要

简介

神经管缺陷管理研究（MOMS）的纳入标准排除了母体 BMI≥35kg/m2 时胎儿脊柱裂（fSB）的宫内手术。一些中心仍然遵守这一标准，而其他中心，如我们的中心，则不遵守。本研究旨在评估较高的母体 BMI 是否会影响母婴安全。

方法

回顾性分析了在我院行开放性 fSB 修复术的 192 例患者的数据。根据 BMI，将患者分为三组：组 1（BMI＜30kg/m2）、组 2（BMI 30-35kg/m2）和组 3（BMI＞35kg/m2）。进行亚组分析以评估母婴结局的差异。此外，根据严重程度和后果将并发症分为 1-5 级，并在各组之间进行比较。

结果

在 192 例患者中，146 例（76.0%）BMI＜30kg/m2，28 例（14.6%）BMI 30-35kg/m2，18 例（9.4%）BMI＞35kg/m2。与组 1 相比，组 2 或组 3 中更常发生的显著差异包括母体切口血清肿（50%或 56% vs. 32%，p=0.04）、羊水漏出（14%或 6% vs. 2%，p=0.01）和阴道出血（11%或 35% vs. 9%，p=0.01）。相反，阿托西班保胎治疗的时间在 BMI＞30kg/m2 的患者中更短（4 天或 5 天 vs. 6 天，p=0.01）。当比较母体或胎儿并发症的严重程度时，组 3 中与组 1 或组 2 相比，1 级干预相关并发症更常见（78% vs. 45%或 57%，p=0.02）。所有组的分娩时的孕周均约为 36 周，无显著差异。