Bonanni Giulia, Zargarzadeh Nikan, Krispin Eyal, Northam Weston T, Bevilacqua Elisa, Mustafa Hiba J, Shamshirsaz Alireza A
Maternal Fetal Care Center, Division of Fetal Medicine and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Department of Women, Children, and Public Health Sciences, IRCCS Agostino Gemelli University Polyclinic Foundation, Catholic University of the Sacred Heart, 00168 Rome, Italy.
J Clin Med. 2024 Sep 24;13(19):5661. doi: 10.3390/jcm13195661.
Obesity rates have significantly increased globally, affecting up to 40% of women of childbearing age in the United States. While prenatal repair of open fetal spina bifida has shown improved outcomes, most fetal surgery centers exclude patients with a body mass index (BMI) ≥ 35 kg/m based on criteria from the Management of Myelomeningocele Study (MOMS) trial. This exclusion raises concerns about healthcare equity and highlights a significant knowledge gap regarding the safety and efficacy of fetal spina bifida repair in patients with obesity. To review the current state of knowledge regarding open fetal surgery for fetal spina bifida in patients with obesity, focusing on safety, efficacy, and clinical considerations. A comprehensive literature search was conducted using the PubMed and EMBASE databases, covering articles from the inception of the databases to April 2024. Studies discussing fetal surgery for neural tube defects and documenting BMI measurements and their impact on surgical outcomes, published in peer-reviewed journals, and available in English were included. Quantitative data were extracted into an Excel sheet, and data synthesis was conducted using the R programming language (version 4.3.3). Three retrospective studies examining outcomes of prenatal open spina bifida repair in a total of 43 patients with a BMI ≥ 35 kg/m were identified. These studies did not report significant adverse maternal or fetal outcomes compared to patients with lower BMIs. Our pooled analysis revealed a perinatal mortality rate of 6.1% (95% CI: 1.76-18.92%), with 28.0% (95% CI: 14.0-48.2%) experiencing the premature rupture of membranes and 82.0% (95% CI: 29.2-98.0%) delivering preterm (<37 weeks). Membrane separation was reported in 10.3% of cases (95% CI: 3.3-27.7%), the mean gestational age at birth was 34.3 weeks (95% CI: 32.3-36.3), and the average birth weight was 2651.5 g (95% CI: 2473.7-2829.4). Additionally, 40.1% (95% CI: 23.1-60.0%) required a ventriculoperitoneal shunt. While current evidence suggests that fetal spina bifida repair may be feasible in patients with obesity, significant limitations in the existing body of research were identified. These include small sample sizes, retrospective designs, and a lack of long-term follow-up data. There is an urgent need for large-scale, prospective, multicenter studies to definitively establish the safety and efficacy of fetal spina bifida repair in patients with obesity. Such research is crucial for developing evidence-based guidelines, improving clinical outcomes, and addressing healthcare disparities in this growing patient population with obesity.
全球肥胖率显著上升，在美国，高达40%的育龄妇女受其影响。虽然开放性胎儿脊柱裂的产前修复已显示出更好的治疗效果，但大多数胎儿手术中心根据脊髓脊膜膨出研究（MOMS）试验的标准，将体重指数（BMI）≥35kg/m²的患者排除在外。这种排除引发了对医疗公平性的担忧，并凸显了肥胖患者胎儿脊柱裂修复安全性和有效性方面的重大知识空白。为了回顾肥胖患者开放性胎儿脊柱裂手术的现有知识状况，重点关注安全性、有效性和临床考虑因素。使用PubMed和EMBASE数据库进行了全面的文献检索，涵盖从数据库建立到2024年4月的文章。纳入在同行评审期刊上发表、以英文提供的讨论神经管缺陷胎儿手术并记录BMI测量值及其对手术结果影响的研究。将定量数据提取到Excel表格中，并使用R编程语言（版本4.3.3）进行数据合成。确定了三项回顾性研究，共43例BMI≥35kg/m²的患者接受了产前开放性脊柱裂修复手术。与BMI较低的患者相比，这些研究未报告显著的孕产妇或胎儿不良结局。我们的汇总分析显示围产期死亡率为6.1%（95%CI：1.76 - 18.92%），28.0%（95%CI：14.0 - 48.2%）发生胎膜早破，82.0%（95%CI：29.2 - 98.0%）早产（<37周）。10.3%的病例（95%CI：3.3 - 27.7%）报告有胎膜分离，出生时的平均孕周为34.3周（95%CI：
