Citations 1
Fetal Myelomeningocele Closure in the Setting of Maternal Body Mass Index 35 to 40
Hersh, David S. , Anuar, A. Khairul , Bennett, Kelly, Clifford, Caitlin , Emery, Stephen P. , Goodnight, William , Hirose, Shinjiro , Jampa, Alekhya , Lillegard, Joseph B. , Luks, François I. , Moldenhauer, Julie S. , Schenone, Mauro , Zaretsky, Michael V. , Crombleholme, Timothy M., Anuar, Amirul, Elbabaa, Samer K. , Lim, Foong‐Yen Y. , Miller, Jena L. , Moehrlen, Ueli , Schenone, Mauro H , Shaaban, Aimen F. , Tsao, KuoJen
Neurosurgery | October 17, 2025 | Volume: 98 | Issue: 6 | Pages: 1278-1287
BACKGROUND AND OBJECTIVES: The Management of Myelomeningocele Study established a role for maternal-fetal surgery for myelomeningocele (MMC) but was limited to patients with a maternal body mass index (BMI) less than 35 kg/m 2 . However, as the rate of obesity has increased globally, some centers have extended the Management of Myelomeningocele Study criteria to include patients with a BMI of 35 to 40 kg/m 2 . We used the Fetal MMC Consortium registry to analyze the complications associated with maternal-fetal surgery in patients with a maternal BMI < 35 kg/m 2 compared with 35 to 40 kg/m 2 . METHODS: The prospective observational Fetal MMC Consortium registry sponsored by the North American Fetal Therapy Network was used to extract deidentified “maternal complication” and “fetal/neonatal complication” data sets, corresponding to patients with complete entries related to maternal or fetal/neonatal complications, respectively. Demographics, clinical characteristics, and complications were recorded. Propensity score matching was conducted with a 2:1 algorithm, and outcomes were compared between patients with BMI < 35 kg/m 2 and those with BMI 35 to 40 kg/m 2 . RESULTS: Propensity score matching resulted in 156 patients with BMI < 35 kg/m 2 and 78 patients with BMI 35 to 40 kg/m 2 in the “maternal complication” data set, and 130 patients with BMI < 35 kg/m 2 and 65 patients with BMI 35 to 40 kg/m 2 in the “fetal/neonatal complication” data set. No significant differences in the median number of maternal (2.0 vs 2.0; P = .257) or median number of fetal/neonatal (1.0 vs 1.0; P = .409) complications were observed between the 2 cohorts. Furthermore, prematurity rates did not differ significantly between the BMI < 35 and BMI 35 to 40 cohorts. CONCLUSION: Maternal-fetal surgery for open neural tube defect closure is not associated with increased risks among patients with a maternal BMI of 35 to 40 kg/m 2 . Extending the initial inclusion criteria for prenatal MMC closure has the potential to expand access to patients with a higher risk for open neural tube defects.