Reproductive Outcomes Following Open Maternal-Fetal Surgery for Myelomeningocele Closure: Analysis of MOMS Trial Participants

Document Type

Journal Article

Publication Date

8-29-2025

Journal

American journal of obstetrics & gynecology MFM

DOI

10.1016/j.ajogmf.2025.101765

Keywords

MOMS trial; fetal surgery; gynecology; infertility; myelomeningocele; open maternal-fetal surgery; spina bifida; subsequent pregnancy

Abstract

BACKGROUND: In utero closure of myelomeningocele has become an accepted alternative in the management of prenatally diagnosed spina bifida. Maternal reproductive risk has been previously described based on registry data and institutional outcomes. Here we aim to provide maternal reproductive outcomes from participants in the Management of Myelomeningocele Study. OBJECTIVE: Open maternal fetal surgery (OMFS) for in utero closure of myelomeningocele (MMC) is associated with childhood benefit through school age, however obstetric and maternal reproductive risk are also factors to consider. The objective of this analysis was to evaluate reproductive outcomes after OMFS compared to standard postnatal MMC closure. STUDY DESIGN: The Management of Myelomeningocele Study (MOMS) was a randomized trial comparing prenatal versus postnatal closure of MMC. Women in the prenatal closure arm underwent OMFS at 21-26 weeks and were delivered by cesarean at 37 weeks if not delivered prior to that. In the postnatal closure arm, cesarean delivery was performed at 37 weeks and neonates underwent surgical closure soon after birth. Families returned for follow-up at 30 months and again at school age between 6-10 years. Maternal reproductive questionnaires were administered at the time of the follow-up visits to assess menstruation, fertility, gynecologic issues, and subsequent pregnancy outcomes. We compared continuous variables using the Wilcoxon test and categorical variables using the chi-square or Fisher's exact test, as appropriate. RESULTS: 174 randomized women (86 in the prenatal closure group and 88 in the postnatal closure group) completed reproductive questionnaires with 91 women reporting no subsequent pregnancies since MOMS. 36 women in the prenatal closure group reported 60 subsequent, of which 45 (75%) progressed ≥ 20 weeks. 43 women in the postnatal closure group reported 71 pregnancies, of which 50 (70%) progressed ≥ 20 weeks. The prenatal closure group was more likely to deliver < 37 weeks (p < 0.001). One uterine rupture (2.2%) and two uterine dehiscence cases (4.4%) were reported among the prenatal closure group; none in the postnatal closure group (p<0.001). Use of fertility treatments or gynecologic surgeries were not different between the groups. CONCLUSIONS: Preterm delivery was more common in subsequent pregnancies after OMFS. The risk for uterine rupture and dehiscence in the prenatal group was higher than the postnatal group, but lower than what has been previously reported with OMFS. Reproductive outcomes were otherwise similar between women undergoing OMFS for MMC closure compared to the postnatal closure group in the MOMS trial.

Department

Biostatistics and Bioinformatics

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