Cesarean delivery is not associated with decreased at-birth fracture rates in osteogenesis imperfecta

Abstract

Purpose Osteogenesis imperfecta (OI) predisposes to recurrent fractures. The moderate-to-severe forms of OI present with antenatal fractures and the mode of delivery that would be safest for the fetus is not known. Methods We conducted systematic analyses on the largest cohort of individuals (n=540) with OI enrolled to-date in the OI Linked Clinical Research Centers. Self-reported at-birth fracture rates were compared in individuals with OI types I, III, and IV. Multivariate analyses utilizing backward-elimination logistic regression model building were performed to assess the effect of multiple covariates including method of delivery on fracture-related outcomes. Results When accounting for other covariates, at-birth fracture rates did not differ based on whether delivery was by vaginal route or by cesarean section (CS). Increased birth weight conferred higher risk for fractures irrespective of the delivery method. In utero fracture, maternal history of OI, and breech presentation were strong predictors for choosing CS for delivery. Conclusion Our study, the largest to analyze the effect of various factors on at-birth fracture rates in OI shows that delivery by CS is not associated with decreased fracture rate. With the limitation that the fracture data were self-reported in this cohort, these results suggest that CS should be performed only for other maternal or fetal indications, but not for the sole purpose of fracture prevention in OI.

A multicenter study to evaluate pulmonary function in osteogenesis imperfecta

“…The establishment of the LCRC and subjects enrolled in the Longitudinal Study of Osteogenesis Imperfecta have been previously described . Participants were enrolled at one of five clinical sites: Baylor College of Medicine (Houston, TX); Kennedy Krieger Institute (Baltimore, MD) and Nemours/Alfred I. DuPont Hospital for Children (Wilmington, DE); Oregon Health & Science University and Shriners Hospital for Children (Portland, OR); Shriners Hospital for Children (Chicago, IL); and Shriners Hospital for Children (Montreal, QC).…”

A Multicenter Observational Cohort Study to Evaluate the Effects of Bisphosphonate Exposure on Bone Mineral Density and Other Health Outcomes in Osteogenesis Imperfecta

“…Data were collected on 551 individuals by visits conducted on an annual basis as previously described . Data on age, BPN exposure, and OI subtype were available on 478 individuals who were included in the analyses.…”

“…In this study, we used data from the Osteogenesis Imperfecta Foundation's linked clinical research centers (LCRCs) to assess the effect of ever‐exposure to BPN (past or present) on lumbar spine (LS), areal bone mineral density (aBMD), fractures, scoliosis, and mobility in individuals with OI. The LCRCs were composed of clinical centers in the United States and Canada, a data management coordinating center, and a center for molecular and biochemical analysis . This group collaborated to conduct a longitudinal study of osteogenesis imperfecta, a large observational study that enrolled 551 individuals with various types of OI.…”

Hearing loss in individuals with osteogenesis imperfecta in North America: Results from a multicenter study

“…The establishment of the OI LCRC and the participants enrolled in the longitudinal study have been previously described (Bellur et al, ; Jain et al, ; Patel et al, ; Tam et al, ). The OI LCRC enrolled total of 552 patients between 2009 and 2013 at the following sites: Baylor College of Medicine (Houston, TX); Kennedy Krieger Institute (Baltimore, MD); Nemours/Alfred I. DuPont Hospital for Children (Wilmington, DE); Oregon Health & Science University and Shriners Hospital for Children (Portland, OR); Shriners Hospital for Children (Chicago, IL); and Shriners Hospital for Children (Montreal, QC).…”