Pregnancy in spina bifida patients: a comparative analysis of peripartum procedures and complications

Abstract

Spina Bi da (S.B.) is caused by a failure in neural tube closure that can present with lower extremity sensory de cits, paralysis, and hydrocephalus. Medical advances have allowed increased pregnancies among S.B. patients, but management and pregnancy-associated complications have not been thoroughly investigated. The objective is to delineate peripartum procedures and complications in patients with S.B. MethodsA national de-identi ed database, TriNetX, was retrospectively queried to evaluate pregnant S.B. patients and the general population. Procedures and complications were investigated using corresponding ICD-10 and CPT codes within 1 year of pregnancy diagnosis. Results 11,405 SB patients were identi ed and compared to 9,269,084 non-S.B. patients. SB patients were signi cantly more likely to undergo cesarean delivery (1.200; 95% CI [1.133-1.271]) and less likely to receive neuraxial analgesia (0.406; 95% CI [0.383-0.431]). Additionally, patients with SB had an increased risk of seizures (3.922; 95% CI [3.529-4.360]) and venous thromboembolism (VTE) (3.490; 95% CI [3.070-3.969]). Risks of pre-eclampsia and hemorrhage were comparable. S.B. patients with hydrocephalus and Chiari malformation type 1 (CM-1) or type 2 (CM-2) were compared to patients without these comorbid conditions. This sub-group analysis showed a signi cantly increased risk of having cesarean deliveries (S.B. with hydrocephalus: 12.55%, S.B. with CM-1 or CM-2: 12.81% vs. S.B. without hydrocephalus or CM: 6.16%) and VTE (3.74%, 2.43% vs. 0.81%). There were also increased risks of hemorrhage and seizures and decreased use of neuraxial analgesia, but the sample size was insu cient. ConclusionS.B. patients were more likely to undergo cesarean section and exhibit peripartum complications compared to those without S.B. to coding errors. Patient-level information regarding speci c diagnostic tests and radiographic information was not provided to con rm disease, gravida, medications, and insurance status. Risks of peripartum outcomes may vary depending on the level of defect. As a database study, our study relies on the accuracy of each health care organization's CPT and ICD 10 coding, which is a potential source of inaccurate or incomplete reporting. Further limitations include the data source is restricted to healthcare organizations in the United States that participate in the database retrieval system. Mothers with S.B. were more likely to have a c-section and exhibit peripartum complications compared to those without S.B. Further studies are needed so that multidisciplinary care teams can address the complexity of conditions in S.B. mothers to provide optimal comprehensive peripartum care.