(470) Factors associated with uptake of prenatal repair for fetal myelomeningocele

Objective:
Single-center data from a high-volume fetal care center (FCC) demonstrate 71% of patients eligible for prenatal fetal myelomeningocele repair (fMMC) ultimately proceed with surgery. However, little is known about the sociodemographic and biomedical factors associated with electing for prenatal fMMC repair.

Study Design:
We conducted a retrospective cohort study of patients offered prenatal repair for fMMC at an FCC in Illinois between 2017-2025. All included patients were offered prenatal repair based on the criteria established by the Management of Myelomeningocele Study, except for a body mass index cutoff of 40 kg/m²,rather than 35 kg/m2. Our center began offering fetoscopic repair in 2020. The primary outcome was uptake of prenatal repair. Unadjusted odds ratios were generated. Significance was set at an alpha of 0.05.

Results:

Among 107 patients offered prenatal repair, 92 (86%) chose prenatal repair and 15 (14%) chose postnatal repair. Maternal age and gestational age at initial consultation did not differ between groups. Non-White race, LatinX ethnicity, nulliparity, route of surgery, and governmental payor insurance were not associated with prenatal or postnatal repair choice (Table 1). However, in-state residence and the presence of talipes equinovarus were associated with a lower likelihood of choosing prenatal repair (OR 0.24;  p-value =0.03; OR 0.29, p-value=0.03)  (Table 2).


Conclusion:

A majority of patients elected for prenatal repair of fMMC, at a frequency higher than previously reported in the literature. In-state residents were more likely to opt for postnatal repair despite their proximity to the FCC suggesting that factors beyond geographic access, such as regional referral patterns, inter-state cultural differences, or patient propensity to seek specialized care, may influence fMMC repair decision-making. Furthermore, the presence of talipes equinovarus was associated with decreased uptake of prenatal repair, which likely reflects team counseling about the limited benefits of prenatal fMMC repair when motor function is impaired.