extended criteria for fetal myelomeningocele repair

Conditions: Obesity; Myelomeningocele; Pregnancy; Diabetes Mellitus in Pregnancy; Fetal Anomaly

Summary: the purpose of this study is to offer pre-natal myelomeningocele (mmc) repair surgery to pregnant women with one of the former surgery exclusion factors * a bmi of 35-40 kg/m2 * diabetes; patients will require good glycemic control * history a previous preterm birth, as long as it was followed by a full term birth * structural abnormality in the fetus; abnormality must be minor, not increasing the risk of prematurity. for example cleft lip and palate, minor ventricular septal defect, pyelectasis. * maternal rh alloimmunization. must have a low level of anti-red blood cell antibody that is not associated with fetal disease, specifically anti-e \< 1:4 or anti-m. or alloimmunization with negative fetal red blood cell antigen status determined by amniocentesis. we will be extending the management of myelomeningocele study (moms) criteria by including these factors. prenatal clinical and outcome information will be collected; safety and efficacy will be evaluated

the purpose of this study is to extend the moms requirements for pre-natal mmc repair surgery and evaluate safety and efficacy. this will be accomplished through prenatal and post-operative observation and data collection. the data collected will be documented and collected from prenatal ultrasounds, operative, and delivery reports. we will share our preliminary data with naftnet in order to prompt a multicenter trial; this collaboration will help propagate further research and answer clinical questions regarding this extension in surgery criteria.

Eligibility criteria:
inclusion criteria: * any woman with a prenatal diagnoses of myelomeningocele. * pre-pregnancy bmi of 35-45 kg/m2. * diabetes; patients will require good glycemic control * history a previous preterm birth, as long as it was followed by a full term birth * structural abnormality in the fetus; abnormality must be minor, not increasing the risk of prematurity. for example cleft lip and palate, minor ventricular septal defect, pyelectasis. * maternal rh alloimmunization. must have a low level of anti-red blood cell antibody that is not associated with fetal disease, specifically anti-e \< 1:4 or anti-m. or alloimmunization with negative fetal red blood cell antigen status determined by amniocentesis. * same moms trial inclusion criteria with the exception of the above. exclusion criteria: * poor glycemic control (i.e., hba1c ≥ 8%) in spite a medical antidiabetic therapy in accordance with good clinical practice (gcp) * presence of significant co-morbidities or complications (such as dyslipidemia, uncontrolled arterial hypertension, impaired renal function, neuropathy, retinopathy, cvd) * severe diabetes complications or associated medical conditions (such as blindness, endstage renal failure, liver cirrhosis, malignancy, chronic congestive heart failure) * recent (within preceding 12 months) myocardial infarction, stroke or tia * unstable angina pectoris * same moms trial exclusion criteria (with the exception of extended inclusion criteria)

Keywords: myelomeningocele repair open neural tube defect bmi of 35-40 kg/m2, open fetal surgery elevated body mass index