Specialty-Based Variation in Applying Maternal-Fetal Surgery Trial Evidence

Ryan M. Antiel, Alan W. Flake, Mark P. Johnson, Nahla Khalek, Natalie E. Rintoul, John D. Lantos, Farr A. Curlin, Jon C Tilburt, Chris Feudtner

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Introduction: The Management of Myelomeningocele Study (MOMS) compared prenatal with postnatal surgery for fetal myelomeningocele (MMC). We sought to understand how subspecialists interpreted the trial results and whether their practice has changed. Materials and Methods: Cross-sectional, mailed survey of 1,200 randomly selected maternal-fetal medicine (MFM) physicians, neonatologists, and pediatric surgeons. Results: Of 1,176 eligible physicians, 670 (57%) responded. Compared to postnatal closure, 33% viewed prenatal closure as “very favorable” and 60% as “somewhat favorable.” Most physicians reported being more likely to recommend prenatal surgery (69%), while 28% were less likely to recommend pregnancy termination. In multivariable analysis, neonatologists were more likely to report prenatal closure as “very favorable” (OR 1.6; 95% CI: 1.03-2.5). Pediatric surgeons and neonatologists were more likely to recommend prenatal closure (OR 2.1; 95% CI: 1.3-3.3, and OR 2.9; 95% CI: 1.8-4.6) and less likely to recommend termination (OR 3.8; 95% CI: 2.2-6.7, and OR 4.7; 95% CI: 2.7-8.1). In addition, physicians with a higher tolerance for prematurity were more likely to report prenatal closure as “very favorable” (OR 1.02; 95% CI: 1.00-1.05). Discussion: In light of the MOMS trial, the vast majority of pediatric subspecialists and MFMs view prenatal MMC closure favorably. These attitudes vary by specialty and risk tolerance.

Original languageEnglish (US)
JournalFetal Diagnosis and Therapy
DOIs
StateAccepted/In press - Mar 17 2017

Keywords

  • Maternal-fetal surgery
  • Myelomeningocele
  • Physician attitudes
  • Prenatal diagnosis
  • Spina bifida

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Embryology
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology

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    Antiel, R. M., Flake, A. W., Johnson, M. P., Khalek, N., Rintoul, N. E., Lantos, J. D., Curlin, F. A., Tilburt, J. C., & Feudtner, C. (Accepted/In press). Specialty-Based Variation in Applying Maternal-Fetal Surgery Trial Evidence. Fetal Diagnosis and Therapy. https://doi.org/10.1159/000455024