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

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Antiel, RM; Flake, AW; Johnson, MP; Khalek, N; Rintoul, NE; Lantos, JD; Curlin, FA; Tilburt, JC; Feudtner, C

Published Date

  • 2017

Published In

Volume / Issue

  • 42 / 3

Start / End Page

  • 210 - 217

PubMed ID

  • 28301843

Pubmed Central ID

  • 28301843

Electronic International Standard Serial Number (EISSN)

  • 1421-9964

Digital Object Identifier (DOI)

  • 10.1159/000455024

Language

  • eng

Conference Location

  • Switzerland