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Abstract：
BACKGROUND: The Management of Myelomeningocele Study (MOMS) eligibility criteria preclude in utero surgery for fetal spina bifida (fSB) when the maternal body mass index (BMI) is ≥35 kg/m2. Some centers still respect this criterion, while others, like ours, do not. This study aimed to assess whether maternal and fetal safety is compromised with higher maternal BMIs.
METHODS: Data of 192 patients with open fSB repair at our center were retrospectively analyzed. According to their BMI, patients were divided into three groups: group 1 (BMI <30 kg/m2), group 2 (BMI 30-35 kg/m2), and group 3 (BMI >35 kg/m2). Subgroup analysis was performed to assess differences in maternal and fetal outcomes. Additionally, complications were divided into grades 1 to 5 according to their severity and outcome consequences and compared among groups.
RESULTS: Out of 192 patients, 146 (76.0%) had a BMI <30 kg/m2, 28 (14.6%) had a BMI 30-35 kg/m2, and 18 (9.4%) had a BMI >35 kg/m2. Significant differences occurring more often in either group 2 or 3 compared to group 1 were maternal wound seroma (50% or 56% vs. 32%, p = 0.04), amniotic fluid leakage (14% or 6% vs. 2%, p = 0.01) as well as vaginal bleeding (11% or 35% vs. 9%, p = 0.01). On the contrary, duration of tocolysis with atosiban was shorter in patients with BMI >30 kg/m2 (4 or 5 vs. 6 days, p = 0.01). When comparing severity of maternal or fetal complications, grade 1 intervention-related complications occurred significantly more often in group 3 compared to group 1 or 2 (78% vs. 45% or 57%, p = 0.02). Gestational age at delivery was around 36 weeks in all groups without significant differences.
CONCLUSIONS: This investigation did not identify clinically relevant maternal and/or fetal outcome problems related to BMIs >35 kg/m2. Additional studies are however needed to confirm our results.
METHODS: Data of 192 patients with open fSB repair at our center were retrospectively analyzed. According to their BMI, patients were divided into three groups: group 1 (BMI <30 kg/m2), group 2 (BMI 30-35 kg/m2), and group 3 (BMI >35 kg/m2). Subgroup analysis was performed to assess differences in maternal and fetal outcomes. Additionally, complications were divided into grades 1 to 5 according to their severity and outcome consequences and compared among groups.
RESULTS: Out of 192 patients, 146 (76.0%) had a BMI <30 kg/m2, 28 (14.6%) had a BMI 30-35 kg/m2, and 18 (9.4%) had a BMI >35 kg/m2. Significant differences occurring more often in either group 2 or 3 compared to group 1 were maternal wound seroma (50% or 56% vs. 32%, p = 0.04), amniotic fluid leakage (14% or 6% vs. 2%, p = 0.01) as well as vaginal bleeding (11% or 35% vs. 9%, p = 0.01). On the contrary, duration of tocolysis with atosiban was shorter in patients with BMI >30 kg/m2 (4 or 5 vs. 6 days, p = 0.01). When comparing severity of maternal or fetal complications, grade 1 intervention-related complications occurred significantly more often in group 3 compared to group 1 or 2 (78% vs. 45% or 57%, p = 0.02). Gestational age at delivery was around 36 weeks in all groups without significant differences.
CONCLUSIONS: This investigation did not identify clinically relevant maternal and/or fetal outcome problems related to BMIs >35 kg/m2. Additional studies are however needed to confirm our results.
摘要：
背景：MOMS试验的资格标准排除了母体体重指数（BMI）≥35kg/m2时胎儿脊柱裂（fSB）的子宫内手术。一些中心仍然尊重这一标准，而另一些中心，像我们一样,不要。这项研究旨在评估孕妇和胎儿的安全性是否受到较高的孕妇BMI的影响。
方法：对我中心192例开放fSB修复术患者的资料进行回顾性分析。根据他们的BMI,将患者分为三组；第1组（BMI<30kg/m2），第2组（BMI30-35kg/m2）和第3组（BMI>35kg/m2）。进行亚组分析以评估母体和胎儿结局的差异。此外,根据并发症的严重程度和结局,将其分为1~5级,并进行组间比较.
结果：在192名患者中，146（76.0％）的BMI<30kg/m2，28（14.6％）的BMI为30-35kg/m2，18（9.4％）的BMI>35kg/m2。与第1组相比，第2组或第3组中更常见的显着差异是：母体伤口血清肿（50％或56％与32%,p=0.04),羊水渗漏（14%或6%vs.2%,p=0.01）以及阴道出血（11%或35%vs.9%,p=0.01)。相反,BMI>30kg/m2的患者使用阿托西班的分娩时间较短（4或5vs.6天,p=0.01)。比较母体或胎儿并发症的严重程度时，与第1组或第2组相比，第3组的干预相关并发症1级发生率明显更高(78%vs.45%或57%，p=0.02)。所有组分娩时的妊娠年龄约为36周，没有显着差异。
结论：本研究未发现与BMI>35kg/m2相关的临床相关的母体和/或胎儿结局问题。然而，需要更多的研究来证实我们的结果。
方法：对我中心192例开放fSB修复术患者的资料进行回顾性分析。根据他们的BMI,将患者分为三组；第1组（BMI<30kg/m2），第2组（BMI30-35kg/m2）和第3组（BMI>35kg/m2）。进行亚组分析以评估母体和胎儿结局的差异。此外,根据并发症的严重程度和结局,将其分为1~5级,并进行组间比较.
结果：在192名患者中，146（76.0％）的BMI<30kg/m2，28（14.6％）的BMI为30-35kg/m2，18（9.4％）的BMI>35kg/m2。与第1组相比，第2组或第3组中更常见的显着差异是：母体伤口血清肿（50％或56％与32%,p=0.04),羊水渗漏（14%或6%vs.2%,p=0.01）以及阴道出血（11%或35%vs.9%,p=0.01)。相反,BMI>30kg/m2的患者使用阿托西班的分娩时间较短（4或5vs.6天,p=0.01)。比较母体或胎儿并发症的严重程度时，与第1组或第2组相比，第3组的干预相关并发症1级发生率明显更高(78%vs.45%或57%，p=0.02)。所有组分娩时的妊娠年龄约为36周，没有显着差异。
结论：本研究未发现与BMI>35kg/m2相关的临床相关的母体和/或胎儿结局问题。然而，需要更多的研究来证实我们的结果。
