Pregnancy outcomes of women with spina bifida

Abstract

Purpose: To assess the pregnancy outcomes of women with spina bifida.

Materials and methods: We analyzed a population-based cohort of 397 pregnant women with spina bifida and 1,083,211 without spina bifida who delivered infants in hospitals in Quebec, Canada, 1989-2013. Outcomes included maternal and infant morbidity and mortality at delivery. We used log-binomial regression models to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for the association of maternal spina bifida with pregnancy outcomes, accounting for maternal characteristics.

Results: Women with spina bifida had a higher prevalence of several adverse outcomes compared with women who had no birth defects. Maternal risks were highest for intensive care unit admission during the delivery hospitalization (PR 3.41, CI 95% 1.56–7.43) and respiratory morbidity (PR 9.46, CI 95% 3.31–26.99). Infant risks were greatest for intracranial hemorrhage (PR 6.85, CI 95% 2.23–21.08), birth hypoxia (PR 1.64, CI 95% 1.21–2.22), and hospital length of stay ≥14 days (PR 2.56, CI 95% 1.58–4.15). After adjustment for confounders, maternal spina bifida was associated with risk of oral clefts and abdominal wall defects in infants.

Conclusions: Women with spina bifida have an increased risk of severe maternal and infant complications at delivery, compared with no spina bifida.

Implications for Rehabilitation

• A growing number of women with spina bifida achieve pregnancy, but pregnancy outcomes are poorly understood.

• In a large pregnancy cohort, women with spina bifida had a high risk of severe maternal and infant morbidity at delivery.

• Women with spina bifida may benefit from enhanced periconceptional counseling and obstetric monitoring by health professionals.

• Guidelines should be developed for rehabilitation care providers to improve the obstetric management of women with spina bifida.

Keywords:

• Cohort studies
• infant
• newborn
• outcomes
• pregnancy
• spina bifida cystic

Acknowledgements

The authors thank Aimina Ayoub for assistance with manuscript revision.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by the Spina Bifida and Hydrocephalus Association of Canada; and Fonds de recherche du Québec-Santé [grant 34695].