Surgery Before Birth Improves Outcomes

Spina bifida best treated with surgery in the uterus before a baby is born

(RxWiki News) Caring for a child with spina bifida can be costly from emotional, psychological and financial perspectives. Having surgery before birth relieves at least one of these.

A recent study reveals that the most cost-effective way to address spina bifida is to conduct surgery on a baby while still carried in the mother's uterus because these costs are dwarfed by the lifetime costs of the condition.

"Take prenatal vitamins with folic acid if you're pregnant or trying."

Dr. Erika Werner, M.D. at Johns Hopkins University, Gynecology and Obstetrics, led the study evaluating the costs and effects on the health care system if doctors operated on babies before birth instead of after.

Previous studies have shown that children who had surgery for spina bifida before they were born have a higher quality of life than those who don't.

However, the procedure has risks for the mother, including fluid build-up in the lungs, dangerous loss of amniotic fluid, having her water break early, placental abruption (the placenta detaches from the uterus), hemorrhage and losing the baby altogether.

Werner's study takes into account the differences between the costs of the prenatal surgery and the costs of caring for a child with the disorder who did not get the surgery before birth. Pre-birth surgery is typically done between 19 and 26 weeks.

Werner's team accounted for the risks of the surgery as well as possible risks in future pregnancies, such as early birth, rupture of the uterus, a placenta that attaches too tightly to the uterine wall or a medically necessary hysterectomy.

Their mathematical calculations predict that $3,135,557 is saved for every 100 babies that received surgery before birth.

The quality of life of these infants is also significantly increased - by 96 quality-adjusted life years (QALYs) - but at the expense of 23 fewer QALYs for the mother and 9 fewer for future siblings.

"Given the large costs associated with caring for a child with significant deficits, the improved outcomes with in utero surgery make it less costly over a lifetime than surgery after delivery," Werner said. They concluded this was true "under a wide-range of circumstances."

The challenge, Dr. Kevin Gordon, M.D. told dailyRx, is availability. Gordon is an obstetrician and gynecologist in Arlington, Texas, who was not associated with this study.

"In-utero surgery is done at very few centers in the U.S., meaning that availability, family travel, lodging, etc. could be problematic," Gordon said.

Spina bifida is a birth defect that occurs when the neural tube within the spinal cord does not completely close before a baby is born. Severe forms can cause paralysis.

Typically, the neural tube should fully close by the first four weeks of pregnancy, often before the woman knows she's pregnant.

Taking folic acid before conception and during the first six weeks of pregnancy has been shown to reduce the likelihood that the fetus's spinal cord does not close.

The study was presented February 9 at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting, in Dallas, TX. No information was available regarding the study's funding or financial disclosures of the authors.

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