دورية أكاديمية
Route of delivery does not impact postnatal surgical morbidity in pregnancies affected by fetal achondroplasia.
| العنوان: | Route of delivery does not impact postnatal surgical morbidity in pregnancies affected by fetal achondroplasia. |
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| المؤلفون: | Brar BK; Division of Maternal - Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD; Greenberg Center for Skeletal Dysplasias, Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD. Electronic address: bbrar1@jhu.edu., Bober MB; Nemours/A.I. duPont Hospital for Children, Wilmington, DE., Gough E; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD., Hashmi SS; McGovern Medical School, University of Texas Health, Houston, TX., Hecht JT; McGovern Medical School, University of Texas Health, Houston, TX., Dujmusic L; University of Wisconsin School of Medicine and Public Health, Madison, WI., Little ME; Nemours/A.I. duPont Hospital for Children, Wilmington, DE., Modaff P; University of Wisconsin School of Medicine and Public Health, Madison, WI., Pauli RM; University of Wisconsin School of Medicine and Public Health, Madison, WI., Rodriguez-Buritica DF; McGovern Medical School, University of Texas Health, Houston, TX., Serna ME; McGovern Medical School, University of Texas Health, Houston, TX., Smid C; University of Wisconsin School of Medicine and Public Health, Madison, WI., Legare JM; University of Wisconsin School of Medicine and Public Health, Madison, WI., Hoover-Fong JE; Greenberg Center for Skeletal Dysplasias, Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD. |
| المصدر: | Genetics in medicine : official journal of the American College of Medical Genetics [Genet Med] 2023 Jul; Vol. 25 (7), pp. 100845. Date of Electronic Publication: 2023 Apr 12. |
| نوع المنشور: | Multicenter Study; Journal Article; Comment |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 9815831 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1530-0366 (Electronic) Linking ISSN: 10983600 NLM ISO Abbreviation: Genet Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2022- : [New York] : Elsevier Original Publication: Baltimore, MD : Lippincott, Williams & Wilkins, c1998- |
| مواضيع طبية MeSH: | Cesarean Section* , Achondroplasia*/surgery , Achondroplasia*/complications, Pregnancy ; Female ; Humans ; Cohort Studies ; Fetus ; Morbidity ; Retrospective Studies |
| مستخلص: | Purpose: Pregnancies affected by maternal or fetal achondroplasia present unique challenges. The optimal route of delivery in fetuses with achondroplasia has not been established. Our objective was to determine whether the route of delivery affects postnatal achondroplasia-related surgical burden. Methods: We conducted a secondary analysis of Achondroplasia Natural History Study (CLARITY), which is a multicenter natural history cohort study of patients with achondroplasia. Achondroplasia-related surgical morbidity, which we defined as the need for one or more postnatal achondroplasia-related surgeries, was assessed in relation to the route of delivery and whether the mother also had achondroplasia. Rate of each individual surgery type (otolaryngology, brain, foramen magnum, spine, and extremity) was also assessed in relation to the route of delivery. Results: Eight hundred fifty-seven patients with achondroplasia with known route of delivery and known maternal stature were included. Three hundred sixty (42%) patients were delivered vaginally, and 497 (58%) patients were delivered by a cesarean delivery. There was no difference in the odds of requiring any postnatal achondroplasia-related surgery in those with achondroplasia who were delivered vaginally compared with those delivered by cesarean birth (odds ratio 0.95, 95% CI = 0.68-1.34, P = .80). No difference was present in the odds of requiring any postnatal achondroplasia-related surgery when route of delivery was compared for fetuses born to 761 average stature mothers (odds ratio 1.05, 95% CI = 0.74-1.51, P = .78). There was also no difference in the odds of requiring each of the individual achondroplasia-related surgeries by route of delivery, including cervicomedullary decompression. Conclusion: Our study suggests that it is reasonable for average stature patients carrying a fetus with achondroplasia to undergo a trial of labor in the absence of routine obstetric contraindications. Competing Interests: Conflict of Interest J.E.H.-F. has participated in advisory boards sponsored by BioMarin pertaining to achondroplasia. J.E.H.-F. has been consulted by BioMarin, Alexion, and Therachon for clinical issues related to achondroplasia and other genetic skeletal conditions as well as acting as a site principal investigator (PI) for clinical trials for BioMarin and Therachon. J.T.H. has participated in advisory boards pertaining to achondroplasia sponsored by BioMarin. D.F.R.-B. has participated in advisory boards pertaining to achondroplasia sponsored by BioMarin and has lectured for BioMarin. J.M.L. is acting as a site PI for Ascendis and is on the speakers’ bureau for BioMarin. M.B.B. has participated in advisory boards sponsored by BioMarin; has consulted with BioMarin, Ascendis, Therachon, and QED for clinical issues related achondroplasia; and has acted as a site PI in their clinical trials in achondroplasia. He is a member of Alexion’s Speaker’s Bureau (HPP). M.B.B. is a site PI and consultant for MedLife Discoveries (RCDP) and a site PI for Shire (Hunter) and SOBI (Sanfilliopo). The other authors declare no conflicts of interest. (Copyright © 2023 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved.) |
| التعليقات: | Comment on: Genet Med. 2021 Aug;23(8):1498-1505. doi: 10.1038/s41436-021-01165-2. (PMID: 34006999) |
| فهرسة مساهمة: | Keywords: Achondroplasia; Cesarean section; Prenatal genetics; Route of delivery; Vaginal delivery |
| تواريخ الأحداث: | Date Created: 20230416 Date Completed: 20230710 Latest Revision: 20240627 |
| رمز التحديث: | 20240627 |
| DOI: | 10.1016/j.gim.2023.100845 |
| PMID: | 37061874 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1530-0366 |
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| DOI: | 10.1016/j.gim.2023.100845 |