Route of delivery does not impact postnatal surgical morbidity in pregnancies affected by fetal achondroplasia

Bobby K Brar; Michael B Bober; Ethan Gough; S Shahrukh Hashmi; Jacqueline T Hecht; Lorena Dujmusic; Mary E Little; Peggy Modaff; Richard M Pauli; David F Rodriguez-Buritica; Maria E Serna; Cory Smid; Janet M Legare; Julie E Hoover-Fong

doi:10.1016/j.gim.2023.100845

Route of delivery does not impact postnatal surgical morbidity in pregnancies affected by fetal achondroplasia

Genet Med. 2023 Jul;25(7):100845. doi: 10.1016/j.gim.2023.100845. Epub 2023 Apr 12.

Authors

Affiliations

¹ 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.
² Nemours/A.I. duPont Hospital for Children, Wilmington, DE.
³ Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
⁴ McGovern Medical School, University of Texas Health, Houston, TX.
⁵ University of Wisconsin School of Medicine and Public Health, Madison, WI.
⁶ Greenberg Center for Skeletal Dysplasias, Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD.

PMID: 37061874
DOI: 10.1016/j.gim.2023.100845

Abstract

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.

Keywords: Achondroplasia; Cesarean section; Prenatal genetics; Route of delivery; Vaginal delivery.

Publication types

Multicenter Study

MeSH terms

Achondroplasia* / complications
Achondroplasia* / surgery
Cesarean Section*
Cohort Studies
Female
Fetus
Humans
Morbidity
Pregnancy
Retrospective Studies