Pregnancy in Spina Bifida Patients: A Comparative Analysis of Peripartum Procedures and Complications

Purpose: Spina Bifida (S.B.) is caused by a failure in neural tube closure that can present with lower extremity sensory deficits, paralysis, and hydrocephalus. Medical advances have allowed increased pregnancies among S.B. patients, but management and pregnancy-associated complications have not been thoroughly investigated. The objective is to delineate peripartum procedures and complications in patients with S.B. Methods A national de-identified database, TriNetX, was retrospectively queried to evaluate pregnant S.B. patients and the general population. Procedures and complications were investigated using corresponding ICD-10 and CPT codes within 1 year of pregnancy diagnosis. Results 11,405 SB patients were identified and compared to 9,269,084 non-S.B. patients. SB patients were significantly more likely to undergo cesarean delivery (1.200; 95% CI [1.133–1.271]) and less likely to receive neuraxial analgesia (0.406; 95% CI [0.383–0.431]). Additionally, patients with SB had an increased risk of seizures (3.922; 95% CI [3.529–4.360]) and venous thromboembolism (VTE) (3.490; 95% CI [3.070–3.969]). Risks of pre-eclampsia and hemorrhage were comparable. S.B. patients with hydrocephalus and Chiari malformation type 1 (CM-1) or type 2 (CM-2) were compared to patients without these comorbid conditions. This sub-group analysis showed a significantly increased risk of having cesarean deliveries (S.B. with hydrocephalus: 12.55%, S.B. with CM-1 or CM-2: 12.81% vs. S.B. without hydrocephalus or CM: 6.16%) and VTE (3.74%, 2.43% vs. 0.81%). There were also increased risks of hemorrhage and seizures and decreased use of neuraxial analgesia, but the sample size was insufficient. Conclusion S.B. patients were more likely to undergo cesarean section and exhibit peripartum complications compared to those without S.B.