Pregnancy Among Mothers with Spina Bifida
Courtney L. Shepard, MD, MS, Phyllis L. Yan, MA, John M. Hollingsworth, MD, MS, Kate H. Kraft, MD.
University of Michigan, Ann Arbor, MI, USA.
Purpose:
Recognizing the importance of sexual and reproductive health to patients with spina bifida, pediatric and transitional urologists have taken responsibility for initiating conversations regarding this topic with adolescent and young adult spina bifida patients. However, the sexual and reproductive health of women with spina bifida remains under-investigated. It is unknown how many women are having babies, what mode of delivery is used, and if this has changed over time with the increasing life expectancy of these patients. A better understanding of pregnancy and delivery among young women with spina bifida will enable urologists to provide more informed, comprehensive counseling to patients. In this context, we sought to compare hospitalizations for delivery in women with and without spina bifida to determine differences in the mode of delivery utilized and changes in the rate of deliveries over time.
Materials and Methods:
Utilizing the Healthcare Cost and Utilization's National Inpatient Sample, we identified all hospitalizations for delivery in 2003-2013. After distinguishing between hospitalizations among women with and without spina bifida, temporal trends analysis and bivariate comparison were performed to determine differences in patient and hospital characteristics and mode of deliveries.
Results:
We identified 10,147 hospitalizations for deliveries amongst women with spina bifida and 42,197,763 amongst women without. Of all hospitalizations for deliveries, the percent of deliveries by women with spina bifida increased by 56% between 2003-2013 (629 to 925 deliveries per year, p<0.001). Women with spina bifida hospitalized for a delivery differed from those without spina bifida. They had a higher number of comorbidities and were more likely to be white, have Medicare or private insurance, live outside a city, and deliver at an urban teaching hospital (all p<0.001). Women with spina bifida were significantly more likely to undergo a caesarean section (52.4% of women with spina bifida versus 31.9% of those without, p<0.001) although nearly half were able to undergo vaginal delivery. For women with spina bifida, 25.9% of all deliveries occurred by age 22, which did not differ significantly from women without spina bifida.
Discussion:
There are significant differences in the characteristics and mode of delivery between women with and without spina bifida who are hospitalized for a delivery. The number of deliveries among these women are significantly increasing and over a quarter of the deliveries occur by age 22. This reinforces the need for pediatric and transitional urologists to discuss sexual and reproductive health with young patients with spina bifida beginning in adolescence.
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