Pregnant Women with a BMI above 35 Now Eligible for Fetal Spina Bifida Repair Surgery Study at the St. Louis Fetal Care Institute

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The SSM St. Louis Fetal Care Institute is one of the first fetal surgery centers in the country to have an Institutional Review Board (IRB) approved study to allow pregnant women with a body mass index (BMI) of up to 40 to be considered for fetal myelomeningocele surgery.

SSM St. Louis Fetal Care Institute surgeons perform a fetal myelomeningocele repair.

SSM St. Louis Fetal Care Institute surgeons perform a fetal myelomeningocele repair.

After studying the benefits and risks to mom and baby, we believe that the benefits of prenatal spina bifida repair may outweigh the risks for those moms who have a BMI in the 35 to 40 range. - Fetal Care Institute Director Dr. Mike Vlastos

"After studying the benefits and risks to mom and baby, we believe that the benefits of prenatal spina bifida repair may outweigh the risks for those moms who have a BMI in the 35 to 40 range," says Fetal Care Institute Director Dr. Mike Vlastos, who is a fetal surgeon and maternal fetal medicine specialist. "The goal of the study is to gain an understanding of how to best care for these mothers and their unborn babies."

Studies have shown that mothers with an elevated BMI have an increased chance of having a baby with spina bifida because of typically lower levels of folate. They are also at increased risk for blood clots and other complications during surgery. The team and facilities at SSM St. Mary's Health Center, where the fetal surgeries take place, are prepared to handle the risks associated with higher BMI surgeries and deliveries.

Myelomeningocele, the most severe form of spina bifida, is caused when a fetus' back bones do not close over to protect the spinal cord. It can cause paralysis and brain damage before a baby is even born. The fetal myelomeningocele repair surgery, which is performed between 19 weeks and 25 weeks and six days into a pregnancy, involves making a opening in the uterus, closing the fetal spinal cord opening and then repairing the womb.

“Research has shown that babies who receive the surgery before they are born have a better chance of walking, and a decreased chance of needing a brain shunt to release excess fluid,” says Vlastos.

Since 2011, the St. Louis Fetal Care Institute has used the surgery inclusion and exclusion criteria set forth in the MOMS (Management of Myelomeningocele Study) trial. One of these exclusion criteria was a BMI above 34.9. According to the CDC (Centers for Disease Control and Prevention), a BMI of 18.5 to 24.9 is considered normal, 25 - 29.9 is overweight and above 30 is obese.

The St. Louis Fetal Care Institute will continue to follow the other criteria set forth in the MOMS trial. "For example, if a mother has hypertension, diabetes or other risk factors she will not be eligible for the fetal surgery," says Vlastos.

An IRB is a committee composed of scientists and non-scientists who serve as patient advocates in medical research studies. There are currently three fetal surgery centers offering the surgery to mothers who have a BMI higher than 35.

In May 2011, the St. Louis Fetal Care Institute became one of the first centers to offer the operation after the release of the MOMS trial results. The team has evaluated more than 70 patients carrying a baby with myelomeningocele since 2009, and performed 39 fetal myelomeningocele repair surgeries since 2011 when the trial concluded.

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ABOUT THE FETAL CARE INSTITUTE
The St. Louis Fetal Care Institute is a partnership between SSM Cardinal Glennon Children’s Medical Center, SSM St. Mary’s Health Center, and Saint Louis University School of Medicine. Bringing together renowned maternal fetal medicine (MFM) specialists, pediatric and fetal surgeons, specialized nurses, cutting-edge technology, and a family-oriented approach, The Institute offers state-of-the-art diagnostic methods and treatment options for families whose unborn babies are facing medical challenges. It is the leading comprehensive fetal care program in Middle America offering a variety of fetal interventions and treatments, including open and minimally invasive fetal surgery for babies in the womb.

ABOUT THE MOMS TRIAL
In May 2011 The St. Louis Fetal Care Institute was one of the first centers to offer the surgery following the release of the MOMS (Management of Myelomeningocele) trial results. In this National Institute of Health (NIH) sponsored trial, patients facing a spina bifida diagnosis were randomly assigned to undergo fetal surgery or receive standard postnatal surgery. It was found that babies who have the fetal surgery often have better outcomes than those who receive the standard repair surgery after birth.

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