Pregnancy among mothers with spina bifida

Recognizing the importance of sexual and reproductive health to patients with spina bifida (SB), pediatric urologists have taken responsibility for initiating conversations regarding this topic with adolescent and young adult SB patients. However, the sexual and reproductive health of women with SB 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 SB will enable urologists to provide more informed, comprehensive counseling to patients.

We sought to compare hospitalizations for delivery in women with and without SB to determine differences in the mode of delivery used and changes in the rate of deliveries over time.

Using 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 SB, temporal trends analysis and bivariate comparison were performed to determine differences in patient and hospital characteristics and mode of deliveries.

We identified 10,147 hospitalizations for deliveries among women with SB and 42,197,763 among women without. Of all hospitalizations for deliveries, the percentage of deliveries by women with SB increased by 56% between 2003 and 2013 (629-925 deliveries per year, p < 0.001). Women with SB hospitalized for a delivery differed from those without SB. 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 SB were significantly more likely to undergo a caesarean section (see Figure, 52.4% of women with SB vs. 31.9% of those without, p < 0.001), although nearly half were able to undergo vaginal delivery. For women with SB, 25.9% of all deliveries occurred by age 22, which did not differ significantly from women without SB (24.7% of all deliveries).

There are significant differences in the characteristics and mode of delivery between women with and without SB 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.

With increasing rates of deliveries and young age at delivery for women with SB, it is imperative that pediatric and transitional urologists initiate discussions on sexual and reproductive health beginning in adolescence.