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
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Article info
Publication history
Published online: April 12, 2023
Accepted:
April 3,
2023
Received in revised form:
April 2,
2023
Received:
February 25,
2023
Identification
Copyright
© 2023 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved.
