Route of delivery does not impact postnatal surgical morbidity in pregnancies affected by fetal achondroplasia.

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. 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. 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. 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.

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Copyright © 2023 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Conflict of Interest J.E.H.-F. has participated in advisory boards sponsored by BioMarin pertaining to achondroplasia. J.E.H.-F. has been consulted by BioMarin, Alexion, and Therachon for clinical issues related to achondroplasia and other genetic skeletal conditions as well as acting as a site principal investigator (PI) for clinical trials for BioMarin and Therachon. J.T.H. has participated in advisory boards pertaining to achondroplasia sponsored by BioMarin. D.F.R.-B. has participated in advisory boards pertaining to achondroplasia sponsored by BioMarin and has lectured for BioMarin. J.M.L. is acting as a site PI for Ascendis and is on the speakers’ bureau for BioMarin. M.B.B. has participated in advisory boards sponsored by BioMarin; has consulted with BioMarin, Ascendis, Therachon, and QED for clinical issues related achondroplasia; and has acted as a site PI in their clinical trials in achondroplasia. He is a member of Alexion’s Speaker’s Bureau (HPP). M.B.B. is a site PI and consultant for MedLife Discoveries (RCDP) and a site PI for Shire (Hunter) and SOBI (Sanfilliopo). The other authors declare no conflicts of interest.