title: Specialty-Based Variation in Applying Maternal-Fetal Surgery Trial Evidence.
abstract: BACKGROUND
  The Management of Myelomeningocele Study (MOMS) compared prenatal with postnatal surgery for fetal myelomeningocele (MMC). We sought to understand how subspecialists interpreted the trial results and whether their practice has changed.
  
  
  METHODS
  Cross-sectional, mailed survey of 1,200 randomly selected maternal-fetal medicine (MFM) physicians, neonatologists, and pediatric surgeons.
  
  
  RESULTS
  Of 1,176 eligible physicians, 670 (57%) responded. Compared to postnatal closure, 33% viewed prenatal closure as "very favorable" and 60% as "somewhat favorable." Most physicians reported being more likely to recommend prenatal surgery (69%), while 28% were less likely to recommend pregnancy termination. In multivariable analysis, neonatologists were more likely to report prenatal closure as "very favorable" (OR 1.6; 95% CI: 1.03-2.5). Pediatric surgeons and neonatologists were more likely to recommend prenatal closure (OR 2.1; 95% CI: 1.3-3.3, and OR 2.9; 95% CI: 1.8-4.6) and less likely to recommend termination (OR 3.8; 95% CI: 2.2-6.7, and OR 4.7; 95% CI: 2.7-8.1). In addition, physicians with a higher tolerance for prematurity were more likely to report prenatal closure as "very favorable" (OR 1.02; 95% CI: 1.00-1.05).
  
  
  CONCLUSIONS
  In light of the MOMS trial, the vast majority of pediatric subspecialists and MFMs view prenatal MMC closure favorably. These attitudes vary by specialty and risk tolerance.
authors.affiliation: University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Antiel
authors.forename: Alan W
authors.initials: AW
authors.lastname: Flake
authors.forename: Mark P
authors.initials: MP
authors.lastname: Johnson
authors.forename: Nahla
authors.initials: N
authors.lastname: Khalek
authors.forename: Natalie E
authors.initials: NE
authors.lastname: Rintoul
authors.forename: John D
authors.initials: JD
authors.lastname: Lantos
authors.forename: Farr A
authors.initials: FA
authors.lastname: Curlin
authors.forename: Jon C
authors.initials: JC
authors.lastname: Tilburt
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D005332:Fetoscopy; D006801:Humans; D008591:Meningomyelocele / Q000601:surgery*; D010820:Physicians / Q000523:psychology; D011247:Pregnancy; D016896:Treatment Outcome
keywords: Maternal-fetal surgery; Myelomeningocele; Physician attitudes; Prenatal diagnosis; Spina bifida