Abortion consideration and completion among people with a fetus affected with myelomeningocele: a single maternal-fetal surgical center experience

Due to advancements in prenatal diagnostics and therapeutics, there are now multiple interventions available to pregnant persons carrying fetuses affected with myelomeningocele (fMMC), including prenatal repair, postnatal repair, and abortion. There has been little previous research on the factors associated with consideration or completion of abortion among patients with fMMC. As Illinois is one of few states in the U.S. that has legally protected access to abortion, it serves as a unique environment for investigating abortion outcomes among people with fMMC presenting to fetal treatment centers (FTC). Thus, our objectives were to evaluate the prevalence of abortion and factors associated with abortion consideration and completion among people seeking consultation at an FTC for fMMC. We conducted a retrospective cohort analysis of all patients presenting with fMMC to a single FTC in Chicago, Illinois. The two primary outcomes of interest were 1) patient-reported consideration of abortion prior to FTC consultation and 2) abortion following consultation. Prior to consultation, all patients were asked as part of routine intake whether they were considering pregnancy termination. After multimodal imaging, patients underwent coordinated counseling and subsequently made pregnancy management decisions. Pregnancy outcomes and biomedical data were obtained from patient report or medical record review. Severity of myelomeningocele was evaluated by size and upper level of lesion, grade of Chiari malformation, and presence of severe ventriculomegaly, talipes, and additional genetic/structural abnormalities. Bivariate and multivariate regression analyses were performed. Covariates were selected using backwards elimination with p