Management of�Myelomeningocele�Study - A Randomized Trial of Prenatal Versus Postnatal Repair of Myelomeningocele

The Management of Myelomeningocele Study (MOMS), a randomized trial of prenatal versus postnatal repair for myelomeningocele, randomly assigned eligible women to undergo either prenatal surgery before 26 weeks of gestation or standard postnatal repair. One primary outcome was a composite of fetal or neonatal death or the need for placement of a cerebrospinal fluid shunt by the age of 12 months. Another primary outcome at 30 months was a composite of mental development and motor function.

This study found that prenatal surgery resulted in reduced hindbrain herniation and need for shunt diversion at 12 months of age and better motor function at 30 months. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT00060606.)

In the MOMS2 study, we compared adaptive behavior and other outcomes at school age (5.9–10.3 years) between prenatal versus postnatal surgery groups for 161 children who were enrolled in MOMS. Assessments included neuropsychological and physical evaluations. Children were evaluated by trained blinded examiners at either a MOMS center or their home.

We concluded that there was no significant difference between surgery groups in overall adaptive behavior. Long-term benefits of prenatal surgery included improved mobility and independent functioning and fewer surgeries for shunt placement and revision, with no strong evidence of improved cognitive functioning.