Prenatal Decision-Making for Myelomeningocele: Can We Minimize Bias and Variability?

Prenatal decision-making for myelomeningocele changed in 2011, when MOMS (Management of Myelomeningocele Study) demonstrated the effectiveness of intrauterine fetal surgery, thereby securing this intervention as an alternative to either pregnancy termination or postnatal repair. Although it is hoped that an evidence-based approach to medical decisions using the MOMS results would improve the quality of information received by pregnant patients, we believe that unless specific steps are taken, prenatal counseling for myelomeningocele (counseling that occurs in myriad locations across the United States) will be persistently marred by hidden biases and excess variability.