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Myelomeningocele is a devastating congenital malformation that is associated with considerable mortality and lifelong morbidity. Its incidence in the U.S. is 3.4 per 10,000 live births, despite reductions associated with prenatal folic acid fortification. Damage might result from both altered anatomy and prolonged intrauterine exposure of neural tissue. Some prenatal damage cannot be reversed, even with early postnatal surgery. To evaluate the efficacy of prenatal closure, investigators at three sites randomly assigned women at 19 to 26 weeks' gestation with an anomalous fetus (myelomeningocele starting between T1 and S1, without chromosomal anomalies) to either prenatal or postnatal surgery.
Of an anticipated 200 women, 183 were randomized …