{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T09:54:15Z","timestamp":1783072455760,"version":"3.54.6"},"reference-count":29,"publisher":"Wiley","issue":"19","license":[{"start":{"date-parts":[[2019,10,23]],"date-time":"2019-10-23T00:00:00Z","timestamp":1571788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2019,11,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>It is hypothesized that cesarean delivery may reduce mortality among infants with spina bifida (e.g., by reducing trauma to the open lesion); however, few studies have assessed this relationship.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used the Texas Birth Defects Registry to identify neonates with spina bifida born between 1999 and 2014. The mode of delivery (main exposure) was abstracted from each subject's birth certificate. The vital status (main outcome) was determined based on the presence or absence of a death certificate. When a death certificate was present, survival time was calculated by subtracting the date of birth from the date of death. We then conducted multivariable Cox proportional hazards regression to estimate the adjusted hazard ratio between cesarean delivery and death prior to 29\u2009days. We adjusted for maternal race\/ethnicity, maternal education, gestational age\/birthweight, and breech presentation. This analysis was repeated for death prior to 365\u2009days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We analyzed 1,983 nonsyndromic, liveborn neonates with spina bifida, and 68% of these neonates were delivered by cesarean. After adjusting for potential confounders, the adjusted hazard ratio [aHR] for death prior to 29\u2009days was 0.77 (95% confidence interval [CI] 0.49, 1.21) and the aHR for death prior to 365\u2009days was 0.93 (95% CI 0.63, 1.38) comparing infants delivered by cesarean to those delivered vaginally.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite a lack of strong prior epidemiologic evidence, cesarean rates for neonates with spina bifida were high. Further investigations of the relationship between mode of delivery and infant outcomes, including mortality, complications, and long\u2010term prognosis, are warranted.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.1608","type":"journal-article","created":{"date-parts":[[2019,10,23]],"date-time":"2019-10-23T10:58:12Z","timestamp":1571828292000},"page":"1543-1550","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Mortality by mode of delivery among infants with spina bifida in Texas"],"prefix":"10.1002","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6406-4247","authenticated-orcid":false,"given":"Renata H.","family":"Benjamin","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Human Genetics and Environmental Sciences UTHealth School of Public Health  Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Lopez","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Human Genetics and Environmental Sciences UTHealth School of Public Health  Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura E.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Human Genetics and Environmental Sciences UTHealth School of Public Health  Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KuoJen","family":"Tsao","sequence":"additional","affiliation":[{"name":"Center for Surgical Trials and Evidence\u2010based Practice Department of Pediatric Surgery at UTHealth McGovern Medical School and Children's Memorial Hermann Hospital  Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, and Pediatric Surgery UTHealth McGovern Medical School and The Fetal Center at Children's Memorial Hermann Hospital  Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6765-4963","authenticated-orcid":false,"given":"Peter H.","family":"Langlois","sequence":"additional","affiliation":[{"name":"Birth Defects Epidemiology and Surveillance Branch Texas Department of State Health Services  Austin Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Swartz","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science UTHealth School of Public Health  Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5874-4155","authenticated-orcid":false,"given":"A. 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