{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T19:23:39Z","timestamp":1780514619273,"version":"3.54.1"},"reference-count":43,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T00:00:00Z","timestamp":1697673600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Prenatal Diagnosis"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Our objective was to determine the optimal timing of delivery of growth restricted fetuses with gastroschisis in the setting of normal umbilical artery (UA) Dopplers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We designed a decision analytic model using TreeAge software for a hypothetical cohort of 2000 fetuses with isolated gastroschisis, fetal growth restriction (FGR), and normal UA Dopplers across 34\u201339\u00a0weeks of gestation. This model accounted for costs and quality adjusted life years (QALYs) for the pregnant individual and the neonate. Model outcomes included stillbirth, respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), short gut syndrome (SGS), neonatal sepsis, neonatal death, and neurodevelopmental disability (NDD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found 38\u00a0weeks to be the optimal timing of delivery for minimizing overall perinatal mortality and leading to the highest total QALYs. Compared to 37\u00a0weeks, delivery at 38\u00a0weeks resulted in 367.98 more QALYs, 2.22 more cases of stillbirth, 2.41 fewer cases of RDS, 0.02 fewer cases of NEC, 1.65 fewer cases of IVH, 0.5 fewer cases of SGS, 2.04 fewer cases of sepsis, 11.8 fewer neonatal deaths and 3.37 fewer cases of NDD. However, 39\u00a0weeks were the most cost\u2010effective strategy with a savings of $1,053,471 compared to 38\u00a0weeks. Monte Carlo analysis demonstrated that 38\u00a0weeks was the optimal gestational age for delivery 51.70% of the time, 39\u00a0weeks were optimal 47.40% of the time, and 37\u00a0weeks was optimal 0.90% of the time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Taking into consideration a range of adverse perinatal outcomes and cost effectiveness, 38\u201339\u00a0weeks gestation is ideal for the delivery of fetuses with gastroschisis, FGR, and normal UA Dopplers. However, there are unique details to consider for each case, and the timing of delivery should be individualized using shared multidisciplinary decision making.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pd.6452","type":"journal-article","created":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T07:15:09Z","timestamp":1697699709000},"page":"1506-1513","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Optimal timing of delivery for growth restricted fetuses with gastroschisis: A decision analysis"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3185-4696","authenticated-orcid":false,"given":"Claire H.","family":"Packer","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel A.","family":"Pilliod","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Oregon Health &amp; Science University  Portland Oregon USA"},{"name":"Department of Maternal Fetal Medicine Allina Health  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron B.","family":"Caughey","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8593-2186","authenticated-orcid":false,"given":"Teresa N.","family":"Sparks","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, &amp; Reproductive Sciences University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2021.1909563"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.24759"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6502a2"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00383\u2010010\u20102679\u20101"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2014.08.001"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.08.036"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2021.100415"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2017.171"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.06.039"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000425.Factors"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/2193\u20101801\u20103\u2010114"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000427"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpm\u20102018\u20100295"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010016\u20101085\u20107"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/bf00262235"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/mpg.0b013e318174e855"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/4126245"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100042\u20101744510"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2006.01.001"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.12.005"},{"key":"e_1_2_8_22_1","unstructured":"SurmanG NewdickH KingA DavenportH KurinczukJJ.4Child: Four Counties Database of Cerebral Palsy Vision Loss and Hearing Loss in Children. 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