Survival of prenatally diagnosed fetuses with neural tube defects, at three university teaching hospitals, Addis Ababa: survival analysis

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Background Worldwide, the incidence of Neural Tube Defects (NTDs) has been decreasing over the years due to increased periconceptional folic acid use. In Ethiopia, where the national fortification of foods with folic acid is not yet implemented, NTDs remain a major cause of perinatal and infant mortality. Although prenatal ultrasound scanning identifies NTDs, data on subsequent survival are scarce. This study aimed to assess the survival of fetuses diagnosed with NTDs on prenatal ultrasound and identify factors associated with survival. Methods This retrospective cohort study included all pregnancies diagnosed with NTDs by ultrasound at the Maternal-Fetal Medicine units of three university teaching hospitals in Addis Ababa between January 2018 and December 2021. Fetuses were followed from the date of prenatal diagnosis through infancy. Survival was estimated using the Kaplan–Meier method. The log-rank test and multivariable Cox proportional hazards regression were used to identify factors associated with death. Results Of 258 eligible cases, 140 (54.3%) pregnancies were terminated, and 118 (45.7%) continued. Among the 118 continued pregnancies, the cumulative Kaplan-Meier survival calculated from the time of prenatal diagnosis (t 0 ) was 56.8% at live birth (intrauterine survival), 26.3% at the end of the neonatal period (neonatal survival), and 11.7% at 1 year of age (1-year overall infant survival). Independent predictors of death were cranial lesions (AHR 3.58, 95% CI 1.83–7.00), upper spinal lesions (AHR 4.08, 95% CI 1.25–13.37), associated anomalies (AHR 8.49, 95% CI 3.90–18.50), and cephalocentesis (AHR 3.79, 95% CI 2.18–6.59), with the latter primarily reflecting baseline hydrocephalus severity. Conclusion Survival among prenatally diagnosed NTD pregnancies that continued to the third trimester was low. Cranial or upper spinal lesions, associated structural anomalies, and performance of cephalocentesis were independent predictors of mortality, with the latter specifically performed for extreme ventriculomegaly. Clinical trial number Not applicable.