Bowel-prompted delivery in gastroschisis not associated with improved neonatal outcomes, 20-year study finds

Delivery prompted by fetal bowel concern in pregnancies complicated by gastroschisis was not associated with improvements in key neonatal outcomes compared with spontaneous labor or medically indicated delivery, according to a 20-year retrospective cohort study published in Pregnancy, the official journal of the Society for Maternal-Fetal Medicine. The findings raise questions about the clinical utility of bowel appearance alone as a sole indication for delivery timing in this population.

Gastroschisis occurs in approximately 1 in every 3,268 live births, and its etiology remains unknown. The condition generates a disproportionate amount of resource use compared with other neonatal intensive care unit (NICU) admission conditions, and no consensus currently exists for initial neonatal management. In contemporary practice, delivery timing for affected pregnancies varies substantially, reflecting ongoing debate over how to balance the risks of prematurity against the potential for progressive prenatal bowel compromise from prolonged in utero amniotic fluid exposure.

Researchers conducted an Institutional Review Board-approved retrospective cohort study at a single tertiary care center, including all pregnancies with a prenatal ultrasound diagnosis of gastroschisis delivered between 34 0/7 and 38 6/7 weeks' gestation from January 2000 through December 2023. This gestational age window was selected as a clinically relevant range during which delivery timing is frequently influenced by physician decision-making rather than spontaneous labor.

A total of 83 infants met the inclusion criteria and were categorized into 3 groups based on the indication for delivery:

• 36 infants delivered for medically indicated reasons, defined as maternal, fetal, or placental conditions including abnormal fetal surveillance findings
• 25 infants delivered following spontaneous labor, without preceding fetal surveillance abnormalities or ultrasound-based concerns
• 22 infants delivered for fetal bowel concern, defined as ultrasound findings suggestive of bowel compromise including persistent bowel dilation, wall thickening, or increased echogenicity

Neonatal outcomes assessed included age at abdominal wall closure, number of surgical interventions within the first month and first year of life, length of hospital stay, incidence of sepsis, age at initiation of enteral feeding, and rate of complex gastroschisis. Comparisons across groups were adjusted for gestational age at delivery.

Age at abdominal wall closure occurred significantly earlier in both the medically indicated delivery group and the spontaneous labor group compared with the fetal bowel concern group after adjustment for gestational age at delivery (P = 0.013 and P = 0.025, respectively). No significant differences were identified across delivery indication groups in any of the following outcomes:

• Number of surgical interventions within the first month or first year of life
• Length of hospital stay
• Incidence of sepsis
• Age at initiation of enteral feeding
• Rate of complex gastroschisis

Prior studies examining delivery timing in gastroschisis have produced conflicting results. Some have suggested potential benefits of earlier delivery, including reduced sepsis rates or earlier initiation of enteral feeding, while others have demonstrated increased risks related to prematurity such as feeding intolerance, infection, and prolonged hospitalization. The GOOD study specifically examined late preterm delivery at 35 to 35⁺⁶ weeks versus term delivery at 38^{+0 to 38+6} weeks, a hypothesis that subsequent research has found controversial, given the well-established neonatal morbidities associated with earlier delivery, such as “respiratory and feeding failure, length of hospital stay, and infections,” according to the study authors.

Abnormal prenatal bowel findings, such as bowel dilation, wall thickening, or increased echogenicity, are commonly cited in clinical practice as justification for earlier delivery, despite limited evidence that bowel appearance alone predicts improved neonatal outcomes. American College of Obstetricians and Gynecologists (ACOG) guidance distinguishes medically indicated from spontaneous deliveries before 39 weeks' gestation, a framework the study authors suggest should guide decision-making in this population.

The study's findings support reliance on established obstetric surveillance and guideline-consistent decision-making when determining delivery timing in pregnancies complicated by gastroschisis, within the context of the study's limitations as a single-center retrospective cohort.

Reference:

Zargarzadeh N, Bonanni G, Sambatur E, et al. Indication for delivery and neonatal outcomes in prenatally diagnosed gastroschisis: A 20-year retrospective cohort study. Pregnancy. Published June 3, 2026. Accessed June 5, 2026. doi:10.1002/pmf2.70333Digital Object Identifier (DOI)