Extended Criteria For Fetal Myelomeningocele Repair

Inclusion Criteria: * Any woman with a prenatal diagnoses of myelomeningocele. * Pre-pregnancy BMI of 35-45 kg/m2. * Diabetes; patients will require good glycemic control * History a previous preterm birth, as long as it was followed by a full term birth * Structural abnormality in the fetus; abnormality must be minor, not increasing the risk of prematurity. For example cleft lip and palate, minor ventricular septal defect, pyelectasis. * Maternal Rh alloimmunization. Must have a low level of anti-red blood cell antibody that is not associated with fetal disease, specifically anti-E \< 1:4 or anti-M. Or alloimmunization with negative fetal red blood cell antigen status determined by amniocentesis. * same MOMs Trial inclusion criteria with the exception of the above. Exclusion Criteria: * poor glycemic control (i.e., HbA1c ≥ 8%) in spite a medical antidiabetic therapy in accordance with good clinical practice (GCP) * presence of significant co-morbidities or complications (such as dyslipidemia, uncontrolled arterial hypertension, impaired renal function, neuropathy, retinopathy, CVD) * severe diabetes complications or associated medical conditions (such as blindness, endstage renal failure, liver cirrhosis, malignancy, chronic congestive heart failure) * recent (within preceding 12 months) myocardial infarction, stroke or TIA * unstable angina pectoris * same MOMs Trial exclusion criteria (with the exception of extended inclusion criteria)