Short- and Long-Term Outcomes of Offspring According to Cerclage Placement in Twin Pregnancy: A National Cohort Study...

To evaluate the short- and long-term outcomes of the offspring of twin pregnancies undergoing cerclage.

Using the Korean National Health Insurance Service database, we identified primigravid women who delivered live twins between January 2005 and December 2019. Women with a history of miscarriage, stillbirth, or prolonged hospitalization (>7 days post-cerclage) were excluded. The participants were grouped by gestational age at cerclage placement as follows: <16 weeks, 16-24 weeks, and >24 weeks. We calculated the adjusted odds ratios (OR) and hazard ratios (HR) for offspring outcomes, controlling for factors such as maternal age and Charlson index.

Among 89617 twin pregnancies, cerclage was associated with increased odds of preterm birth compared to no cerclage: OR: 2.45 [95% confidence interval (CI): 2.09-2.88] for <16 weeks, 1.35 (95% CI: 1.19-1.53) for 16-24 weeks, and 3.00 (95% CI: 2.43-3.69) for >24 weeks. The >24 week-group showed the highest neonatal composite morbidities (OR: 3.66; 95% CI: 2.93-4.56) and significantly elevated rates of bronchopulmonary dysplasia (OR: 11.64; 95% CI: 8.22-16.49) and intraventricular hemorrhage (OR: 8.36; 95% CI: 3.40-20.56). Regarding long-term outcomes, the >24 week-group also had higher HR for autism (2.44), attention-deficit/hyperactivity disorder (2.23), and cerebral palsy (6.39).

Cerclage performed after 24 weeks in twin pregnancies is linked to adverse short- and long-term outcomes in offspring, suggesting that late cerclage should be avoided when possible.