Short- and Long-Term Outcomes of Offspring According to Cerclage Placement in Twin Pregnancy: A National Cohort Study Over 15 Years

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PURPOSE: To evaluate the short- and long-term outcomes of the offspring of twin pregnancies undergoing cerclage. MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSION: 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.

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