Abstract
BACKGROUND: This study assessed short- and long-term neonatal outcomes in nulliparous women with singleton pregnancies who underwent cerclage compared with those who did not. METHODS: This nationwide retrospective cohort study included all singleton nulliparous women from the Korean National Health Insurance Service database with live births between January 2006 and December 2019. Women were categorized into three groups based on gestational age at cerclage placement: < 16 weeks, 16-24 weeks, and > 24 weeks. We compared short-term neonatal outcomes of preterm birth rates, admission to a neonatal intensive care unit, and composite neonatal morbidity and long-term outcomes (including mortality and developmental problems) of the cerclage groups against those who did not undergo cerclage placement. RESULTS: A total of 2,896,271 women and their neonates were included in this study, with a median follow-up period of 10.4 years. The cerclage group had a higher rate of preterm birth compared with the control group (control: 2.9%, cerclage at < 16 weeks: 9.8%, 16-24 weeks: 18.2%, > 24 weeks: 36.4%). The cerclage group also showed higher rates of admission to the neonatal intensive care unit and composite neonatal morbidities within 1 month and 1 year compared with the control group. The cerclage group had a significantly higher risk of all-cause mortality compared with the control group (cerclage at < 16 weeks: adjusted hazard ratio [HR], 1.49; 95% confidence interval [CI], 0.88-2.52; at 16-24 weeks: HR, 2.07; 95% CI, 1.29-3.33; at > 24 weeks: HR, 15.85; 95% CI, 11.06-22.71). The rate of developmental problems, including autism, attention-deficit/hyperactivity disorder, cerebral palsy, and developmental delay, was significantly greater in the cerclage group than in the control group. Cerclage placement after 24 weeks was associated with a higher risk of autism (adjusted HR, 2.31; 95% CI, 1.37-3.91), attention-deficit/hyperactivity disorder (HR, 1.70; 95% CI, 1.17-2.45), cerebral palsy (HR, 19.32; 95% CI, 14.63-25.53), and cognitive developmental delay (HR, 1.81; 95% CI, 1.25-2.62) after adjusting for confounders including neonatal birth weight. CONCLUSION: Cerclage placement in nulliparous women without a history of miscarriage or stillbirth can be associated with adverse short- and long-term developmental problems in offspring. This study underscores the importance of adhering to evidence-based guidelines when considering cerclage placement.