Short- and Long-Term Neonatal Outcomes According to Cerclage in Nulliparous Singleton Women: A National Cohort Study Over 15 Years.

IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Ji-Hee Sung, Danbee Kang, Sir-Yeon Hong, Hyejeong Park, You-Ri Lee, Sooji Ham, Juhee Cho, Suk-Joo Choi, Cheong-Rae Roh, Soo-Young Oh
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引用次数: 0

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.

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根据未产单胎妇女环扎术的短期和长期新生儿结局:一项超过15年的国家队列研究。
背景:本研究评估了接受环扎术和未接受环扎术的未生育单胎妊娠妇女的短期和长期新生儿结局。方法:这项全国性的回顾性队列研究纳入了2006年1月至2019年12月期间韩国国民健康保险服务数据库中所有活产的单胎未生育妇女。根据结扎时的胎龄,将妇女分为三组:< 16周、16-24周和10 -24周。我们比较了环扎组和未环扎组的短期新生儿结局,包括早产率、新生儿重症监护病房入院、新生儿综合发病率和长期结局(包括死亡率和发育问题)。结果:共有2869271名妇女及其新生儿被纳入本研究,中位随访期为10.4年。结扎组早产率高于对照组(对照组2.9%,< 16周结扎组9.8%,16-24周结扎组18.2%,16-24周结扎组36.4%)。与对照组相比,环扎组在新生儿重症监护病房的入院率和1个月和1年内新生儿的综合发病率也更高。与对照组相比,环切术组的全因死亡风险明显更高(环切术< 16周:校正危险比[HR], 1.49;95%置信区间[CI], 0.88-2.52;16-24周:HR, 2.07;95% ci, 1.29-3.33;24周时:HR, 15.85;95% ci, 11.06-22.71)。发育问题的发生率,包括自闭症、注意力缺陷/多动障碍、脑瘫和发育迟缓,在环扎组明显高于对照组。24周后环扎术与更高的自闭症风险相关(调整后风险比,2.31;95% CI, 1.37-3.91),注意缺陷/多动障碍(HR, 1.70;95% CI, 1.17-2.45),脑瘫(HR, 19.32;95% CI, 14.63-25.53)和认知发育迟缓(HR, 1.81;95% CI, 1.25-2.62),校正了新生儿出生体重等混杂因素。结论:无流产或死产史的未生育妇女行环扎术可导致后代短期和长期的不良发育问题。这项研究强调了在考虑环扎置入时遵循循证指南的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Korean Medical Science
Journal of Korean Medical Science 医学-医学:内科
CiteScore
7.80
自引率
8.90%
发文量
320
审稿时长
3-6 weeks
期刊介绍: The Journal of Korean Medical Science (JKMS) is an international, peer-reviewed Open Access journal of medicine published weekly in English. The Journal’s publisher is the Korean Academy of Medical Sciences (KAMS), Korean Medical Association (KMA). JKMS aims to publish evidence-based, scientific research articles from various disciplines of the medical sciences. The Journal welcomes articles of general interest to medical researchers especially when they contain original information. Articles on the clinical evaluation of drugs and other therapies, epidemiologic studies of the general population, studies on pathogenic organisms and toxic materials, and the toxicities and adverse effects of therapeutics are welcome.
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