Offspring Long-Term Infectious Morbidity following Pregnancies with Cervical Cerclage

Introduction Cervical cerclage is an acceptable procedure in women with cervical insufficiency and known as effective in prevention of preterm delivery. Since the presence of foreign body during pregnancy may change the vaginal microbiom, we aimed to study whether a cervical cerclage is associated with long-term infectious morbidity of the offspring. Study design A population-based cohort study was performed at a tertiary medical center, including all singleton deliveries between the years 1991-2021. Long-term infectious morbidity was compared among offspring after pregnancies with and without cervical cercalge. The diagnoses of infectious morbidities were defined based on ICD-9 codes as recorded in community clinics and hospitalization files. A Kaplan-Meier survival curve was utilized to evaluate the cumulative incidence. A Cox proportional hazards model was used to control for confounders. Results Out of 354,940 offspring included in the analysis, 0.4% (n=1416) were following pregnancies with cervical cerclage. Total infectious morbidity was comparable between the two study groups (OR 1.0, 95% CI 0.9 – 1.1; p = 0.369, Table). Cumulative infectious morbidity was not statistically significant (log-rank test P-value = 0.19, Figure). However, while controlling for confounders such as gestational age and mode of delivery, a significant association between cervical cerclage placement during pregnancy and long term offspring’s infectious morbidities risk reduction was demonstrated (adjusted HR 0.9, 95% CI 0.87 – 0.99, p = 0.036). Conclusion Although cervical cerclage introduces a foreign body and has the theoretical potential to alter the vaginal microbiome, our population based study suggests that cerclage placement during pregnancy might have a protective effect for long-term infectious morbidity of the offspring. These findings support the safety of cerclage in this context. Further investigation regarding the influence of cervical cerclage on vaginal microbiome may be valuable.