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- Title
Longitudinal Cervical Length Measurements and Spontaneous Preterm Birth in Singleton and Twin Pregnancies.
- Authors
Wu, Tianchen; Li, Shuang; Gong, Xiaoli; Li, Jiaxin; Li, Xuening; Zhai, Yujia; Huang, Jiaqi; Li, Xiaona; Li, Luyao; Yang, Jing; Wang, Xueju; Shi, Huifeng; Yuan, Pengbo; Zhao, Yangyu; Wei, Yuan
- Abstract
This cohort study examines cervical length trajectories and their association with risk of spontaneous preterm birth in individuals with singleton and twin pregnancies. Key Points: Question: What disparities in the pathogenesis of spontaneous preterm birth (sPTB) exist among pregnant individuals with varying patterns of cervical length changes? Findings: In this cohort study of 41 706 participants with singleton pregnancies and 1853 participants with twin pregnancies, 2 distinct patterns of change in cervical length were observed among twin pregnancies: stable and shortened. For twin pregnancies, immune factors were associated only with sPTB in the shortened pattern; no association was observed in the stable pattern. Meaning: Findings of this study suggest that the mechanisms of sPTB in twin pregnancies are not entirely similar to those in singleton pregnancies; in particular, for twin pregnancies with a stable cervix, the sPTB is unrelated to immunological factors. Importance: Changes in cervical length in twin pregnancies exhibit various patterns, but it is unclear whether the mechanism underlying spontaneous preterm birth (sPTB) is consistent. The existence of detailed phenomena in singleton pregnancies is also unclear. Objectives: To explore the different patterns in cervical length trajectories in singleton and twin pregnancies and to analyze whether the immunological mechanisms of sPTB are consistent among these cervical length patterns. Design, Setting, and Participants: This cohort study recruited pregnant individuals who received antenatal care and delivered at Peking University Third Hospital in Beijing, China, between January 1, 2014, and December 31, 2022. Individuals with singleton and twin pregnancies were included. Exposures: Cervical length measurements and white blood cell (WBC) indicators. Main Outcomes and Measures: The primary outcome was sPTB. Longitudinal trajectory cluster analysis was used to identify patterns of changes in cervical length in singleton and twin pregnancies. A random-effects model with cubic spline was used to fit and compare the longitudinal trajectory of WBC indicators among early preterm birth, moderate to late preterm birth, and term birth. Results: A total of 43 559 pregnant individuals were included; of these, 41 706 had singleton pregnancies (mean [SD)] maternal age, 33.0 [4.0] years) and 1853 had twin pregnancies (mean [SD] maternal age, 33.3 [3.6] years). Two distinct patterns of cervical length changes were observed in both singleton and twin pregnancies: shortened (21 366 singletons and 546 twins) and stable (20 340 singletons and 1307 twins). In singleton pregnancies, WBC count was associated with early sPTB in individuals with both shortened cervix (odds ratio [OR], 1.35; 95% CI, 1.00-1.82) and stable cervix (OR, 1.64; 95% CI, 1.07-2.50). However, for twin pregnancies, the association of WBC count (OR, 3.13; 95% CI, 1.58-6.18) with the risk of early sPTB was observed only in individuals with a shortened cervix. Conclusions and Relevance: This study identified 2 distinct cervical length patterns: shortened and stable. These patterns revealed 2 preterm birth mechanisms in twin pregnancies, with the immunopathogenesis of sPTB found only in the shortened cervix pattern; in singleton pregnancies, maternal immune response was associated with a higher risk of sPTB regardless of a shortened or stable cervix.
- Subjects
CHINA; RISK assessment; LEUKOCYTE count; ACADEMIC medical centers; CLUSTER analysis (Statistics); BODY mass index; STATISTICAL hypothesis testing; T-test (Statistics); RESEARCH funding; MULTIPLE pregnancy; PREMATURE infants; FETAL ultrasonic imaging; PREGNANT women; RETROSPECTIVE studies; CHI-squared test; DESCRIPTIVE statistics; IMMUNE system; LONGITUDINAL method; PRENATAL care; DURATION of pregnancy; ODDS ratio; KAPLAN-Meier estimator; GESTATIONAL age; ANTHROPOMETRY; CONFIDENCE intervals; DATA analysis software; CERVIX uteri
- Publication
JAMA Network Open, 2024, Vol 7, Issue 4, pe244592
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.4592