Longitudinal Cervical Length Measurements and Spontaneous Preterm Birth in Singleton and Twin Pregnancies

Overview

Journal JAMA Netw Open

Publisher American Medical Association

Specialty General Medicine

Date 2024 Apr 11

PMID 38602679

Authors

Tianchen Wu

Shuang Li

Xiaoli Gong

Jiaxin Li

Xuening Li

Yujia Zhai

Jiaqi Huang

XiaoNa Li

Luyao Li

Jing Yang

Xueju Wang

Huifeng Shi

Pengbo Yuan

Yangyu Zhao

Yuan Wei

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

The single-cell immune profile throughout gestation and its potential value for identifying women at risk for spontaneous preterm birth.

Feyaerts D, Diop M, Galaz J, Einhaus J, Arck P, Diemert A Eur J Obstet Gynecol Reprod Biol X. 2025; 25:100371.

PMID: 40052005 PMC: 11883378. DOI: 10.1016/j.eurox.2025.100371.

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