Diabetes Mellitus as a Risk Factor for Spontaneous Preterm Birth in Women with a Short Cervix after Ultrasound-Indicated Cerclage

TL;DR

This study shows that diabetes, especially when combined with obesity, increases the risk of preterm birth in women with a short cervix who undergo a specific procedure to prevent it.

Contribution

The study identifies diabetes and obesity as independent risk factors for preterm birth after cervical cerclage in women with a short cervix.

Findings

Diabetes and obesity significantly increase the risk of spontaneous preterm birth after ultrasound-indicated cerclage.

Women with pregestational diabetes or insulin-treated diabetes are at higher risk of preterm delivery than those with diet-controlled gestational diabetes.

Optimizing glucose control and weight management is crucial for reducing preterm birth risk in this population.

Abstract

Background: Preterm birth (PTB) is a significant challenge in contemporary obstetrics, affecting over one in ten infants worldwide and accounting for 75% of perinatal mortality. Short cervical length during mid-trimester is well known to be associated with an increased risk of spontaneous preterm birth (sPTB). Ultrasound-indicated cerclage (UIC) is recommended to prevent sPTB in women with a short cervix at mid-trimester and a history of sPTB. Objectives: This retrospective observational study aimed to examine the impact of diabetes and obesity on the occurrence of sPTB in women who underwent UIC due to mid-trimester cervical shortening. Methods/Results: The analysis revealed that cervical length at the time of operation, preoperative erythrocyte sedimentation rate levels, and diabetes were independent risk factors for sPTB. Additionally, the presence of diabetes, particularly when combined with obesity, significantly elevated the risk of sPTB. Women with pregestational diabetes or those requiring insulin treatment had a higher propensity for preterm delivery compared to those with gestational diabetes managed through diet control alone. Conclusions: These findings emphasize the importance of considering maternal metabolic factors, such as diabetes and obesity, in women with a short cervix when planning for UIC and highlight the crucial role of optimizing maternal glucose control and weight management in reducing the risk of sPTB.

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