{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:01:19Z","timestamp":1777982479485,"version":"3.51.4"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005005","name":"Ben-Gurion University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005005","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Gynecol Obstet"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cervical cerclage is an acceptable procedure in women with cervical insufficiency and is known to be effective in the prevention of preterm delivery. However, limited data exist regarding long-term health outcomes among offspring exposed to cerclage during pregnancy. Since the presence of a foreign body during pregnancy may change the vaginal microbiome, we aimed to study whether a cervical cerclage is associated with long-term infectious morbidity of the offspring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>A retrospective population-based cohort study was performed at a tertiary medical center, including all singleton deliveries between the years 1991\u20132021. Long-term infectious morbidity was compared among offspring after pregnancies with and without cervical cerclage. The diagnoses of infectious morbidities were defined based on ICD-9 codes as recorded in community clinics and hospitalization files. A Kaplan\u2013Meier survival curve was utilized to evaluate the cumulative incidence. A Cox proportional hazards model was used to control for confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of 356,356 offspring included in the analysis, 0.4% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091416) were following pregnancies with cervical cerclage. Unadjusted analyses demonstrated no significant difference in total infectious morbidity between the groups (OR 1.0, 95% CI 0.9\u20131.1;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.369, Table 1). Kaplan\u2013Meier analysis showed no difference in cumulative incidence (log-rank test\n                      <jats:italic>P<\/jats:italic>\n                      -value\u2009=\u20090.19, Fig.\u00a01). In the primary analysis, cerclage was not associated with long-term infectious morbidity. However, in a secondary model, after adjustment for confounders including gestational age, obesity and diabetes, cerclage exposure was associated with a modest reduction in the risk of long-term infectious morbidity (adjusted HR 0.9, 95% CI 0.87\u20130.99,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.036).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large population-based cohort, cervical cerclage was not associated with increased long-term infectious morbidity in offspring. A modest association with reduced infectious morbidity was observed after adjustment for confounding factors. These findings should be interpreted cautiously given the observational design and potential residual confounding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00404-026-08431-1","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T19:41:42Z","timestamp":1777318902000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Offspring long-term infectious morbidity following pregnancies with cervical cerclage"],"prefix":"10.1007","volume":"313","author":[{"given":"Amir","family":"Snir","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Polina","family":"Schwarzman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamar","family":"Wainstock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eyal","family":"Sheiner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"issue":"9606","key":"8431_CR1","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/S0140-6736(08)60074-4","volume":"371","author":"RL Goldenberg","year":"2008","unstructured":"Goldenberg RL, Culhane JF, Iams JD, Romero R (2008) Epidemiology and causes of preterm birth. Lancet 371(9606):75\u201384","journal-title":"Lancet"},{"issue":"3","key":"8431_CR2","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1097\/AOG.0b013e31820ca847","volume":"117","author":"V Berghella","year":"2011","unstructured":"Berghella V, Rafael TJ, Szychowski JM, Rust OA, Owen J (2011) Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a meta-analysis. Obstet Gynecol 117(3):663\u2013671","journal-title":"Obstet Gynecol"},{"key":"8431_CR3","first-page":"CD008991","volume":"4","author":"Z Alfirevic","year":"2012","unstructured":"Alfirevic Z, Stampalija T, Roberts D, Jorgensen AL (2012) Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database Syst Rev 4:CD008991","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"8431_CR4","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1097\/01.AOG.0000443276.68274.cc","volume":"123","author":"American College of Obstetricians and Gynecologists","year":"2014","unstructured":"American College of Obstetricians and Gynecologists (2014) Practice Bulletin No. 142: cerclage for the management of cervical insufficiency. Obstet Gynecol 123(2):372\u2013379. https:\/\/doi.org\/10.1097\/01.AOG.0000443276.68274.cc","journal-title":"Obstet Gynecol"},{"issue":"7","key":"8431_CR5","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1111\/1471-0528.17003","volume":"129","author":"AH Shennan","year":"2022","unstructured":"Shennan AH, Story L (2022) Royal College of Obstetricians, Gynaecologists. Cervical Cerclage: Green-top Guideline No. 75. BJOG 129(7):1178\u20131210. https:\/\/doi.org\/10.1111\/1471-0528.17003","journal-title":"Cervical Cerclage: Green-top Guideline No. 75. BJOG"},{"key":"8431_CR6","first-page":"009166","volume":"10","author":"TJ Rafael","year":"2014","unstructured":"Rafael TJ, Berghella V, Alfirevic Z (2014) Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy. Cochrane Database Syst Rev 10:009166","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"8431_CR7","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.jmig.2017.07.021","volume":"25","author":"GN Moawad","year":"2018","unstructured":"Moawad GN, Tyan P, Bracke T et al (2018) Systematic review of transabdominal cerclage placed via laparoscopy for the prevention of preterm birth. J Minim Invasive Gynecol 25(2):277\u20132868","journal-title":"J Minim Invasive Gynecol"},{"issue":"3","key":"8431_CR8","doi-asserted-by":"publisher","first-page":"317.e1","DOI":"10.1016\/j.ajog.2007.06.060","volume":"197","author":"RH Debbs","year":"2007","unstructured":"Debbs RH, DeLa Vega GA, Pearson S et al (2007) Transabdominal cerclage after comprehensive evaluation of women with previous unsuccessful transvaginal cerclage. Am J Obstet Gynecol 197(3):317.e1-317.e4","journal-title":"Am J Obstet Gynecol"},{"issue":"6555","key":"8431_CR9","doi-asserted-by":"publisher","first-page":"eabf3002","DOI":"10.1126\/science.abf3002","volume":"373","author":"AI Lim","year":"2021","unstructured":"Lim AI et al (2021) Prenatal maternal infection promotes tissue-specific immunity and inflammation in offspring. Science 373(6555):eabf3002","journal-title":"Science"},{"issue":"1","key":"8431_CR10","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1038\/pr.2014.57","volume":"76","author":"DD Gleditsch","year":"2014","unstructured":"Gleditsch DD, Shornick LP, Van Steenwinckel J et al (2014) Maternal inflammation modulates infant immune response patterns to viral lung challenge in a murine model. Pediatr Res 76(1):33\u201340","journal-title":"Pediatr Res"},{"issue":"5","key":"8431_CR11","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1097\/SHK.0b013e31826f862c","volume":"38","author":"S Mukherjee","year":"2012","unstructured":"Mukherjee S, Allen RM, Lukacs NW et al (2012) STAT3-mediated IL-17 production by postseptic T cells exacerbates viral immunopathology of the lung. Shock 38(5):515\u2013523","journal-title":"Shock"},{"issue":"2","key":"8431_CR12","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1111\/1471-0528.13115","volume":"122","author":"SS Witkin","year":"2015","unstructured":"Witkin SS (2015) The vaginal microbiome, vaginal anti-microbial defence mechanisms, and the clinical challenge of reducing infection-related preterm birth. BJOG 122(2):213\u2013218","journal-title":"BJOG"},{"issue":"21","key":"8431_CR13","doi-asserted-by":"publisher","first-page":"8266","DOI":"10.3390\/ijms21218266","volume":"21","author":"G Lacroix","year":"2020","unstructured":"Lacroix G, Gouyer V, Gottrand F, Desseyn JL (2020) The cervicovaginal mucus barrier. Int J Mol Sci 21(21):8266","journal-title":"Int J Mol Sci"},{"issue":"3","key":"8431_CR14","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1016\/j.bpobgyn.2006.12.005","volume":"21","author":"H Leitich","year":"2007","unstructured":"Leitich H, Kiss H (2007) Asymptomatic bacterial vaginosis and intermediate flora as risk factors for adverse pregnancy outcome. Best Pract Res Clin Obstet Gynaecol 21(3):375\u2013390","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"issue":"350","key":"8431_CR15","doi-asserted-by":"publisher","first-page":"350102","DOI":"10.1126\/scitranslmed.aag1026","volume":"8","author":"LM Kindinger","year":"2016","unstructured":"Kindinger LM et al (2016) Relationship between vaginal microbial dysbiosis, inflammation, and pregnancy outcomes in cervical cerclage. Sci Transl Med 8(350):350102","journal-title":"Sci Transl Med"},{"key":"8431_CR16","first-page":"79","volume":"7","author":"JM Melville","year":"2013","unstructured":"Melville JM, Moss TJM (2013) The immune consequences of preterm birth. Front Mol Neurosci 7:79","journal-title":"Front Mol Neurosci"},{"issue":"8","key":"8431_CR17","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1016\/S1473-3099(16)00150-X","volume":"16","author":"JE Miller","year":"2016","unstructured":"Miller JE, Hammond GC, Strunk T et al (2016) Association of gestational age and growth measures at birth with infection-related admissions to hospital throughout childhood: a population-based, data-linkage study from Western Australia. Lancet Infect Dis 16(8):952\u2013961","journal-title":"Lancet Infect Dis"},{"issue":"9","key":"8431_CR18","doi-asserted-by":"publisher","first-page":"3008","DOI":"10.3390\/jcm9093008","volume":"9","author":"S Davidesko","year":"2020","unstructured":"Davidesko S, Wainstock T, Sheiner E, Pariente G (2020) Long-term infectious morbidity of premature infants: is there a critical threshold? J Clin Med 9(9):3008","journal-title":"J Clin Med"},{"issue":"2","key":"8431_CR19","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1007\/s00404-018-4973-4","volume":"299","author":"E Padeh","year":"2019","unstructured":"Padeh E, Wainstock T, Sheiner E et al (2019) Gestational age and the long-term impact on children\u2019s infectious urinary morbidity. Arch Gynecol Obstet 299(2):385\u2013392","journal-title":"Arch Gynecol Obstet"},{"issue":"2","key":"8431_CR20","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1017\/S2040174418000685","volume":"10","author":"M Imterat","year":"2019","unstructured":"Imterat M, Wainstock T, Moran-Gilad J et al (2019) The association between gestational age and otitis media during childhood: a population-based cohort analysis. J Dev Orig Health Dis 10(2):214\u2013220","journal-title":"J Dev Orig Health Dis"},{"issue":"1","key":"8431_CR21","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1186\/s12905-022-01751-9","volume":"22","author":"S Cai","year":"2022","unstructured":"Cai S, Wu Y, Zeng L, Ding Y (2022) Effects of vaginal microecology and immunity on the pregnancy outcome of cervical cerclage. BMC Womens Health 22(1):167","journal-title":"BMC Womens Health"},{"key":"8431_CR22","doi-asserted-by":"publisher","first-page":"245","DOI":"10.2147\/JIR.S393666","volume":"16","author":"J Fang","year":"2023","unstructured":"Fang J, Lin Y, Chen Z et al (2023) The association of inflammatory markers with maternal-neonatal outcome after cervical cerclage. J Inflamm Res 16:245\u2013255","journal-title":"J Inflamm Res"},{"key":"8431_CR23","doi-asserted-by":"publisher","unstructured":"Apostol AC, L\u00f3pez DA, Lebish EJ, et al. Prenatal inflammation perturbs fetal hematopoietic development and causes persistent changes to postnatal immunity. bioRxiv. Published May 8, 2022. https:\/\/doi.org\/10.1101\/2022.05.08.491095","DOI":"10.1101\/2022.05.08.491095"},{"issue":"1","key":"8431_CR24","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.tcb.2017.08.003","volume":"28","author":"R Espin-Palazon","year":"2018","unstructured":"Espin-Palazon R, Weijts B, Mulero V, Traver D (2018) Proinflammatory signals as fuel for the fire of hematopoietic stem cell emergence. Trends Cell Biol 28(1):58\u201366","journal-title":"Trends Cell Biol"},{"issue":"6","key":"8431_CR25","doi-asserted-by":"publisher","first-page":"1439","DOI":"10.1016\/j.immuni.2019.05.003","volume":"50","author":"SA Mariani","year":"2019","unstructured":"Mariani SA, Li Z, Rice S et al (2019) Pro-inflammatory aorta-associated macrophages are involved in embryonic development of hematopoietic stem cells. Immunity 50(6):1439-1452.e5","journal-title":"Immunity"},{"key":"8431_CR26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jri.2023.103922","volume":"157","author":"MS Vidal Jr","year":"2023","unstructured":"Vidal MS Jr, Menon R (2023) In utero priming of fetal immune activation: myths and mechanisms. J Reprod Immunol 157:103922","journal-title":"J Reprod Immunol"},{"issue":"12","key":"8431_CR27","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1111\/j.1471-0528.1993.tb15198.x","volume":"100","author":"M Quinn","year":"1993","unstructured":"Quinn M (1993) Final report of the MRC\/RCOG randomised controlled trial of cervical cerclage. Br J Obstet Gynaecol 100(12):1154\u20131155","journal-title":"Br J Obstet Gynaecol"},{"key":"8431_CR28","doi-asserted-by":"publisher","first-page":"1072960","DOI":"10.3389\/fcimb.2023.1072960","volume":"13","author":"Y Xiao","year":"2023","unstructured":"Xiao Y, Huang S, Yu W et al (2023) Effects of emergency\/nonemergency cervical cerclage on the vaginal microbiome of pregnant women with cervical incompetence. Front Cell Infect Microbiol 13:1072960","journal-title":"Front Cell Infect Microbiol"},{"issue":"12","key":"8431_CR29","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.1111\/aogs.14460","volume":"101","author":"M Vargas","year":"2022","unstructured":"Vargas M, Ya\u00f1ez F, Elias A et al (2022) Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes. Acta Obstet Gynecol Scand 101(12):1403\u20131413","journal-title":"Acta Obstet Gynecol Scand"}],"container-title":["Archives of Gynecology and Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-026-08431-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00404-026-08431-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-026-08431-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T19:41:44Z","timestamp":1777318904000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00404-026-08431-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,27]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["8431"],"URL":"https:\/\/doi.org\/10.1007\/s00404-026-08431-1","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-8757654\/v1","asserted-by":"object"}]},"ISSN":["1432-0711"],"issn-type":[{"value":"1432-0711","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,27]]},"assertion":[{"value":"1 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"176"}}