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Differential Impact of Bacterial Infection on Preterm Birth in Singleton and Twin Pregnancies and Its Association with Cervical Cerclage or Arabin Pessary: A Retrospective Cohort Study
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DOI：10.3390/jcm15166254.png)
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Abstract
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Background: Bacterial infection’s differential impact in singleton versus twin pregnancies and the modifying role of cervical interventions remain unclear. The objective is to investigate the association between bacterial infection and preterm birth in singleton and twin pregnancies and to evaluate whether cervical intervention modifies this relationship. Methods: A retrospective cohort study was conducted at a tertiary referral maternity center. Medical records of 146 pregnancies managed between December 2019 and December 2024 were reviewed, including 70 singleton and 76 twin pregnancies. Bacterial infection was defined as the presence of at least one positive microbiological culture during pregnancy. Associations between bacterial infection and gestational age at delivery were assessed using chi-square tests and binary logistic regression analyses. Additional models evaluated the effects of cervical intervention and interactions between bacterial infection and gestational type. Results: Among singleton pregnancies, bacterial infection was significantly associated with earlier preterm birth in the unadjusted analysis. Positive cultures were identified in 66.7% of women delivering between 28 and 33 weeks compared with 20.6% of those delivering between 34 and 37 weeks (χ2 = 15.047, p < 0.001). However, bacterial infection was not independently associated with preterm birth in the regression model including intervention type and the infection-by-intervention interaction (OR = 0.375, 95% CI 0.049–2.887, p = 0.346). In twin pregnancies, no significant association was observed, with similar rates of positive cultures across gestational age categories (45.5% vs. 40.6%; χ2 = 0.176, p = 0.675). Cervical intervention did not significantly modify the relationship between bacterial infection and preterm birth in either gestational group. In the combined model, a significant interaction was identified between gestational type and bacterial infection (OR = 0.158, 95% CI 0.038–0.655, p = 0.011). Conclusions: In this retrospective cohort, bacterial infection was associated with earlier preterm birth in singleton pregnancies in unadjusted analyses, but this association was not confirmed in the regression model. No significant association was observed in twin pregnancies. The interaction between gestational type and bacterial infection suggests that this relationship may differ according to pregnancy type, while cervical interventions did not appear to modify it. These findings should be considered exploratory and require confirmation in larger prospective studies.
Keywords:
preterm birth
bacterial infection
singleton pregnancy
twin pregnancy
cervical pessary
cervical cerclage
prematurity
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