Vaginal Deliveries Were as Safe as Cesarean Sections for the Long-Term Cardiovascular Health of Preterm Twins

Aim: There is no established consensus on the safest or most beneficial delivery mode for preterm twins. We assessed the associations between how premature twins were delivered and their long-term cardiovascular morbidity during childhood. Methods: A retrospective cohort study was conducted at the Soroka University Medical Center, the only tertiary hospital in southern Israel, which provides obstetric services to the whole country. Twins born between 1991 and 2021 were included, and their cardiovascular morbidity was followed up until 18 years of age. Data was collected from the hospital's databases. A Kaplan–Meier survival curve compared cumulative cardiovascular morbidity between the groups, and a Cox proportional hazard model adjusted the data for confounders. Results: The study comprised 6856 premature twins: 3986 (58.1%) were born via Caesarean delivery and the other 2870 (41.9%) were born by vaginal delivery. Long-term cardiovascular morbidity rates were comparable between twins born vaginally and via Cesarean delivery. Likewise, the cumulative incidence of long-term cardiovascular morbidity did not differ. The Cox proportional hazard model, which controlled for maternal age, diabetes mellitus and hypertensive disorders, showed no associations with the two delivery groups. Conclusion: No associations were documented between delivery mode in preterm twins and childhood cardiovascular morbidity.