Brown Rebekah E, Noah Akaninyene I, Hill Ashley V, DePaoli Taylor Brandie
Department of Obstetrics and Gynecology, Division of Basic Science and Translational Research, University of Texas Medical Branch, Galveston, TX, USA.
Department of Epidemiology, School of Public Health, University of Pittsburgh, USA.
medRxiv. 2023 Nov 11:2023.11.10.23298403. doi: 10.1101/2023.11.10.23298403.
In singleton pregnancies, fetal sexual dimorphism has been observed in hypertensive disorders of pregnancy (HDP), particularly preeclampsia, a morbid syndrome that increases risk of adult onset cardiovascular disease for mothers and their offspring. However, few studies have explored the effect of fetal sex on HDP among twin pregnancies.
We conducted a retrospective cohort study of 1,032 twin pregnancies between 2011 - 2022 using data from a perinatal database that recruits participants from three hospitals in Houston, TX. We categorized pregnancies based on fetal sex pairings into female/female, male/male, and female/male. Pregnancies with a female/female fetal sex were used as our reference group. Our primary outcomes included gestational hypertension, preeclampsia, superimposed preeclampsia, and preeclampsia subtyped by gestational age of delivery. A modified Poisson regression model with robust error variance was used to calculate the relative risk (RR) and 95% confidence interval (CI) for the association between fetal sex pairs and HDP.
Adjusted models of female/male fetal sex pairs were associated with preterm preeclampsia (RR 2.01, 95% CI 1.15-3.53) relative to those with female/female fetuses. No associations with other HDP were observed among pregnancies with male/male fetal sex compared to those with female/female fetal sex pairs.
We found some evidence of sexual dimorphism for preterm preeclampsia among female/male twin pairs. Additional research is needed to understand what biological mechanisms could explain these findings.
在单胎妊娠中，已观察到妊娠高血压疾病（HDP）存在胎儿性别差异，尤其是子痫前期，这是一种会增加母亲及其后代成年后患心血管疾病风险的病态综合征。然而，很少有研究探讨双胎妊娠中胎儿性别对HDP的影响。
我们利用德克萨斯州休斯顿三家医院围产期数据库的数据，对2011年至2022年间的1032例双胎妊娠进行了一项回顾性队列研究。我们根据胎儿性别配对将妊娠分为女性/女性、男性/男性和女性/男性。以女性/女性胎儿性别的妊娠作为我们的参照组。我们的主要结局包括妊娠期高血压、子痫前期、叠加子痫前期以及按分娩孕周分型的子痫前期。采用具有稳健误差方差的修正泊松回归模型来计算胎儿性别配对与HDP之间关联的相对风险（RR）和95%置信区间（CI）。
相对于女性/女性胎儿的妊娠，女性/男性胎儿性别的校正模型与早产子痫前期相关（RR 2.01，95% CI 1.15 - 3.53）。与女性/女性胎儿性别的妊娠相比，男性/男性胎儿性别的妊娠未观察到与其他HDP相关。
我们发现了一些证据表明女性/男性双胎对子中早产子痫前期存在性别差异。需要进一步研究以了解哪些生物学机制可以解释这些发现。
