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Association between fetal sex and pregnancy outcomes among women with twin pregnancies: a multicenter cross-sectional study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To examine the frequency and to what extent fetal sex is associated with pregnancy outcomes among twin pregnancies, stratified by chorionicity.

Methods

This registry-based multicenter cross-sectional study was conducted using the Japan Society of Obstetrics and Gynecology perinatal database between 2007 and 2016. The sample population was restricted to women with twin pregnancies. The main pregnancy-related outcomes included preterm birth, very preterm birth, extremely preterm birth, preeclampsia, twin-to-twin transfusion syndrome (TTTS), and selective intrauterine growth restriction (s-IUGR). Birth weight, small for gestational age (SGA), and fetal death were also investigated.

Results

The primary analysis was performed based on 37,953 women, including 23,804 women with dichorionic diamniotic (DD) twins and 14,149 women with monochorionic diamniotic (MD) twins. Women with male/male DD twins had a significantly higher risk of preterm birth (adjusted risk ratio [aRR]: 1.07, 95% confidence interval [CI]: 1.03–1.10) and a lower risk of preeclampsia (aRR: 0.74, 95% CI: 0.62–0.88) than women with female/female DD twins. Women with male/male MD twins also had a significantly higher risk of preterm birth (aRR: 1.06, 95% CI: 1.04–1.09) than women with female/female MD twins. Risks of preeclampsia, TTTS, and s-IUGR did not differ by sex among MD pregnancies. Male SGA risk was significantly higher among male/male twins than among male/female DD twins. Among MD twins, risks of SGA and fetal death were significantly higher in male/male fetuses.

Conclusions

This study demonstrated significant associations between fetal sex and several pregnancy outcomes in twin pregnancies, some of which differed by chorionicity.

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Availability of data and material

The data that support the findings of this study are available from the Japan Society of Obstetrics and Gynecology, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of the Japan Society of Obstetrics and Gynecology.

Code availability

STATA custom code cannot be shared publicly, but it is available on request from Kohei Ogawa (ogawa-k@ncchd.go.jp).

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Acknowledgements

We thank the Japan Society of Obstetrics and Gynecology Perinatal Committee, as well as all participating hospitals for data provision.

Funding

This study was partially supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (20K18181) and a grant from the Takeda Science Foundation.

Author information

Authors and Affiliations

  1. Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan

    Satoru Funaki, Kohei Ogawa, Nobuaki Ozawa, Satoshi Hosoya & Haruhiko Sago

  2. Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Satoru Funaki, Satoshi Hosoya & Aikou Okamoto

  3. Department of Social Medicine, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan

    Kohei Ogawa, Kevin Y. Urayama & Naho Morisaki

  4. Graduate School of Public Health, St. Luke’s International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Kevin Y. Urayama

Authors
  1. Satoru Funaki
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  2. Kohei Ogawa
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  3. Nobuaki Ozawa
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  4. Satoshi Hosoya
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  5. Aikou Okamoto
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  8. Haruhiko Sago
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Contributions

SF: project development, data management, manuscript writing. KO: project development, data management, data analysis, manuscript writing. NO: project development, manuscript editing. SH: manuscript writing. AO: manuscript editing. NM: manuscript editing. KYU: manuscript editing. HS: manuscript editing.

Corresponding author

Correspondence to Kohei Ogawa.

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Conflict of interest

All the authors declare that they have no conflicts of interest associated with the publication of this research.

Ethical approval

The registry of the Japan Society of Obstetrics and Gynecology Perinatal Database was conducted in accordance with the guidelines of the Declaration of Helsinki and other nationally valid regulations. The protocol for this study was approved by the Institutional Review Board at the National Center for Child Health and Development on November 29, 2018 (No. 1983).

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Funaki, S., Ogawa, K., Ozawa, N. et al. Association between fetal sex and pregnancy outcomes among women with twin pregnancies: a multicenter cross-sectional study. Arch Gynecol Obstet 307, 1397–1405 (2023). https://doi.org/10.1007/s00404-022-06623-z

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