Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

The association between fetal gender in twin pregnancies and the risk of pediatric infectious diseases of the offspring: A population-based cohort study with long-term follow up

Abstract

Objective

We aimed to study the association between fetal gender in twin pregnancies and the risk for childhood infectious morbidity of the offspring.

Study design

A population-based cohort analysis was performed comparing total and subtypes of infectious related pediatric hospitalizations among males versus females offspring of twin pregnancies. The analysis included all dichorionic twins born between the years 1991–2021. A Kaplan–Meier survival curve was used to compare the cumulative infectious morbidity incidence, and a Cox proportional hazards model was constructed to adjust for confounders.

Results

The study population included 4222 newborns (2111 males and 2111 females). Males had higher rates of infectious-related hospitalizations using a Cox proportional hazards model, an independent association was shown between male gender and infectious related hospitalizations of the offspring (Adjusted HR = 1.2, 95% CI: 1.1–1.4; p < 0.001).

Conclusion

Male gender in twin pregnancies is associated with an increased risk for long-term pediatric infectious morbidity.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Fig. 1: Red- Males Blue- Females.

Data availability

Data is available to review upon request.

References

  1. Sheiner E, Levy A, Feinstein U, Hallak M, Mazor M. Risk factors and outcome of failure to progress during the first stage of labor: A population-based study. Acta Obstet Gynecol Scand. 2002;81:222–6.

    PubMed  Google Scholar 

  2. Feinstein U, Sheiner E, Levy A, Hallak M, Mazor M. Risk factors for arrest of descent during the second stage of labor. Int J Gynaecol Obstet. 2002;77:7–14.

    Article  CAS  PubMed  Google Scholar 

  3. Hershkovitz R, Silberstein T, Sheiner E, Shoham-Vardi I, Holcberg G, Katz M, et al. Risk factors associated with true knots of the umbilical cord. Eur J Obstet Gynecol Reprod Biol. 2001;98:36–9.

    Article  CAS  PubMed  Google Scholar 

  4. Yohai D, Baumfeld Y, Zilberstein T, Yaniv Salem S, Elharar D, Idan I, et al. Does gender of the fetus have any relation with fetal heart monitoring during the first and second stage of labor? J Matern Fetal Neonatal Med. 2017;30:150–4. https://doi.org/10.3109/14767058.2016.1168802.

    Article  PubMed  Google Scholar 

  5. Bekedam DJ, Engelsbel S, Mol BW, Buitendijk SE, van der Pal-de Bruin KM. Male predominance in fetal distress during labor. Am J Obstet Gynecol. 2002;187:1605–16.

    Article  PubMed  Google Scholar 

  6. Eogan MA, Geary MP, O’Connell MP, Keane DP. Effect of fetal sex on labour and delivery: Retrospective review. BMJ. 2003;18:326.

    Google Scholar 

  7. Sheiner E, Levy A, Katz M, Hershkovitz R, Leron E, Mazor M. Gender does matter in perinatal medicine. Fetal Diagn Ther. 2004;19:366–9. https://doi.org/10.1159/000077967.

    Article  PubMed  Google Scholar 

  8. Lieberman E, Lang JM, Cohen AP, Frigoletto FD Jr, Acker D, Rao R. The association of fetal sex with the rate of cesarean section. Am J Obstet Gynecol. 1997;176:667–71.

    Article  CAS  PubMed  Google Scholar 

  9. Gluckman PD, Hanson MA, Beedle AS. Early life events and their consequences for later disease: a life history and evolutionary perspective. Am J Hum Biol. 2007;19:1–19. https://doi.org/10.1002/ajhb.20590.

    Article  PubMed  Google Scholar 

  10. Nizet V, Klein JO. Bacterial sepsis and meningitis. In: Infectious diseases of the Fetus and Newborn Infant, 8th ed, Remington JS, et al. (Eds), Elsevier Saunders, Philadelphia 2016. p.217.

  11. Sheiner E, Wainstock T, Landau D, Walfisch A. The association between sex and long-term pediatric cardiovascular morbidity. J Pediatr. 2017;180:68–73.e1. https://doi.org/10.1016/j.jpeds.2016.09.014.

    Article  PubMed  Google Scholar 

  12. Freud A, Sheiner E, Wainstock T, Landau D, Walfisch A. Gender affects long-term neurological outcome of neonates. Pediatr Neurol. 2017;74:68–73.e1. https://doi.org/10.1016/j.pediatrneurol.2017.04.020.

    Article  PubMed  Google Scholar 

  13. Ben-Shmuel A, Sheiner E, Wainstock T, Landau D, Vaknin F, Walfisch A. The association between gender and pediatric respiratory morbidity. Pediatr Pulmonol. 2018;53:1225–30. https://doi.org/10.1002/ppul.24083.

    Article  PubMed  Google Scholar 

  14. Lawn JE, Wilczynska-Ketende K, Cousens SN. Estimating the causes of 4 million neonatal deaths in the year 2000. Int J Epidemiol. 2006;35:706–18.

    Article  PubMed  Google Scholar 

  15. Nussbaum C, Gloning A, Pruenster M, Frommhold D, Bierschenk S, Genzel-Boroviczeny O, et al. Neutrophil and endothelial adhesive function during human fetal ontogeny. J Leukoc Biol. 2013;93:175–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. McGreal EP, Hearne K, Spiller OB. Off to a slow start: under-development of the complement system in term newborns is more substantial following premature birth. Immunobiology. 2012;217:176–86.

    Article  CAS  PubMed  Google Scholar 

  17. Gluckman P, Hanson M. Developemental origins of health and disease. Cambridge University Press, 2006.

  18. Gluckman PD, Hanson MA, Beedle AS. Non-genomic transgenerational inheritance of disease risk. Bioessays. 2007;29:145–54.

    Article  CAS  PubMed  Google Scholar 

  19. Waterland RA, Micheles KB. Epigenetic epidemiology of the developemental origins hypothesis. Annu Rev Nutr. 2007;27:363–88.

    Article  CAS  PubMed  Google Scholar 

  20. Cohen R, Gutvirtz G, Wainstock T, Sheiner E. Maternal urinary tract infection during pregnancy and long-term infectious morbidity of the offspring. Early Hum Dev. 2019;136:54–9.

    Article  PubMed  Google Scholar 

  21. Dan N, Sheiner E, Wainstock T, Marks K, Kessous R. Maternal Smoking during Pregnancy and the Risk for Childhood Infectious Diseases in the Offspring: A Population-Based Cohort Study. Am J Perinatol. 2021;38:166–70.

    Article  PubMed  Google Scholar 

  22. Padeh E, Wainstock T, Sheiner E, Landau D, Walfisch A. Gestational age and the long-term impact on children’s infectious urinary morbidity. Arch Gynecol Obstet. 2019;299:385–92.

    Article  PubMed  Google Scholar 

  23. Paz Levy D, Walfisch A, Wainstock T. Meconium‐stained amniotic fluid exposure is associated with a lower incidence of offspring long‐term infectious morbidity. Am J Reprod Immunol. 2019;81:e13108.

    Article  PubMed  Google Scholar 

  24. Muenchhoff M, Goulder PJ. Sex differences in pediatric infectious diseases. J Infect Dis. 2014;209:S120–6. https://doi.org/10.1093/infdis/jiu232.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Ye L, Pien GW, Ratcliffe SJ, Weaver TE. Gender differences in obstructive sleep apnea and treatment response to continuous positive airway pressure. J Clin Sleep Med. 2009;5:512–8.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Thordstein M, Lofgren N, Flisberg A, Lindecrantz K, Kjellmer I. Gender differences in electrocortical activity in human neonates. Neuroreport. 2006;17:1165–8. https://doi.org/10.1097/01.wnr.0000227978.98389.43.

    Article  PubMed  Google Scholar 

  27. Altman M, Vanpée M, Cnattingius S, Norman M. Risk factors for acute respiratory morbidity in moderately preterm infants. Paediatr Perinat Epidemiol. 2013;27:172–81.

    Article  PubMed  Google Scholar 

  28. Shi T, Balsells E, Wastnedge E. Risk factors for respiratory syncytial virus associated with acute lower respiratory infection in children under five years: systematic review and meta-analysis. J Glob Health. 2015;5:020416.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Seaborn T, Simard M, Provost PR, Piedboeuf B, Tremblay Y. Sex hormone metabolism in lung development and maturation. Trends Endocrinol Metab. 2010;21:729–38.

    Article  CAS  PubMed  Google Scholar 

  30. Raghavan D, Jain R. Increasing awareness of sex differences in airway diseases. Respirology. 2016;21:449–59.

    Article  PubMed  Google Scholar 

  31. Sheiner E, Hallak M, Twizer I, Mazor M, Katz M, Shoham-Vardi I. Lack of prenatal care in two different societies living in the same region and sharing the same medical facilities. J Obstet Gynaecol. 2001;21:453–8. https://doi.org/10.1080/01443610120071974.

    Article  CAS  PubMed  Google Scholar 

  32. Abu-Ghanem S, Sheiner E, Sherf M, Wiznitzer A, Sergienko R, Shoham-Vardi I. Lack of prenatal care in a traditional community: trends and perinatal outcomes. Arch Gynecol Obstet. 2012;285:1237–42. https://doi.org/10.1007/s00404-011-2153-x.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

All authors on the manuscript contributed to the concept, design, results interpretation, and drafting of the manuscript. LHN wrote the first draft of the manuscript. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript.

Corresponding author

Correspondence to Noa Leybovitz-Haleluya.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval

The study received the approval of the Institutional Review Board Committee of the Soroka University Medical Center (IRB # 0357-19-SOR).

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Leybovitz-Haleluya, N., Sheiner, E., Pariente, G. et al. The association between fetal gender in twin pregnancies and the risk of pediatric infectious diseases of the offspring: A population-based cohort study with long-term follow up. J Perinatol 42, 1587–1591 (2022). https://doi.org/10.1038/s41372-022-01448-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-022-01448-9

Search

Quick links