Fetal sex and the development of gestational diabetes mellitus in gravidae with multiple gestation pregnancies.
Fetal sex and the development of gestational diabetes mellitus in gravidae with multiple gestation pregnancies.
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DOI：
10.1111/aogs.14625
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发表时间：
2023-12
影响因子：
4.3
通讯作者：
Aagaard KM
中科院分区：
文献类型：
--
作者：
Sassin AM;Sangi-Haghpeykar H;Aagaard KM
双胎妊娠的发生率不断增加。多胎妊娠更可能发生的一种结果是妊娠期糖尿病。研究表明，在单胎妊娠中，胎儿性别可能会影响胰岛素抵抗。然而，双胞胎胎儿性别和妊娠糖尿病发展的影响尚不清楚。我们假设，妊娠期糖尿病的发生率和胰岛素抵抗程度可能会根据胎儿性别配对（男-男、男-女或女-女）而有所不同。我们的目的是利用一个基于人口的大型数据库来确定多胎妊娠中胎儿性别与妊娠糖尿病之间的相关性。采用了一个两医院、单一学术机构的数据库，包含 2011 年 8 月至 2022 年 1 月期间超过 39000 名参与者的怀孕数据。所有胎龄大于 24 周且没有既往患有糖尿病或双胎输血综合征的活产新生儿的双胎分娩均被包括在内。然后根据配对的胎儿性别对条目进行分组。确定是否存在妊娠糖尿病以及妊娠糖尿病类型——饮食控制（妊娠糖尿病分类 A1）与药物控制（妊娠糖尿病分类 A2）。采用广义线性混合方法进行统计分析，P值≤0.05被认为有统计学意义。我们确定了 1924 例符合数据库纳入标准的双胞胎分娩（男-男=652；男-女 = 638；女-女 = 634）。我们发现胎儿性别配对与妊娠期糖尿病的发生之间没有关联。胎儿性别配对与妊娠糖尿病类型之间存在显着相关性，其中 32.0% 的男-男双胞胎、33.3% 的男-女双胞胎和 58.3% 的女-女双胞胎分娩与药物控制妊娠糖尿病分类 A2 相关：男-女 vs 女-女 (P = 0.05) 和男-男 vs 女性-女性（P = 0.046）。虽然妊娠糖尿病是多因素造成的，但我们发现胎儿性别配对与患有妊娠糖尿病的双胞胎孕妇所需的治疗之间存在显着关联。与男性-女性或男性-男性分娩相比，女性-女性双胞胎的比例较高，与妊娠期糖尿病分类A2相关。有必要对驱动这种关联的生理学进行进一步的研究。虽然妊娠糖尿病是多因素造成的，但本研究旨在调查双胎妊娠中妊娠糖尿病和胰岛素抵抗程度是否可能因胎儿性别配对（男-男、男-女或女-女）而有所不同。在双胞胎妊娠孕妇中观察到的妊娠期糖尿病的发生与胎儿性别配对之间没有关系，男性与男性、男性与女性以及女性与女性双胞胎的孕妇中患该疾病的比例相同。然而，在患有妊娠期糖尿病的双胞胎孕妇中，与男性/女性或男性/男性双胞胎的分娩相比，女性/女性双胞胎的分娩与药物控制的 A2 级妊娠糖尿病相关的比例较高。
There is an increasing incidence of pregnancies with twin gestations. One outcome more likely to occur with multiple gestations is gestational diabetes mellitus. Studies have suggested that in singleton pregnancies, fetal sex may affect insulin resistance. However, the effects of fetal sex in twins and the development of gestational diabetes mellitus are unknown. We hypothesized that rates of gestational diabetes mellitus and degree of insulin resistance might vary in twin gestations based on the fetal sex pairing: male–male, male–female or female–female. We aimed to employ a large population‐based database to ascertain any correlations between fetal sex and gestational diabetes mellitus in multifetal gestations. A two‐hospital, single academic institution database comprised of over 39 000 participants with pregnancy data from August 2011 to January 2022 was employed. All twin deliveries of live‐born neonates >24 weeks’ gestational age from gravidae without preexisting diabetes or twin–twin transfusion syndrome were included. Entries were then grouped based on the fetal sex of the pairing. The presence or absence of gestational diabetes and type of gestational diabetes – diet‐controlled (gestational diabetes mellitus classification A1) vs medication‐controlled (gestational diabetes mellitus classification A2) – were identified. Statistical analysis was performed using a generalized linear mixed method, and a P‐value ≤0.05 was considered statistically significant. We identified 1924 twin deliveries that met the inclusion criteria in our database (male–male =652; male–female = 638; female–female = 634). We found no association between fetal sex pairing and the development of gestational diabetes mellitus. There was a significant association between the fetal sex pairing and the type of gestational diabetes mellitus developed, with 32.0% of male–male twins, 33.3% of male–female twins and 58.3% of the female–female twin deliveries associated with medication‐controlled gestational diabetes classification A2: male–female vs female–female (P = 0.05) and male–male vs female–female (P = 0.046). While gestational diabetes mellitus is of multifactorial origin, we found a significant association between the fetal sex pairing and the treatment needed for gravidae with twins who develop gestational diabetes mellitus. A higher proportion of female–female twins was associated with gestational diabetes classification A2 compared with male–female or male–male deliveries. Further research on the physiology driving this association is warranted. While gestational diabetes mellitus is of multifactorial origin, this study was designed to investigate whether gestational diabetes mellitus and degree of insulin resistance might vary in twin gestations based on the fetal sex pairing: male–male, male–female or female–female. There was no relationship between the development of gestational diabetes mellitus and the fetal sex pairing observed in gravidae with twin gestations, with equal proportions of gravidae with male–male, male–female and female–female twins developing the disease. However, in gravidae with twins that develop gestational diabetes mellitus, a higher proportion of deliveries of female–female twins was associated with medication‐controlled gestational diabetes class A2 compared with deliveries of male–female or male–male twins.
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影响因子：
5.6
作者：
Stern C;Schwarz S;Moser G;Cvitic S;Jantscher-Krenn E;Gauster M;Hiden U
通讯作者：
Hiden U
影响因子：
3.2
作者：
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影响因子：
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作者：
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通讯作者：
Aagaard, Kjersti M.
影响因子：
2
作者：
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通讯作者：
Coustan, Donald R.
影响因子：
16.2
作者：
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通讯作者：
Flack, Jeff R.