(589) Gender as a Determinant of Neurological Sequelae in Twin Gestations

Evidence suggests that biological and genetic differences between genders may influence the prevalence and severity of various perinatal and chronic health outcomes. To further investigate these discrepancies, we conducted a detailed evaluation of the long-term neurological outcomes in male and female offspring from twin gestations.

Study Design:

A population-based sibling analysis was conducted at a tertiary referral center, focusing on twin births of male-female dyads. The study aimed to compare the occurrence of neurological-related morbidity throughout childhood, considering both community and hospital-based diagnoses, in relation to offspring gender. A Kaplan-Meier survival curve was utilized to evaluate the cumulative incidence of neurological morbidity, while a Cox proportional hazards model was applied to control for confounding variables.

Results:

The analysis of 1,471 twin pairs revealed gender differences in neurological and psychiatric conditions (Table). Males exhibited higher rates of ADHD (8.3% vs. 3.5%, p< 0.001) and total neurological-related morbidity (21.5% vs. 17.4%, p=0.006). Notably, sleep disorders were only reported in males (0.3%, p=0.02), and developmental disorders were also more prevalent among males compared to females (4.3% vs. 2.5%, p=0.008). The Kaplan-Meier analysis demonstrated an increased cumulative neurological morbidity among male offspring (log-rank p-value = 0.004; Figure). In a Cox regression hazards model, which accounted for mode of delivery and small-for-gestational-age neonates, male gender remained independently associated with long-term neurological sequelae (aHR=1.28, 95% CI 1.08-1.51, p=0.004).

Conclusion:

Male offspring from twin gestations are notably more prone to experiencing long-term neurological morbidity.