PAZIENTI GRAVIDE CON DIABETE PREGESTAZIONALE: ANALISI DELLE DIFFERENZE DI GENERE DEL FETO E DEL NASCITURO, NELLA VALUTAZIONE DEGLI OUTCOMES DELLA GRAVIDANZA, DEL PARTO, FETALI E NEONATALI.

The aim of the study is to evaluate maternal-fetal and neonatal clinical outcomes, in a group of patients with pregestational diabetes mellitus, in relation to fetal gender, to assess whether fetal sex predisposes to the development of specific pathological conditions or whether fetuses of different sexes have neonatal outcomes and/or different responses to maternal pathology. Materials and methods: 109 patients affected by pregestational diabetes (global population) who gave birth at the UOC of Gynecology and Obstetrics, of the University Hospital of Sassari between 2015 and 2022 were enrolled. 76 patients had a diagnosis of type 1 diabetes mellitus (DM1 group) and 33 patients had a diagnosis of type 2 diabetes mellitus (DM2 group). The data were analyzed taking into account the fetal gender of the newborn; the variables analyzed are the following: type of therapy performed by the patients and degree of glycemic compensation at delivery, pregnancy pathologies, fetal pathologies or fetal growth disorders, delivery outcomes, neonatal outcomes. The data were analyzed using the STATA17 software, the level of statistical significance was set at P< 0.05. Results: All patients in the DM1 subgroup were on insulin therapy at the time of admission, while among the patients in the DM2 subgroup, 21 out of 33 were on insulin therapy, and among them there were significantly more patients expecting a female fetus (n=15/19), compared to those expecting a male fetus (n=8/14), (p-value=0.04). A higher incidence of threatened preterm delivery was observed among patients expecting a male fetus (n=18/53) compared to patients expecting a female fetus (n=9/56) (p-value=0.03), of pregnancy-induced hypertension among patients expecting a female fetus (n=13/56) compared to patients expecting a male fetus (n=2/53) (p-value=0.003), and of premature rupture of the amniochorionic membranes at term among patients expecting a female fetus (n=6/56) compared to patients expecting a male fetus (n=0/53) (p-value=0.03). A significant difference was observed in the incidence of oligohydramnios, which was not found in any patient expecting a male fetus compared to 6 out of 56 patients expecting a female fetus (p-value=0.03). Polyhydramnios was more frequently observed in patients expecting a male fetus (n=12/53) than in patients expecting a female fetus (n=2/59), (p-value=0.003). A significant difference emerged regarding the median week of delivery; patients expecting a male fetus delivered around the 35th week of pregnancy, patients expecting a female fetus around the 37th week of pregnancy, (p-value=0.003). A significant difference emerged regarding the percentile of the newborn weight higher in male newborns with median weight at the 90th percentile (60th-98th), compared to female newborns with median weight at the 79th percentile (49th-96th), (p-value=0.05). Apgar score values ​​at 1 minute were significantly higher among female newborns 9 (9-9) than among male newborns 9 (8-9), (p-value=0.006). A greater use of CPAP was found among male newborns (n=20/53), compared to female newborns (n=8/56), (p-value=0.005). Conclusions: our study shows how the gender difference, more often in favor of the female sex, gives a biological advantage in pregnancies with high obstetric risk, such as those complicated by pregestational diabetes. Further studies are needed to evaluate in more detail the association of fetal sex with the various pregnancy outcomes, maternal, fetal and neonatal.

The aim of the study is to assess maternal-fetal and neonatal clinical outcomes, in a group of patients with pregestational diabetes mellitus, in relation to fetal gender. Materials and methods: 109 patients, suffering from gestational diabetes, who gave birth at the UOC of Gynecology and Obstetrics, University Hospital of Sassari between 2015 and 2022 were enrolled. the variables analyzed are as follows: pregnancy pathologies, fetal pathologies, birth outcomes, neonatal outcomes. Data were analyzed by STATA17 software, the level of statistical significance was set at P<0.05. Results: Among the patients in the DM2 subgroup, 21 out of 33 were on insulin therapy, and among them there were more female fetus waiting patients (p-value=0.04). A higher incidence of threatened cases of preterm delivery emerged among patients waiting for a male fetus (p=0.03), pregnancy-induced hypertension among patients waiting for a female fetus (p=0.003), premature rupture of membranes in term patients waiting female fetuses (p=0.03). A difference emerged regarding the incidence of oligohydramnios (p-value=0.03), polyhydramnios was found more frequently in patients expecting a male fetus (p=0.003) and they gave birth earlier than patients expecting a fetus (3.00). The percentile of infant weight was higher in male infants, (p=0.05) and Apgar index values at 1st minute are higher among female infants. Greater use of CPAP among infants of male sex (p=0.005). Conclusions: Our study shows how the gender difference, more often in favor of the female sex, gives a biological advantage in pregnancies complicated by pregestational diabetes