Selection in utero against male twins in the United States early in the COVID-19 pandemic

Am J Hum Biol. 2023 Mar;35(3):e23830. doi: 10.1002/ajhb.23830. Epub 2022 Nov 5.


Objectives: We aim to contribute to the literature reporting tests of selection in utero. The theory of reproductive suppression predicts that natural selection would conserve mechanisms, referred to collectively as selection in utero, that spontaneously abort fetuses unlikely to thrive as infants in the prevailing environment. Tests of this prediction include reports that women give birth to fewer than expected male twins, historically among the frailest of infants, during stressful times. The onset of the COVID-19 pandemic in the United States in Spring 2020 demonstrably stressed the population. We test the hypothesis that conception cohorts in gestation at the onset of the pandemic in the United States yielded fewer than expected live male twin births.

Methods: We retrieved deidentified data on the universe of live births in the United States from the National Center for Health Statistics birth certificate records. We applied Box-Jenkins time-series methods to the twin secondary sex ratio computed for 77 monthly conception cohorts spanning August 2013 to December 2019 to detect outlying cohorts in gestation at the onset of the pandemic.

Results: The twin secondary sex ratio fell below expected values in three conception cohorts (i.e., July, September, and October 2019, all p < .05) exposed in utero to the onset of the pandemic.

Conclusions: Our results add to prior findings consistent with selection in utero. The role of selection in utero in shaping the characteristics of live births cohorts, especially during the COVID-19 pandemic, warrants further scrutiny.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • COVID-19* / epidemiology
  • Female
  • Humans
  • Live Birth
  • Male
  • Pandemics*
  • Parturition
  • Pregnancy
  • Sex Ratio
  • United States / epidemiology