Exploring sexual dimorphism in placental circulation at 22–24 weeks of gestation: A cross-sectional observational study

Widnes, Christian; Flo, Kari; Acharya, Ganesh

doi:10.1016/j.placenta.2016.11.005

Cited by 20 publications

(21 citation statements)

References 41 publications

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“…We have reported similar findings from a cross-sectional study previously. 28 The discrepancy in findings between our study and the study by Prior et al, 30 could be related to the differences in study design (longitudinal vs. cross-sectional) and timing of examination (antenatal vs. in early latent phase of labor) and gestational age (19 -41 weeks vs 37 -42 weeks).…”

Section: Interpretation Of Resultscontrasting

confidence: 91%

“…Placental weight, 44 umbilical cord length 45 and UA PI 28,29 are known to be affected by the sex of the fetus, with girls having smaller placentas, shorter cords and higher UA PIs, although the magnitude these differences are small and may be modulated by parity and gestational age. 29,44 Male fetuses are known to have bigger head circumference than the females.…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

“…22 While several reference ranges for CPR, including one longitudinal study of adequate sample size with terms for calculation of conditional ranges, have been published, 27 longitudinal reference intervals for the UCR are lacking. Furthermore, sex-differences are present in placental 28,29 and cerebral 30 circulations, but these have not been taken into account by any studies.…”

Section: Bonnin Et Al Have Shown a Progressive And Proportional Decrmentioning

confidence: 99%

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Sex‐specific reference ranges of cerebroplacental and umbilicocerebral ratios: longitudinal study

Acharya

Ebbing

Karlsen

et al. 2020

Ultrasound in Obstet & Gyne

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Abnormal CPR or UCR reflect fetal cardiac output redistribution in favor of brain compared to placenta. They are shown to be useful in monitoring high-risk pregnancies, but longitudinal reference ranges of adequate sample size are lacking and gestational age related sex differences have not been examined. What are the clinical implications of this work? Longitudinal reference intervals of CPR and UCR were established which are more appropriate for serial monitoring of fetuses at risk of "brain sparing" due to placental insufficiency. Considering sex-differences may refine the the evaluation further.

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Section: Interpretation Of Resultscontrasting

confidence: 91%

Section: Interpretation Of Resultsmentioning

confidence: 99%

Section: Bonnin Et Al Have Shown a Progressive And Proportional Decrmentioning

confidence: 99%

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Sex‐specific reference ranges of cerebroplacental and umbilicocerebral ratios: longitudinal study

Acharya

Ebbing

Karlsen

et al. 2020

Ultrasound in Obstet & Gyne

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“…obs.). Widnes et al (2017) reported that in humans, UA PI is increased in females compared with males, although these authors did not suggest that fetal sex affected any of the other parameters investigated. Therefore, if differences are observed in placental and endometrial tissue supplying fetuses of different sex, this may indicate that the uterine environment of a malebiased litter would be very different to that of a female-biased litter, which may explain the relationships between the sex ratio of the litter and UA blood flow parameters measured in the present study.…”

Section: Discussionmentioning

confidence: 82%

Doppler ultrasound can be used to monitor umbilical arterial blood flow in lightly sedated pigs at multiple gestational ages

Stenhouse

Tennant

Duncan

et al. 2018

Reprod. Fertil. Dev.

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Doppler ultrasound was performed under moderate sedation (ketamine and azaperone) for 30min to monitor umbilical arterial (UA) blood flow in one uterine horn of Large White×Landrace gilts (n=23) at Gestational Days (GD) 30, 45, 60 and 90. Gilts were scanned before they were killed to examine relationships between litter size, sex ratio and five UA parameters (peak systolic velocity (PSV), end diastolic velocity (EDV), A/B (PSV to EDV) ratio, fetal heart rate (FHR) and resistance index (RI)). In gilts in which scans were obtained from all fetuses in the scanned horn, relationships between UA parameters, and fetal weight and sex were examined. A subset of gilts were sedated, scanned and recovered (SSR) earlier in gestation (GD30 or GD45) to assess the effects of sedation on later fetal development by comparison with control litters (no previous sedation). Temporal changes were observed in all UA parameters (P≤0.001). At GD60 and GD90, FHR decreased with increasing duration of sedation (P≤0.001). Sex ratio and fetal weight affected UA blood flow, whereas litter size and fetal sex did not. SSR at GD30 and GD45 was associated with decreased fetal weight at GD60 (P≤0.001) and GD90 (P=0.06) respectively, compared with controls. These results suggest maternal sedation during gestation affects fetal development, which should be investigated further. Measuring UA blood flow in growth-restricted porcine fetuses throughout gestation may be feasible.

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“…One recent study of the feto-placental circulation and cardiac function during 28–34 gestational weeks showed higher preload and lower afterload (significantly lower UA PI) in male fetuses [ 31 ]. In a cross-sectional study investigating maternal hemodynamics and placental circulation, we recently demonstrated significantly lower UA PI in male compared with that in female fetuses at 22 +0 –24 +0 weeks of gestation [ 32 ].…”

Section: Introductionmentioning

confidence: 99%

Sex differences in umbilical artery Doppler indices: a longitudinal study

et al. 2018

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BackgroundSexual dimorphism in placental size and function has been described. Whether this influences the clinically important umbilical artery (UA) waveform remains controversial, although a few cross-sectional studies have shown sex differences in UA pulsatility index (PI). Therefore, we tested whether fetal sex influences the UA Doppler indices during the entire second half of pregnancy and aimed to establish sex-specific reference ranges for UA Doppler indices if needed.MethodsOur main objective was to investigate gestational age-associated changes in UA Doppler indices during the second half of pregnancy and compare the values between male and female fetuses. This was a prospective longitudinal study in women with singleton low-risk pregnancies during 19–40 weeks of gestation. UA Doppler indices were serially obtained at a 4-weekly interval from a free loop of the umbilical cord using color-directed pulsed-wave Doppler ultrasonography. Sex-specific reference intervals were calculated for the fetal heart rate (HR), UA PI, resistance index (RI), and systolic/diastolic ratio (S/D) using multilevel modeling.ResultsComplete data from 294 pregnancies (a total of 1261 observations from 152 male and 142 female fetuses) were available for statistical analysis, and sex-specific reference ranges for the UA Doppler indices and fetal HR were established for the last half of pregnancy. UA Doppler indices were significantly associated with gestational age (P < 0.0001) and fetal HR (P < 0.0001). Female fetuses had 2–8% higher values for UA Doppler indices than male fetuses during gestational weeks 20+0–36+6 (P < 0.05), but not later. Female fetuses had higher HR from gestational week 26+0 until term (P < 0.05).ConclusionsWe have determined gestational age-dependent sex differences in UA Doppler indices and fetal HR during the second half of pregnancy, and correspondingly established new sex-specific reference ranges intended for refining diagnostics and monitoring individual pregnancies.

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Exploring sexual dimorphism in placental circulation at 22–24 weeks of gestation: A cross-sectional observational study

Cited by 20 publications

References 41 publications

Sex‐specific reference ranges of cerebroplacental and umbilicocerebral ratios: longitudinal study

Sex‐specific reference ranges of cerebroplacental and umbilicocerebral ratios: longitudinal study

Doppler ultrasound can be used to monitor umbilical arterial blood flow in lightly sedated pigs at multiple gestational ages

Sex differences in umbilical artery Doppler indices: a longitudinal study

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