Gender Does Matter in Perinatal Medicine

Abstract

Objective: To investigate complications and outcome of pregnancies with male and female fetuses. Methods: A population-based study comparing all singleton deliveries between the years 1988 and 1999 was performed. We compared pregnancies with male vs. female fetuses. Patients with a previous cesarean section (CS) were excluded from the study. Statistical analyses with the Mantel-Haenszel technique and multiple logistic regression models were performed to control for confounders. Results: During the study period there were 55,891 deliveries of male and 53,104 deliveries of female neonates. Patients carrying male fetuses had higher rates of gestational diabetes mellitus (OR = 1.1; 95% CI 1.01–1.12; p = 0.012), fetal macrosomia (OR = 2.0; 95% CI 1.8–2.1; p < 0.001), failure to progress during the first and second stages of labor (OR = 1.2; 95% CI 1.1–1.3; p < 0.001 and OR = 1.4; 95% CI 1.3–1.5; p < 0.001, respectively), cord prolapse (OR = 1.3; 95% CI 1.1–1.6; p = 0.014), nuchal cord (OR = 1.2; 95% CI 1.1–1.2; p < 0.001) and true umbilical cord knots (OR = 1.5; 95% CI 1.3–1.7; p < 0.001). Higher rates of CS were found among male compared with female neonates (8.7 vs. 7.9%; OR = 1.1; 95% CI 1.06–1.16; p < 0.001). Using three multivariate logistic regression models and controlling for birth weight and gestational age, male gender was significantly associated with non-reassuring fetal heart rate patterns (OR = 1.5; 95% CI 1.4–1.6; p < 0.001), low Apgar scores at 5 min (OR = 1.5; 95% CI 1.3–1.8; p < 0.001) and CS (OR = 1.2; 95%CI 1.2–1.3; p < 0.001). Controlling for possible confounders like gestational diabetes, cord prolapse, failed induction, nonprogressive labor, fetal macrosomia, nuchal cord and true umbilical cord knots using the Mantel-Haenszel technique did not change the significant association between male gender and CS. Conclusion: Male gender is an independent risk factor for adverse pregnancy outcome.

Foetal Gender and Obstetric Outcome

“…For this there is a need to acquire basic knowledge about the intrinsic and extrinsic triggers of the threatening preterm birth as a complex event under consideration of gender-specific characteristics. We can also confirm the high rates of interventions among males foetuses sub partu (vaginal surgical conclusion of the birth process, Caesarean section) demonstrated in the studies of Di Renzo et al, Sheiner et al and Dunn et al [7,8,14]. The relatively higher rate of micro blood gas analyses (MBA) employed during the birth of boys allows the conclusion of a higher rate of at least suspected hypoxia in the foetal metabolism.…”

“…The rates of gestational diabetes mellitus, macrosomia, protracted opening and expulsion phases, umbilical cord prolapses, umbilical cord looping and genuine umbilical cord knots are significantly elevated. Furthermore, male babies are more frequently delivered by Caesarean section than female babies [7][8][9]. Also, the rates of vaginal surgical deliveries are higher, and the indication for birth completion is more frequently given with the diagnosis of "threatening intrauterine asphyxia" in the case of male babies.…”

“…Several studies have recognised male gender as being a risk factor during pregnancy and birth. The biological mechanisms of this gender-specific difference are, however, still virtually unknown even though various theories discuss the influence of hormonal, physiological or genetic factors [8,[11][12][13][14]. Although new management strategies have led to better and better therapeutic results for very preterm infants, boys still exhibit higher mortality and morbidity than girls.…”

Sex of the baby and risk of gestational diabetes mellitus in the mother: a systematic review and meta-analysis

“…Indeed, carrying a male fetus confers increased risks of multiple adverse perinatal outcomes including premature rupture of membranes, pre-term delivery, failure to progress in the first and second stages of labour, nonreassuring fetal heart rate patterns, umbilical cord prolapse, true umbilical cord knot, Caesarean delivery and lower Apgar scores [1,2]. However, it has traditionally not been suspected that the sex of the fetus could hold implications for maternal glucose metabolism.…”

The right way to write

“…Examples are: "Gender does matter" [1], "Caesarean section on demand-an ethical dilemma" [2], "Ultrasound in obstetrics: are we getting too good?" [3] If you want the readers to pay attention to the manuscript you can sure try it.…”